Ciara Conway (Waterford, Labour)
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I am glad to have the opportunity to raise this matter, which I have raised previously at the Joint Committee on Health and Children. Currently, Waterford is without a hospice and it is not only Waterford that is affected but the whole region of Waterford, Wexford, Carlow, Kilkenny and Tipperary, taking in a population of 0.5 million. As we approach 2015, we are still in the shameful situation where the south east of Ireland does not have a dedicated hospice building.

Work is underway to address this, thanks to the hard work of the local hospice movements across the south east, in particular in Waterford. A design team was appointed this summer and meetings have been getting underway with the architects. It is hoped the planning application for the unit will be lodged in March 2015 and that the building will start in the summer of 2016, to be finished by the end of 2017. That is all well and good, and we look forward to seeing the work progressing, but it is currently costing Waterford hospice approximately €600,000 annually to provide home care services. Most of this amount - 67% - has been raised through donations from coffee mornings, sunflower days and local fund-raising by very loyal supporters.

The HSE provides 33% of the remaining funding required. There is a great deal of money being raised and spent locally on the hospice home care packages. From my work with the hospice board, led by the chairperson, Danette Connolly, I know that it has always said that the HSE locally has been very supportive and helpful.

While the HSE is helpful, money talks. I have a rather alarming document, the response to a recent parliamentary question from me requesting a detailed breakdown of the funds. It makes for stark reading. In 2014, Milford Care Centre in Limerick received €11.5 million; Galway Hospice, €3.36 million; North West Hospice in Sligo, €2.59 million; Our Lady’s Hospice in Harold’s Cross, €13.23 million; Marymount Hospice in Cork, €6.5 million; and St. Francis Hospice in Raheny, €7.1 million. These hospices receive between €3 million and €13 million each year to fund services for people at the end of their lives.

The picture in the south east, however, is not pleasant. Until September 2014, the Waterford hospice movement received the miserly sum of €140,000; the Carlow-Kilkenny home care team, €160,000; the Wexford team, €150,000; and the local hospice movement in south Tipperary, €170,000. The combined hospice service in the south east received €620,000 from the HSE until September of this year.

We do not begrudge the money to Limerick or Sligo or anywhere else for those caring for people who are very unwell, managing pain and at the end of their lives. The south east hospice normally gets approximately €800,000 per annum, still the lowest amount for any region in the country. It is hard to read these figures in the awareness that not only are the people across Waterford, Wexford, Carlow, Kilkenny and south Tipperary being asked to fundraise for home care services but also to raise €6 million towards the palliative care unit. Anyone can see from these figures that the south east is missing out on a very big piece of the pie.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Deputy for raising this issue because palliative care is an integral part of the delivery of health services. We should be conscious that it is not always given at the end of life but ensures that people who have a condition that will end their lives can have a quality of life for a prolonged period which allows them live the best life possible. I take on board everything the Deputy has said but I know that the fundraising committee in Marymount in Cork, which is the one I am most familiar with, raised €28 million to put in place the fine hospice in Cork. I accept that there is a huge area of the country that does not have a hospice.

Direct budget allocation for palliative care is €73 million in 2014, but this does not include expenditure on the specialist palliative care provided in 38 acute hospitals, approximately 170 palliative care support beds and designated home care packages. Most of the HSE's palliative care budget is provided to the main voluntary hospice organisations to provide palliative care services, including inpatient beds, home care and day care. The funding is provided under an annual service level arrangement with each organisation. Many agencies also provide additional services which are resourced through charitable fundraising, which as the Deputy said is an active part of what happens in Waterford.

I am aware that Waterford home care services relies on voluntary fundraising to supplement the funding it receives from the HSE. This is also the case for the other palliative care home care services in the south east. The HSE funds approximately 40% of the running costs for each of the four providers. All of these teams provide support for palliative care patients with malignant and non-malignant conditions, and all provide a seven-day service. These teams, and the fundraising efforts behind them, provide a vital service for people with a life-limiting condition and their families in the south east, and this Government greatly appreciates their efforts to ensure quality of life for patients with a life-limiting diagnosis.

I would like to see increased support for these services but despite better economic indications in recent times, funding is under pressure across the health sector and will remain so for quite some time, and it will continue to be very challenging to secure additional funds in these circumstances. I am also aware that Waterford home care services has agreed to raise €6 million to cover the capital cost of the new 20-bed specialist palliative care inpatient unit to be built as part of the redevelopment of Waterford Regional Hospital. The unit will act as a focal point for the provision of specialist inpatient beds, and community and day care services for patients and their families living in the south east.

There are six similar proposals for new hospice units at various stages of development throughout the country where the voluntary hospice groups propose to provide the capital funding on the basis that the HSE will take on the ongoing operational costs. This year 16 new beds have opened at Marymount in Cork and all 24 new hospice beds in St. Francis Hospice, Blanchardstown, will be open by the end of the year. The University Hospital Waterford project, including the palliative care unit, is included in the HSE's capital plan for 2014. It is expected that the planning application will be lodged in March 2015. Construction is planned to commence subject to funding approval in the second quarter of 2016 and to be completed in the third quarter of 2017. Following commissioning and equipping, the unit is planned to open in early 2018.

The provision of the structure sometimes brings additional funding and this will help in the provision of service in that area.

Ciara Conway (Waterford, Labour)
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I thank the Minister of State. I am really delighted that the palliative care unit is in the capital plan for the HSE. Other governments reneged on their promises to the south east and Waterford in this respect. The fundraisers and activists behind this issue are glad to see a finishing line.

In respect of life-limiting illnesses, the Minister of State is absolutely right that this is not just a once-off but can be an ongoing service throughout a person's life to improve quality of life. It is in a patient's interest to be kept at home as long as possible. The home care team does incredible work, which I have seen at first hand. The local fundraisers have to subsidise the home care packages because we get so little funding vis-à-visthe rest of the country, but that money could be diverted into the bricks and mortar of the hospice building. The local HSE has been very good and has a really good working relationship with the hospice. The end result will not just be a hospice unit on the grounds of University Hospital Waterford but a five storey building integrated into the plan for the hospital which will be an incredible facility for the people of Waterford and the south east. In the interim, however, the home care services are very poorly funded vis-à-visthe rest of the country.

I would like the Minister of State to ask the Minister, Deputy Varadkar, why that is the case. This region has a population of approximately 500,000. Between 33% and 40% of the funding is being provided by the HSE. I understand that in other regions of the country, the salaries of the wonderful nurses who go into people's homes to provide such great care are paid for by the HSE, rather than from the buckets of fund-raisers.

Kathleen Lynch (Cork North Central, Labour)
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I suppose I have a little personal knowledge of this matter. I would have an affinity with it. Of course it would be an objective to be able to increase the budget in this area. It is not something that is being forgotten. We are very familiar with what happens, especially with the home care teams. I would like to mention an interesting development. Many people are staying and being maintained at home for a long time. This means the only people who are going into inpatient hospice beds are those with significant levels of need. Their demands are so great that even the very established hospices are experiencing funding difficulties. The fair deal has to be part of it. I would like to mention another matter about which we need to be very conscious. The VHI needs to be conscious of this as well, and it is in terms of the beds. If someone has been paying VHI all of his or her life, it just cannot suddenly stop for that little piece at the end of his or her life. In many cases, they are very conscious of that and they do deliver. We need to have a conversation with them about how best we can do that as well. I think it is far more complex than people imagine. If one talks to most of the voluntary organisations that deal with palliative care, they will clearly tell one that the needs of people during that journey, which can sometimes be extensive, are far more complex than we thought. Of course it would be magnificent to be able to increase the budget. It is not something that will slip off the agenda. We are very conscious of it.