Thursday, 16 April 2015
Topical Issue Debate
I thank the Ceann Comhairle for selecting this matter and the Minister for Health, Deputy Leo Varadkar, for making the effort to attend to take it. The Minister is very familiar with this issue which I have raised with him on a number of occasions. I have been working on the plight of the Galway Hospice for the past three years and in that time have met with the Minister's predecessor. I have also met with other members of Government, senior HSE officials and the Secretary General of the Department of Health, but Deputy Varadkar is the first person who really gets to the nub of the issue and appreciates the challenges faced by Galway Hospice. I mean that sincerely and it is very encouraging that we have a Minister who takes that view.
Galway Hospice is the only hospice in Ireland that has been accredited by the International Society for Quality in Healthcare and the only one in Europe which has received an international quality award for outstanding achievement in the delivery of health care. The fact that it has achieved both of these awards against a backdrop of chronic underfunding is testament to the dedication, commitment and professionalism of the staff working at the hospice. Galway Hospice receives proportionately the lowest amount of funding of any specialist palliative care unit in the State. It is underresourced in other areas also. For example, Milford Hospice in Limerick, which is the closest hospice to Galway Hospice, has 7.2 occupational therapist posts and 4.5 palliative physiotherapist posts. By comparison, Galway Hospice has one occupational therapist and no palliative physiotherapist. As a result of this underfunding, Galway Hospice does not have the capacity to provide vital services and is constrained in its ability to meet demand. Patients are occupying precious and scarce acute hospital beds who should be availing of either the inpatient unit at Galway Hospice or, better again, having care provided by the Galway Hospice home care service in the comfort of their own homes.
The extent of the problem is reflected in the fact that almost 50% of all deaths that take place in the acute hospital in Galway are cancer related. By comparison, the figure at the closest hospital to ours, which is Limerick General Hospital, is 18% as there is a properly funded hospice service at Milford. That obviously puts a strain on University Hospital Galway as well as forcing patients to receive end-of-life care in an inappropriate and undesirable environment. While there are plans afoot to deal with the capacity shortage at the inpatient unit, the more immediate challenge is to deal with the explosion in demand for hospice services, particularly home care services.
In 2011 there were 162 discharges from the acute hospital to Galway Hospice. Last year the figure was 363 and it is expected to increase again this year. The system is at near breaking point. The time for the Government to provide additional resources is long past.
One weekend last month there were five patients in the acute hospital in Galway who were approved for discharge to the home care services provided by Galway Hospice. Four of these patients were not discharged because of capacity issues in the home care services. One patient - luckily for him - is a resident of north County Clare and was discharged because he could avail of services provided by Milford Hospice. The Minister knows that the cost of the provision of an acute bed is estimated to be in the region of €1,000 per night. A person availing of home care services could avail of up to ten home care visits for the same resource. This matter is in urgent need of attention.
There is a very negative impact on staff morale. There has been a change in the dynamic between the public and hospice staff and there is now hostility in some cases towards hospice staff because of their inability to provide services. This issue urgently needs the Minister's attention and I look forward to his response.
I thank the Deputy for raising this issue which I know is of great interest to him. I particularly acknowledge his special interest in Galway Hospice and the service it provides.
It is the aim of the Government that all people will be provided with the type of palliative care service they need, regardless of what diagnosis they have received, how old they are or whether they die in a hospice, an acute hospital, a nursing home or at home. The Health Service Executive has an annual service level arrangement with the Galway Hospice Foundation. In 2014, €3.36 million in funding was provided for the organisation. Funding is provided for local services on the basis of the budget allocation to palliative care services at a national level. It is normal practice for such service level agreements with hospice providers to cover all specialist palliative care services, namely, inpatient care, home care and day care. I am informed that the allocation to Galway Hospice represents the highest rate per specialist palliative care inpatient bed in the country. Perhaps that information is incorrect, but it is the information I have been given. The lowest allocations are for the north east, south east and midlands, where there are few or no inpatient hospices.
The HSE national director for primary care has recently been alerted, through local representation, that there are service pressures in respect of the funding for home care services being provided through Galway Hospice. This is being investigated as a matter of urgency by the executive with local service management in Galway as it raises concerns about the provision of this vital home care service for individuals and their families. It is recognised that hospices are usually funded through a combination of HSE funding and significant voluntary fundraising and this issue will be considered in its totality in the investigation with a view to ensuring value for money is achieved.
I will continue to monitor the position carefully and have asked for an update on progress. On foot of our conversation earlier today, in the debate which the Deputy requested, I was in touch with the director of primary care services who has committed to examine the matter. None of us wants to see terminally ill patients dying in hospital when they could die at home with the help of home care packages. As is always the way with any request for additional resources - it is a very strict rule that I have - the service provider must establish and show that it provides best value for money and that it uses its existing resources to the maximum extent possible before receiving any more.
It is clear that value for money is provided. If the Minister compares the cost of occupying an acute hospital bed with the cost of providing home care services and examines the knock-on and positive impact on things such as waiting lists and trolley counts, when acute hospital beds are freed up, it has to have a very positive impact. The cost of staying one night in an acute hospital bed is €1,000. Ten home care visits could be covered for the same cost. I do not know from where the Minister got the figures for Galway Hospice which show that it receives the highest proportion per acute bed. However, it is worth noting that the only funding it receives is for its inpatient unit beds. I think it is the only hospice in the country that does not receive any assistance from the State for the home care service. Perhaps that is what is throwing up the figures mentioned by the Minister.
This is a no-brainer. It would ensure patients in the later stages of cancer received specialist care in the most appropriate environment. The last thing we want to see happen is loved ones spending the last hours of their lives in a six-bed ward surrounded by a plastic curtain, with perhaps a neighbouring patient watching television or listening to the radio. That is unacceptable, especially when we look at the quality of service that can be provided not just through Galway Hospice but in hospices all over the country.
I mentioned staff. Some staff are, as the Minister said, experiencing hostility from the public because of the inability to meet demand. This obviously affects staff morale. Crucially, it also threatens to adversely impact on the fundraising capacity of the hospice. The people of Galway have been hugely generous during the years and I would hate to see anything happen that would compromise the ability of the hospice to fundraise, as it has plans to develop a new inpatient unit. It is in negotiations with the HSE to develop a state-of-the-art 26-bed inpatient unit, in the provision of which fundraising will be a central part. I hope the Government will include capital funding for that service in the soon to be announced capital plan.
This issue needs to be taken by the scruff of the neck and addressed. We are talking about it long enough. Galway Hospice will not be found wanting in the quality of service and the value for money it provides. One of its directors, Mr. Keith Finnegan, met the director, Mr. Hennessy, earlier today. It was a positive meeting. However, it needs to be followed up. A Government is judged by the way it treats the most vulnerable in society and there is no cohort more vulnerable than those who are preparing for death and for whom the only medical care available is palliative care.
I thank the Minister for taking this issue and showing an interest in it. I ask that he continue to monitor the position in the coming days to ensure funding or resources will be provided to address the issue.
The matter will be examined and will be examined expeditiously. No one can disagree with the statement that we would all much prefer to see people who are terminally ill looked after in a hospice or their own home. That is much more preferable to them dying in a hospital ward, particularly in a shared room. If something can be done, we will do everything we can to do it. When it comes to the financial aspects, it is never a question of whether it is less expensive to have someone in community or primary care versus acute hospital care. As a rule, acute hospital care is always more expensive than community or primary care, but that does not mean that we should not get best value for the money we spend on community, hospice or primary care services. Nor is it about saving money. Money spent well in providing hospice, community and primary care allows us to treat more patients. There will, therefore, be no penny pinching. This is about enuring taxpayers' euro are spent as best as possible to treat and look after as many patients as possible.