Mr. Kevin Dwyer:

I will start with the original questions because there are a few cost issues there which is where I pitched my presentation, knowing that my colleagues would look at the quality issues which is what palliative care is about. One cannot provide palliative care at any cost but on its own merits, the arguments are there that it should be provided. I stand over the good news about the economics of it. That figure of 20% dates back prior to 2008 when so much pressure came on our finances. Whatever savings were made in the acute hospitals would be mirrored in the hospices. Our budgets would be 15% lower than five years ago and yet we are delivering more in the way of activity. We are very conscious of cost in palliative care. It is not about providing whatever one can for every patient; it has to be done on a business basis.

We work very closely with the HSE. Every provider has difficulties in fighting its case and protecting its budget but there is a willingness on the part of the HSE to engage. It was involved in the baseline study and in the 2001 report and it has a framework document on how to deliver the extra beds and where they are needed. It has costed all of that. Obviously over the past five years, there was not much progress towards that but, nevertheless, these are its documents which it is anxious to implement.

Senator O'Donnell asked about the mix. The voluntary sector has provided 81%. I say "we" because, as Deputy McLellan said, it is the people of Ireland who contribute. It is not, by any means, our money. The people contribute 31% of the running cost of the voluntary inpatient units but they contribute 81% of the capital costs. There is project in Tralee, which is one of the 16 capital projects and one of the eight inpatients units to be built. The Kerry Hospice Foundation has committed to providing 100% of the capital cost on the understanding that the HSE will come on board with the revenue, which is the hard bit.

There is a good partnership that delivers. There are active projects, with one on the books in Waterford and others in Castlebar and Kerry. Things are happening. Blanchardstown is ready to go, having been funded 100% on the capital side from donations. Negotiations are ongoing with the HSE as to how to open those 24 beds.