Áine Brady (Kildare North, Fianna Fail)

I thank Senator Doherty for raising this issue. It provides me with an opportunity to update the House on this matter.

Government policy in relation to palliative care is contained in the 2001 report of the national advisory committee on palliative care. The provision of modern, quality services remains high on the Government agenda and is reflected in various significant policy and service developments in recent years. In this context, more than 4,000 patients received palliative services in 2009, with overall expenditure by the HSE on these services last year being in the region of €79 million. Expenditure this year will be in the region of €74 million when public service pay cuts, etc. are taken into account. The investment being directed to palliative care, in the context of the HSE national service plan for 2010, allows for the provision of a wide range of supports, including specialist inpatient beds, other palliative supports in acute hospitals and the provision of community-based services. These include 25 palliative care consultants and 26 home care teams nationally.

While robust financial management systems are an essential feature of any health service, our primary focus obviously must remain on patients. The range of professional and other essential staff involved in each hospital or local health area must aim at all times to provide the best possible service to patients and other clients, in line with available resources. In addition to this, the palliative care services five-year medium-term development framework was published by the HSE in July 2009. It details the actions and initiatives necessary to address the gaps in palliative care service provision, thus adopting a more a patient-centred approach overall in the future.

The HSE recently established an implementation and development committee to monitor progress on the strategy at national level. It is chaired by the HSE and membership includes representatives from organisations previously represented on the National Council for Palliative Care, including the Irish Hospice Foundation and the Irish Association for Palliative Care. The quality standards for end-of-life care in hospitals were launched in May of this year. These were advanced as part of the hospice friendly hospitals programme. The standards aim to support and enhance the provision of quality patient-centred end-of-life care within all hospital settings, especially in acute care facilities.

There are several other initiatives under way at national, regional or local levels. These include, for example, extending the access programme being undertaken by the Irish Hospice Foundation and the HSE which focuses on life-limiting conditions and involves pilot projects to develop best practice models in relation to chronic illnesses; the establishment of a bereavement support service in each HSE region; the inclusion of palliative care as one of the initial national programmes under the HSE directorate of quality and clinical care; and a specific standard in the national quality standards for residential care settings for older people relating to end-of-life care.

Donegal Hospice is an eight-bed unit in Letterkenny. The Health Service Executive has provided funding of slightly in excess of €2 million towards the service this year. The facility is staffed with one consultant in palliative care and three non-consultant hospital doctors, NCHDs. The medical staff is rostered Monday to Friday, with out-of-hours service provided through on-call and overtime. The estimated occupancy figure for the hospice is 70%, with no weekend admissions. The HSE is reviewing current medical pay costs at the hospice. A significant portion of pay costs are associated with issues such as overtime and on-call arrangements.

The HSE has indicated that options to provide some of the out-of-hours services via NorthWestDOC or other doctors at Letterkenny General Hospital are the subject of detailed and ongoing consideration. I understand a meeting has been arranged next week between the HSE and the Irish Hospital Consultants Association, IHCA, to advance matters. While discussions are ongoing regarding restructuring the service, no decision has been made to suppress posts. I stress that the HSE has no plans to close the hospice inpatient unit in Letterkenny. The suggestion of closure is without foundation and caused regrettable concern for families and patients in the county.

It will be clear to this House from what I have just outlined that this Government's commitment to palliative care is obvious. The Senator will appreciate, however, that the HSE has operational responsibility for delivering and supporting specific services at local level, including those at the Donegal Hospice.