Joe McHugh (Donegal North East, Fine Gael)
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In recent days there has been a conversation through the public domain in my constituency about fears and anxieties concerning future funding for Donegal Hospice. In the response from the HSE, I hope for confirmation and reassurance for existing patients and those who have contributed in a voluntary capacity through their time and financially over several years. It is equally important that we reassure those directly and indirectly involved in the hospice that there will be an answer to their concerns and reassurance for the wider community in Donegal, which has been extremely active in the genesis of the hospice movement through the continuation of the care and voluntary contributions to the hospice.

There is concern about the reduction in posts at the hospice from January 2011. At present there are three junior doctors working under a consultant along with other staff. We are at a period where we must consider reductions and funding withdrawals as a result of the financial situation. However, in the answer from the Minister of State I hope for reassurance for the people of Donegal, the patients and the volunteers in this movement so that even if there is a withdrawal of staff, we can have proper standards of patient safety. That is the matter I wish to highlight tonight. Will the Minister of State and the HSE reassure the public of Donegal and those involved in the hospice movement? This includes every person who has contributed time or a euro in a bucket in voluntary fund-raising and the organisations that have put their hearts into this movement. A hospice is not part of the Government. It may be a wing of the Government in terms of the Government providing financial input but it is part of the fabric of our society in Donegal. It belongs to the people and the people require answers on future commitments to patient safety. Patient safety is key to my raising this matter. Reassurance can only be provided through the Minister of State and the HSE, for which the Minister of State and the Minister for Health and Children have accountability. I want assurance provided to the families, to the patients and to the wider Donegal community. The Donegal community not only contributes to this but has been an integral part of the hospice movement in Donegal for years and intends to be part of it for years to come.

Michael Finneran (Roscommon-South Leitrim, Fianna Fail)
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I respond to this Adjournment debate on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Deputy for raising this issue. It provides me with an opportunity to update the House on the matter.

Government policy on palliative care is contained in the report of the national advisory committee on palliative care. The provision of modern, quality services remains high on the Government agenda and is reflected in various significant policy and service developments in recent years. In this context, more than 4,000 patients received palliative care services in 2009, with overall expenditure by the HSE on these services last year approximately €79 million. Expenditure this year will be approximately €74 million when public service pay cuts and so on are taken into account. The investment now directed to palliative care, in the context of the HSE national service plan 2010, allows for the provision of a wide range of supports, including specialist inpatient beds, other palliative supports in acute hospitals and the provision of community-based services. These include 25 palliative care consultants and 26 home care teams nationally.

While robust financial management systems are an essential feature of any health service, our primary focus has to remain on patients. The range of professional and other essential staff involved in each hospital or local health area must aim at all times to provide the best possible service to patients and other clients, in line with available resources.

The palliative care services five year medium-term development framework was published by the HSE in July 2009. It details the actions and initiatives necessary to address the gaps in palliative care service provision, thus adopting a more a patient-centred approach overall in the future. The HSE recently established an implementation and development committee to monitor progress on the strategy at national level. It is chaired by the HSE and membership includes representatives from organisations previously represented on the national council for palliative care, including the Irish Hospice Foundation and the Irish Association for Palliative Care.

The quality standards for end-of-life care in hospitals were launched in May. These were advanced as part of the hospice friendly hospitals programme. The standards aim to support and enhance the provision of quality patient-centred end of life care within all hospital settings, particularly in acute care facilities.

There are several other initiatives under way at national, regional or local levels. These include, for example the extending access programme being undertaken by the Irish Hospice Foundation and the HSE. This focuses on life-limiting conditions and involves pilot projects to develop best practice models for chronic illnesses.

A bereavement support service has been established in each HSE region. Palliative care has been included as one of the initial national programmes under the Health Service Executive directorate of quality and clinical care. A specific standard is included in the national quality standards for residential care settings for older people relating to end of life care.

The Donegal Hospice is an eight-bedded unit in Letterkenny. The executive has provided funding of just over €2 million towards the service this year. The facility is currently staffed with one consultant in palliative care and three non-consultant hospital doctors, NCHDs. The medical staff is rostered Monday to Friday, with out-of-hours service provided through on-call and overtime. The estimated occupancy figure for the hospice is 70%, with no weekend admissions. The Health Service Executive is reviewing current medical pay costs at the hospice. A significant portion of pay costs is associated with issues such as overtime and on-call arrangements.

The Health Service Executive has indicated that options to provide some of the out-of-hours services via NorthWestDOC, or other doctors at Letterkenny General Hospital, are the subject of detailed and ongoing consideration. I understand that a meeting has been arranged next week between the Health Service Executive and the Irish Hospital Consultants Association, IHCA, to advance matters. While discussions are ongoing on restructuring the service, no decision has been made to suppress posts. The Health Service Executive has no plans to close the hospice inpatient unit in Letterkenny. The suggestion of closure is without foundation and caused regrettable concern for families and patients in the county.

It will be clear to this House from what I have just outlined that the Government's commitment to palliative care is obvious. However, the Deputy will appreciate that the Health Service Executive has operational responsibility for delivering and supporting specific services at local level, including those at the Donegal Hospice.