Denis Naughten (Roscommon-South Leitrim, Fine Gael)

I welcome the opportunity to speak on this amendment. Deputies Bruton and O'Donnell highlighted a weakness in the amendment in respect of the 20-bed threshold. Deputy O'Donnell made the valid point that there is no such limit in regard to nursing homes. There is an inherent protection in the amendment in that it requires the approval of the Health Service Executive for a project to go ahead. It is not a question of units being developed at every crossroads. It is extremely difficult to secure HSE approval.

Deputies Finneran and Calleary referred to projects in Roscommon and Mayo. An eight-bed unit is being developed in Roscommon and a 14-bed unit in Mayo. These projects would not have commenced without the commitment of the Mayo Roscommon Hospice Foundation, which was obliged to commit the largest percentage of the capital funding. After much arm twisting, the HSE eventually approved the projects but only on the basis that the Mayo-Roscommon Hospice Foundation would pick up part of the initial running costs. We still have no decision from the HSE in regard to the ongoing running costs, and this is holding up the projects. Premature announcements have been made in regard to this funding but I hope the HSE will finally sanction it as soon as possible.

This amendment will not facilitate the projects in Mayo and Roscommon, for which the bulk of the capital funding came from the voluntary sector and the public. Moreover, as I said, most of the funding for the initial running costs of both operations also came from voluntary contributions. It is important that we recognise and support the tremendous work being done by hospice groups throughout the State. The Government must not turn its back on these projects.

I am concerned that the reason for the imposition of a 20-bed threshold is some type of hidden agenda in the implementation of the national cancer care strategy. The location of the proposed centres of excellence means there will be no services north of a line from Dublin to Galway. The 20-bed threshold proposed by the Minister would restrict the provision of palliative care facilities to large population bases of approximately 200,000 to 250,000. This means that counties with smaller populations will never have the opportunity to avail of these provisions. The Minister and I both come from counties with small populations so I assume that is not the agenda behind this proposal. I ask him to reconsider this provision on the basis that the current proposal will only facilitate large catchment areas and population centres. We see the impact this has already had in respect of the centres of excellence, with counties like Mayo and Sligo left out of the loop.

Another issue is the percentage breakdown of public and private patients, the so-called 80:20 split. I agree with Deputy Bruton that this represents a total imbalance. The ethos behind the hospice movement is that everybody should be treated equally according to need, not on the basis of the health insurance cover they may have. That is even more so the case in Mayo and Roscommon where a significantly lesser percentage of the population has private health insurance. The objective of the Mayo-Roscommon Hospice Foundation is to ensure the eight-bed and 14-bed units are available to everyone regardless of health insurance cover. I ask the Minister to review this aspect of the proposal.

Deputy Bruton referred to the monitoring of standards. It is totally unacceptable that private hospitals, some of which have already availed of various supports and incentives provided by the Government in regard to sites and so on, do not come under the jurisdiction of any type of monitoring agency. This is a national scandal. It is fundamentally important that these facilities are placed under the supervision of the Health Information and Quality Authority, HIQA. Likewise, palliative care facilities must also be subject to independent monitoring via the HIQA. The service provided by the hospice movement throughout the State is excellent. There has never been a complaint about the quality of service provided by the Mayo-Roscommon Hospice Foundation. However, there have been incidents in other areas where disputes have taken place, facilities have lain idle and so on. That must not be allowed to recur. It is important that this protection is put in place.

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