Kathleen Lynch (Cork North Central, Labour)

I thank the Senator for raising this issue. In her contribution she stated that the Jack and Jill Children's Foundation must not be seen as an "annoying little children's charity". Anybody who has met its staff or encountered the type of work they do would never think that. They are a highly professional specialised group of people.

It gives me great pleasure to outline the position. We have gone beyond the argument as to whether Jack and Jill is providing a worthwhile service. The report referred to by the Senator was commissioned by the Jack and Jill Children's Foundation. It recommended, among other things, that the State provide additional funding to the foundation to expand its services. As is the case with all charities, the HSE is not in a position to provide additional funding to the Jack and Jill Children's Foundation to enable the expansion of its services. However, the HSE is working with the foundation to identify and prioritise the needs of each child on a case by case basis to ensure that no child is hospitalised for want of adequate home support, provided by either the foundation or the HSE.

The report asserts that the service provided by Jack and Jill is significantly cheaper than hospital-based care. There is no dispute about the cost of hospital versus home-based services. Where a child needs hospitalisation, it will be provided. However, it is important to point out there is no provision of, or intention to provide, ongoing continuing care to children in an acute setting. In other words, they should be at home wherever they can be. The costs related to a 24 hour acute medical service will always show an unfavourable cost comparator to a home support service which is an entirely different type of service provided to families for a specified number of hours.

HSE disability services reviewed the report, "There's no place like home", as part of its ongoing engagement with the foundation. Subsequently, a review was undertaken pertaining to children aged over four years. This process was to ensure that all children with life-limiting conditions would receive services on an equitable basis and through a standardised approach. The review resulted in approximately 100 children being provided with alternative care. Some care plans have reduced hours as the child is now attending education, or availing of other respite options. In some cases, no further hours were required following discharge by the Jack and Jill Children's Foundation, as the supports provided by the HSE or other providers involved in the case were sufficient to meet the child's and family's needs. For the Jack and Jill Children's Foundation, the priority remains the birth to four year age group, with HSE community services and other non-statutory agencies meeting some level of assessed need thereafter. In some specific cases the foundation will continue to provide services to children aged over four years, as agreed with the HSE.

The Health Service Executive's national service plan for 2012, which has been drawn up against the backdrop of significant funding challenges, is designed to reflect the changed priorities of the new Government and the significant programme of reform to be undertaken. The allocation for disability services will reduce in 2012 by 3.7% as a consequence of the impact of efficiency, procurement and targeted pay reduction savings. However, the aim of the HSE will be to tailor such reductions in a way which minimises as much as possible the impact on service users and their families. The Jack and Jill service is part of a range of services provided to families funded by the HSE and other service providers for children with life-limiting conditions, of whom there are approximately 1,300. Many of the children availing of services provided by Jack and Jill also avail of other specialist hospital and community health supports and disability-services.

The Health Service Executive is committed to working with the Jack and Jill Children's Foundation to ensure that all children with life-limiting conditions receive services on an equitable basis and through a standardised approach, and that they be progressed through the children's palliative care steering group. The national policy, "Palliative Care for Children with Life-Limiting conditions in Ireland", will ensure a national approach to the provision of services for children with life-limiting conditions. All services and service providers will be governed by this approach.