Ms Angela Edghill:

I thank the members for the responses to the submissions. Deputy Ó Caoláin asked about training. As budgets are squeezed and staff are not replaced when on leave or ill, it becomes more difficult for services to release staff for training. We appreciate that. Children's palliative care is a particularly specialised area. This is an ongoing problem. The Irish Hospice Foundation provides much in-house training in hospitals. We find staff are decent and will come in to do training when they are not rostered to come in or when they are on their day off. We cannot rely on people to continue to do that and it is unfair on them when they are already under stress and working hard.

It is an ongoing problem. We appreciate that it is a budgetary problem too and that it costs more to release staff and to replace them while they are being trained. It is an area we need to keep an eye on. The difficulty is that staff are trained, for instance in communications. In particular with children, a lot of it would be about working not only with the child but with the family. A lot of work needs to go into that. If it is not constantly regenerated, all that learning is lost if those staff move on to a different area or leave. It is an ongoing difficulty. I am sorry I cannot be more specific. We are not the direct service provider but I could happily get the committee to talk to one of the children's outreach nurses who would be able to explain the situation a little better.

Senator Marie-Louise O'Donnell asked me what would happen if the budget is reduced any further. What would happen first is that the voluntary sector would try to fill the gap, as it always does, but that would become more and more difficult. In the event that it is now cut to the bone – and it is – in various areas of the country, for instance in Waterford they are paying €400,000 a year towards their home care team. In Kerry the voluntary hospice sector is paying nothing because the HSE fills the gap. The picture is different all around the country.

Palliative care is a relatively new specialty in Ireland and hospices are relatively new here in their current form. The whole situation is a little fragmented and a bit underdeveloped. It will become more so. There may well be waiting lists. Referrals to palliative care come at the very end of life. Often, one does not have a month, two months or three months to think about a waiting list. That may happen. This is conjecture but what we envisage is that the situation will become more fragmented and it will also stifle development. As an organisation, the Irish Hospice Foundation itself invests more than €5.7 million a year into development. A lot of the development is in partnership with people in the HSE and voluntary hospices. They will not always have the resources to give us that back if they do not have the money because they will not have the staff. It is a bit more than two.

Senator Burke asked what would happen if Marymount gets all it is supposed to get. That was in the 2013 HSE south service plan so we hope that will not come out of 2014 and that the money will be ring-fenced. It is a bit like that. We are constantly robbing Peter to pay Paul. There is already inequity around the country and it would be very unfair if it did not happen.

Senator van Turnhout inquired about sustainable funding and where is the gap. There are ongoing discussions with the HSE. We are fearful that the budget might be reduced further. That said, people constantly step up to the plate. All of the organisations would say that. The voluntary sector constantly steps up but there will come a stage where one just cannot step up any further.