Tuesday, 4 December 2012
Topical Issues Debate
I am thankful for the time to raise in the Dáil today the need for the provision of a hospice in County Wicklow and to seek an update on where plans for such a provision are currently within the Department of Health and the HSE. I thank the Minister of State, Deputy Lynch, for her attendance for this topical issue.
The people of County Wicklow, relative to other parts of the country, have been poorly served by the level of palliative care available. In counties such as Limerick, Clare, Tipperary, Donegal and Sligo, the health spend on specialist palliative care services in 2011 was roughly €30 per head of population; in my county of Wicklow, the figure is a paltry €3. Currently, Wicklow does not have the resources to provide a service seven days a week and it cannot provide a weekend on-call service. Whereas the standard of care provided by home care teams of nurses is exceptional and very much appreciated by families in need of such a service, we have experienced weeks in Wicklow where services have been suspended in parts of the county due to staff leave and vacant nursing posts.
Despite this, an amazing group of dedicated and committed people have come together in Wicklow to set up what is known as the Wicklow Hospice Foundation. They have worked day and night and, to date, they have raised in excess of €2.5 million to provide a hospice in Wicklow. They have even obtained a site for the hospice, very kindly donated by nuns, in Magheramore. They now expect to be able to meet all the capital costs of building a hospice through fund-raising, an incredible achievement, particularly in the current economic climate. That makes me very proud to represent such a community in this House.
The people in the Wicklow Hospice Foundation, the residents of Wicklow and I must know where is the provision of the hospice in the view of the HSE and the Department of Health. What consideration has been given to the possible funding streams to staff, equip and maintain such a Wicklow hospice? If the community can build the hospice and has raised funding voluntarily, as well as finding a site for the hospice, where can the Department of Health and HSE meet the community in progressing the work?
I wish to emphasise a few points and seek answers. In 2009, the HSE carried out a major consultation process on palliative care and produced a five-year implementation plan. The list emanating from the plan was based on population, need and clinical opinion on where the hospice facilities should be built, as we cannot build a hospice facility in every town. County Wicklow was included as a location, so the need has already been recognised by the HSE as far back as 2009. Will the Minister of State indicate where the implementation of the five-year plan stands?
The Government's health document, Future Health, has just been published and it has a strong commitment to develop potential funding channels for palliative care. Will the Minister of State elaborate on the issue and will the funding mechanism be based on the model of money following the patient? It is clearly enshrined in the programme for Government and I know both of our political parties campaigned heavily on it in the last general election.
The provision of a Wicklow hospice is clearly right morally and from a societal perspective. It is also right from an economic view. We all know the cost of acute hospital care is far more than the cost of palliative and community care. Will the Minister of State address that point? The provision of a Wicklow hospice is a perfect example of a partnership approach to the delivery of important community health services. The community has played a leadership role and there is significant buy-in and pride in the project. Residents in County Wicklow have put their money where their mouth is and raised more than €2 million. The nuns in the county have played their part and contributed a site, which has been approved as being suitable by the HSE. We now need to advance the issue with the support of the HSE.
I thank the Deputy for raising the issue as it provides me with the opportunity to outline the position to the House. As somebody from a city that has always been extremely well served with palliative care, I understand the value of such a service.
Our policy is to continue to develop and improve palliative care health services in all regions of the country, thus meeting the objective of providing modern, high-quality palliative and end-of-life care services for those who need them. The development of such services is informed by various sources including, for example, the Report of the National Advisory Committee on Palliative Care 2001 mentioned by the Deputy, the ongoing wider reforms for the health service generally and service priorities and resource availability generally, as indicated in the agreed HSE annual service plans. The Deputy will be appreciate, therefore, that the executive has operational responsibility for the delivery of health and social services, including considering in the first instance proposals relating to developing hospice facilities in Wicklow.
Despite existing resource pressures overall on the health care system, the HSE national service plan for 2012 indicates funding of some €78 million for palliative care. Approximately 75% to 80% of this is being provided to the main voluntary organisations. Palliative care is also additionally funded through both acute and community services. The HSE service plan for 2012 specifically identifies the following deliverable outputs which are of relevance to the Wicklow area. These are the development of a national standardised admission, discharge and referral criteria which will improve uniformity of care; development of a systematic process of assessment of need which will result in improved care plans; development of a benchmark which will ensure improvements from referral to first point of contact; development of integrated care pathways to improve access; development of guidelines and pathways to improve out-of-hours services; and production of readily available information on palliative care and bereavement services which will be provided to individuals and organisations to enable them better access to local services.
The HSE palliative care services five year or medium term development framework for 2009 to 2013 identified the need for an inpatient hospice unit for Wicklow, together with associated staffing and revenue. The HSE is keenly aware that the current level of service available is less than optimal. The local Wicklow Hospice Foundation has been engaged in extensive fund-raising for capital to build a hospice. However, in order to staff and operate such a service, it would be necessary to secure substantial revenue funding and staff. The Deputy is aware of the budgetary pressures currently facing this Government and the HSE and all new developments have to be considered against the current budgetary and fiscal constraints. The executive must also to take account of other palliative care issues, such as capital projects approved in the national framework for all areas which face similar service and resource pressures. Nonetheless, the executive is continuing to engage with the hospice to see if it is possible to address funding issues in the context of any flexibility for this from 2013 onwards. In these circumstances the Department and the HSE will continue to keep the matter under review.
This is an issue of equity for people in County Wicklow. As I indicated, spending on palliative care in the county is €3 per head of population as opposed to €30 per head of population in counties Donegal, Sligo and Limerick. While we do not begrudge people in these counties such expenditure, some degree of equity is required. The lack of equity was evident when palliative services in north County Wicklow where I live were suspended during the summer owing to staff leave. Moreover, the Health Service Executive, having carried out interviews for vacant nursing posts, decided not to proceed to fill the positions. While I am aware of the current budgetary difficulties, I ask the Minister of State to convey to the HSE my concerns regarding its failure to fill the relevant nursing posts. Addressing this matter in the first instance is important. However, it is also important to address the issue of equity.
One of the Minister's key commitments is to move to a funding model under which money follows the patient. If we are serious about shifting to such a model, money should leave some of our hospitals with patients and go to hospices. In 2011, the percentage of patients in hospice home care programmes who died in hospital was 6% in Limerick and 40% in Wicklow. As Deputies are aware, it is more expensive to care for patients in hospitals than hospices. If we were to introduce a funding model whereby money follows the patient, some financial resources should follow patients being discharged from acute hospitals into hospices.
Politicians are always asked whether Departments have lists of projects. Does the Department have a list setting out where the next hospices will be built? If so, where does County Wicklow feature in the ranking? I would be grateful if the Minister of State would raise these matters with the Health Service Executive.
I accept that an issue of equity always arises in the development and delivery of services. The Deputy provided stark figures on the percentage of hospice home care patients in Limerick and Wicklow who died in hospital care. All the research suggests people wish to spend their final days at home and in their communities. I am not certain if the list the Deputy seeks exists but I will convey his request to the Health Service Executive. If information is available on this matter, I will ensure he receives it.