Dáil debates
Wednesday, 11 March 2015
Topical Issue Debate
Hospice Services
2:25 pm
Brian Stanley (Laois-Offaly, Sinn Fein)
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I will address with the Minister of State the important issue of hospice services in the four midlands counties - Laois, Offaly, Longford and Westmeath. Hospice services are struggling in those four counties. We have excellent local hospice committees and local hospice groups. The problem is that those groups are carrying a significant proportion of the burden of trying to provide services.
At present, we do not have enough specialist support staff in the community, such as support nurses, social workers, occupational therapists and physiotherapists. We have no inpatient level 3 services. There is a small amount of inpatient level 2 services in the region. Despite being one of the top five areas prioritised by the HSE in 2009 for such a level 3 service, it still has not been provided and the only option is for beds in acute hospital care settings to be used. This option does not come cheap.
As the Minister of State, Deputy Kathleen Lynch, will be aware, this is causing problems in the system. It is costing a lot of money. No money is being saved by having patients remaining in acute hospitals who should not be in them. Not having the hospice inpatient unit is costing money. In the midlands regional hospitals in Mullingar, Tullamore and Portlaoise, an average of 6,411 bed days a year are being used for palliative care. The lack of a hospice level 3 unit in the region to take those persons is causing a significant problem. Home care nurses, social workers and staff are being funded by local hospice groups. There is no day care service. Such a service one day per week would be excellent, if we could have it. I ask the Minister of State to look at the Cuisle centre in Portlaoise as one venue that could be considered in that regard.
Our region has the lowest investment in palliative care of all the regions in the country. In the mid-west region and the north-west region, on average €30 per capitais being used to provide palliative care whereas in the midlands it is less than €9. The 2007 figures are the most recent ones available but I am told by those monitoring it that there has been little variation in it since. As a result, the region has the highest rate of cancer deaths in acute hospitals. Although it is a morbid subject to be talking about, those near the end of life wish to die at home.
A 2001 report from the national advisory committee on palliative care stated that each region should have comprehensive palliative care services, that is, home care, primary care, acute hospital and inpatient specialist services. Fourteen years later, we still do not have it. Two internal HSE reports, in 2007 and 2012, set out the need for palliative care services to be developed specifically in the midlands. There is a significant problem here. The population in the midland counties of Laois, Offaly, Westmeath and Longford is wondering why it is not being given the same priority and why these basic services are not there. For those reaching the end of life and their families, it is important that we provide these services at that crucial stage of life. I ask the Minister of State to address this issue.
Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Stanley for raising this matter. He will be aware that I have a particular interest in palliative care and end-of-life treatment.
It is the intention of the Government that all people will be provided with the type of palliative care services they need regardless of their diagnosis, how old they are or whether they die in a hospice, an acute hospital, a nursing home or, as is the preference for most, at home. Specialist palliative care services in the midlands are provided through the community-based specialist palliative care team led by a consultant in palliative medicine and including a clinical nurse manager, specialist palliative care nurses, a senior social worker, senior physiotherapist and administrative support. The team provides input across the range of care settings and operates an open referral system, with referrals prioritised on the basis of need - there is no waiting list.
In 2013, funding to develop a model for the planning and delivery of specialist palliative care services in the midlands was provided by the Irish Hospice Foundation. A comprehensive plan was developed, integrating specialist home, acute and hospice care with generalist services, all working in collaboration to deliver a quality palliative care service. The most significant gaps identified were the need for a second consultant in palliative medicine, the absence of a specialist inpatient unit and associated day care services, the need for palliative care clinical nurse specialists in each acute hospital and the need for specialist occupational therapy services in the home care teams.
In 2015, the HSE will provide funding for a second consultant in palliative medicine for the midlands. The consultant will be based at the Midland Regional Hospital, Mullingar, covering the Longford-Westmeath area, and will work closely with the existing palliative care consultant. In addition, clinical nurse specialists for Portlaoise and Tullamore regional hospitals are currently being recruited.
Within the midlands, five local hospice groups currently provide funding on an annual basis for agreed core services and service development initiatives. The provision of a specialist palliative care inpatient unit remains a priority for the region. Recent research suggests that a 16-bed unit, with an option for an additional four to six beds, would meet the needs of the population in Laois, Offaly, Longford and Westmeath. The midlands palliative care consultative committee, chaired by the director of public health, has developed draft plans for the building of a hospice for the midlands. They are drawing on the experience of the Mayo and Waterford hospice movements regarding the overall size of unit, architectural design and location. The site for the unit will be identified when the design brief has been completed. The Minister for Health, Deputy Varadkar, met a delegation from the Irish Hospice Foundation on 26 February and among the issues discussed was the need for a comprehensive service plan for palliative care in the midlands.
Brian Stanley (Laois-Offaly, Sinn Fein)
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The Minister of State addressed some of the issues I raised in my opening remarks.
I was aware that there were plans for a second consultant post. The Minister of State confirmed that there is funding for it. When is that likely to happen? Is the recruitment under way or when will it begin? When can we expect to see that second consultant? While the consultant is to be based in the Longford-Westmeath part of the region, the appointment will improve matters in Laois and Offaly because one consultant will be able to dedicate himself or herself to palliative care for the counties of Laois and Offaly.
The Minister of State said research suggests we need a 16-bed unit. As far back as 2001, this was flagged in the report from the national advisory committee on palliative care. The report stated that we needed such a centre and also set out other matters that needed to be addressed. We need to provide this unit now. It is important to do so at a human level, but there are economic and management reasons for doing it also. Some 6,000 plus bed days are being taken up with patients who should be in palliative care. The unit would free up these beds. The Minister of State does not need me to tell her how bad things are in these acute hospitals, and that beds need to be freed up. That is not the primary concern here. The human need is the biggest concern but we must address this aspect also.
When can we expect recruitment of the second consultant and to see him or her in place? Why is there such a continuing low level of investment? I want the Minister of State to address why the spending on providing palliative care in the region is down at €9 per person when it is €30 per person in other areas. Why is each county not served by a full community multidisciplinary palliative service? It is recommended each county should such a service. Why is there not even a firm plan in place at this stage?
The HSE has substantial land resources in all four counties. Why is there not a plan in place already to locate this proposed unit? Why are we not progressing with these plans? Around the country, the Minister of State knows that they are either in place or are being progressed.
2:35 pm
Kathleen Lynch (Cork North Central, Labour)
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To pin down when the consultant will be in the post - I imagine this is the Deputy's central question - is to ask how long is a piece of string.
Brian Stanley (Laois-Offaly, Sinn Fein)
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Has recruitment started?
Kathleen Lynch (Cork North Central, Labour)
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Once we have decided to do it, the request will go into the national recruitment service in Manorhamilton. It will then be put on an order of priority. There clearly are priority lists and lesser priorities. As soon as one becomes available and a suitable candidate identified, there should be no blockage other than whether the person can take up the post. There are all sorts of variables. The only thing we can control is whether there are sufficient funds available and I am told by the HSE that there are.
The other area relates to specialist nurses and physiotherapists within the community based teams. These are hugely important because most people now get their palliative care or end-of-life care within a community setting. I take the Deputy's point on the expense of an acute hospital bed, but these are only used when looking to stabilise the person and to get the medication and the process right. Usually most people go on to live within their own communities. The situation is managed in that way.
Why is the midlands getting less than other areas? Who knows? Perhaps it is because the teams are not fully developed. Perhaps it is because there is no inpatient unit. There could be a multiplicity of reasons. I do not have the answer in front of me. If the Deputy, however, were to put table a question, I am sure that if an answer is available we will do everything to get it to the Deputy.