Dáil debates
Tuesday, 8 November 2011
Topical Issues Debate
Hospice Services
5:00 pm
Brian Walsh (Galway West, Fine Gael)
Link to this: Individually | In context
I thank the Ceann Comhairle and the Minister of State, Deputy Shortall, for facilitating me in raising the issue of public funding for the Galway Hospice Foundation.
The matter of how the State supports hospice care is of massive public interest and importance, given the number of us who have been affected either directly or indirectly by cancer. There will be few people, therefore, who will not appreciate the significance of the role played by a hospice in offering comfort and support to patients and their families. I had the privilege last Friday evening of visiting the Galway Hospice facility in Renmore with the Taoiseach where we witnessed at first hand the exceptional care provided by the hospice for members of the public.
The Leas-Cheann Comhairle will be well aware of the service Galway Hospice provides and he has been a great supporter of the facility during the years. He will know that for over two decades the hospice has served the people of Galway city, County Galway and beyond in a way that is almost impossible for us to quantify or measure. All Galwegians know in their hearts the true value of the work the hospice does and of the thousands of lives it has touched, and this excellence has been independently and internationally recognised. It is the only hospice in Ireland to hold accreditation by the International Society for Quality in Health Care. In May it became the only hospice in Europe to receive an international quality improvement award for outstanding achievement in the delivery of quality care.
I raise this matter because of the significant disproportionality and inequality in the way hospices receive funding from the Health Service Executive. Last year, for example, Galway Hospice received â¬3.6 million in funding from the HSE, in comparison to â¬11.1 million provided for Milford Hospice in Limerick. The amount received in Galway was just over â¬300,000 per hospice bed compared to â¬444,000 per bed in Marymount Hospice in Cork, giving rise to a differential of almost 50% in the level of funding provided for the two hospices.
Not only is Galway Hospice underfunded, it is also under-resourced. Thenumber of consultant hours per hospice bed in Galway is also at variance with other facilities in the HSE west region. It received 1.2 consultant-hours per bed in comparison with 3.4 consultant-hours per bed in Donegal, for example. In spite of being disadvantaged by these inequalities, Galway hospice has continued to lead the way in terms of the provision of an exceptional service.
Galway hospice has had to rely largely on volunteer funding and requires approximately â¬1.5 million per annum through fund raising and voluntary donations in order to continue to provide the level of service it gives. It is a testament to that service and to the esteem in which the facility is held by the people of Galway and the wider region, that it is consistently able to raise that â¬1.5 million on an annual basis to meet the deficit in funding provided by the HSE. As the Leas-Cheann Comhairle is aware, the initial construction of the 12 bed facility at Renmore was financed entirely by voluntary funding, no call was made on the Government purse for the capital expenditure for the hospice. The deficit in finance received by Galway hospice compared to other facilities across the western region has also hampered its development and prevented its expansion. The burden imposed on it by this under-funding has meant that it cannot comply with its service requirement and it remains 14 beds short of that set out by the report of the national advisory committee on palliative care which was prepared back in 2001. The argument is that if this facility was properly funded, it would be in a position to direct all of its fund-raising efforts towards financing the plans it has to expand the facility to meet the needs of the region. The shortage of hospice beds in Galway is also emphasised by the number of cancer deaths which occur annually at the region's principal hospital, University Hospital Galway, UHG. Some 47.5% of all deaths in UHG are cancer related compared to just 17% in Limerick Regional Hospital and 21.5% in Cork University Hospital. In both of these areas, properly structured and financed hospice facilities exist.
I ask the Minister of State, Deputy Shortall to carry out a review of funding for hospice facilities to ensure that greater equality exists, that a level playing field exists and to demonstrate that the Government recognises the exceptional work being carried out by all hospice facilities in the State.
Róisín Shortall (Dublin North West, Labour)
Link to this: Individually | In context
I thank Deputy Walsh for raising this issue and giving me an opportunity to update the House on this matter.
Our policy is to continue to develop and improve palliative care health services in all regions to meet the objective of providing modern, high quality palliative and end of life care services. The development of such services is informed by the report of the National Advisory Committee on Palliative Care 2001 and will be progressed in the context of wider reforms for the health service generally and overall resource availability.
The Health Service Executive has operational responsibility for the delivery of health and social services, including supporting facilities such as Galway hospice. The HSE funds the 12 bed in-patient unit at Galway hospice to the sum of â¬3.5 million in the current year. This has been reduced from â¬3.7 million over the past two years, owing to cost containment measures being implemented right across the Galway area. This reduced funding has resulted in a reduction in day-care services from three to two days each week. The funding reduction is part of the continuing challenge to maximise levels of service, while meeting nationally defined cost containment targets. During 2010, 283 patients were cared for in the in-patient unit and 412 patients were cared for at home by the hospice home care team.
The HSE has also supported the hospice in relation to accreditation and ISO quality awards, through funding a full-time practice development co-ordinator, as well as a part-time pharmacist and dietitian. The HSE has enhanced medical provision in recent times through funding an additional registrar post in 2009 and supporting FETAC training of health care assistants through its nursing and midwifery planning and development unit. In addition, the new palliative care suite opened in Tuam community nursing unit in 2009 complements the Galway hospice and primary care teams in the community. The HSE remains committed to filling a third palliative care consultant post with the post holder having sessions in Galway Hospice and Portiuncula. The HSE is at present in the process of exploring options in this regard.
Under the National Framework for Palliative Services 2009-2013, Galway hospice home care team is earmarked for enhanced staffing for home care services. It is also scheduled for a capital development project, possibly on a less constrained site elsewhere, involving an additional 14 beds enhanced day-care facilities, a rehabilitation department and expanded family support and bereavement services. These proposals must be priorities in the context of a national approach to address recognised wider deficiencies in palliative care where there are large areas of the State with no hospice beds and little or nothing in the way of home care services.
The proposed capital development is at an early planning stage and discussions are ongoing regarding funding options, site location and other relevant matters. I understand that this process involved the hospice board working closely with the HSE, particularly in relation to prioritising the capital and revenue implications involved against a very difficult financial background. These discussions also have to take account of other palliative care issues relevant to the region, such as capital projects approved by the national framework for Donegal, Mayo and Sligo, which face similar service and resource pressures.
I thank the Deputy for raising the matter.
Brian Walsh (Galway West, Fine Gael)
Link to this: Individually | In context
I thank the Minister for her very comprehensive response and for the indication of support for the home care services and the capital expansion plan. The argument the board advances for the capital expansion plan is that if the hospice was properly funded on a year to year operational basis, it could direct the â¬1.5 million that it consistently raises through the generosity of the people of Galway, on the new capital programme. As I said when I made my earlier contribution, the existing facility was funded entirely through fundraising. The figures are available and cannot be disputed. There is a clear inequality vis-Ã-vis hospice facilities in the western region. I hope the Minister of State will be able to use her influence with the HSE to have that inequality addressed.
I thank the Minister of State for her response and the positive elements in regard to the home care service and her support for the capital funding of the proposed expansion.
Róisín Shortall (Dublin North West, Labour)
Link to this: Individually | In context
I take Deputy Walsh's point on the inequality in the funding allocations. I suppose much of that is for historical reasons. Very often where groups are very good at fundraising, they lose out because other facilities in other areas may be fully funded. I take that point. Increasingly, on a policy basis, we are trying to move to a standardised unit cost for funding services. I think that is the correct way to proceed. It is difficult to do that in the context of the very severe financial constraints we are operating under. I have taken note of the Deputy's request for a review of the manner in which funding is allocated across the region and I will take up this point with the Minister for Health, Deputy Reilly.
I thank the Deputy for raising the matter.