David Cullinane (Sinn Fein)
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I welcome the Minister of State at the Department of Health, Deputy Kathleen Lynch. The previous Government made an explicit commitment to provide an oncology unit on the grounds of Waterford Regional Hospital. In 2007, the former Taoiseach, Mr. Bertie Ahern, and former Minister from Waterford, Mr. Martin Cullen, made an unequivocal statement to this effect to the people of Waterford.

The Minister of State may be aware that for more than ten years a campaign has been fought to bring an integrated multi-displinary cancer service to the south-east region. This campaign sought to establish a centre of excellence and an oncology unit that can provide all the modalities of cancer care, including chemotherapy, radiotherapy and surgery, on one integrated site because international best practice demonstrates this approach results in better outcomes for patients. Despite the fact that land was made available on the site of Waterford Regional Hospital, it appears the capital funding is no longer available or else the proposed oncology unit is not part of the current capital programme. This issue causes serious concern for patients in the south east. The region has a population of 450,000 and the hospital in Waterford covers Counties Waterford, south County Tipperary and County Wexford, as well as providing cancer services for patients in counties Carlow and Kilkenny. It is vital, therefore, that the oncology unit is built.

I recently joined my Labour Party colleague, Deputy Ciara Conway, and other Government Members in meeting the local hospice movement, which expressed concern about the delay in constructing the oncology unit and the 20-bed palliative care unit which was to be attached to it. At present, an integrated service with three consultants is based at the hospital but only two inpatient beds are available for a region comprising 450,000 people. There are four community home care specialist palliative care teams with consultant leads but, while these teams do fantastic work, they need in-house facilities for those who cannot be cared for at home. In Cork and Kerry the population is 510,000 but the area has 24 specialist palliative care beds. The south east, with a population of 463,000, has access to two inpatient beds. Some 1,300 patients in the south east per year are seen by the specialist community team, with 850 patients seen in acute hospitals. The estimated cost of the oncology unit which could provide the proper centre of excellence, with integrated care and all modalities on site and which would be part of international best practice in giving patients best outcome, would be approximately €70 million. It may be even less now because of the downturn.

The local hospice movement has provided €2.5 million which is ready to be spent. The money has been raised through hard work and the movement needs to have the unit built. The primary objective is the oncology unit with a palliative care section but if that is not an option, another plan to find an independent palliative care unit should be explored.

There are times when people play politics with very serious health issues. The commitments given by the previous Government were not carried out but my party also gave commitments, as did local Fine Gael and Labour Party candidates. The leaders of Fine Gael and the Labour Party, Deputies Enda Kenny and Eamon Gilmore, gave very clear commitments that if they were in Government, they would deliver on the promise of delivering an oncology unit. I hope the Minister of State will be able to ease some of the fears of patients in the south east. I am being told that the unit is not part of the capital programme and if that is the case we should get the facility on the capital programme so we can expedite the issue.

Kathleen Lynch (Cork North Central, Labour)
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I thank the Senator for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to developing palliative care services. Government policy for palliative care is based on the report of the national advisory committee on palliative care from 2001. Palliative care is primarily concerned with quality of life.

The Government's objective of the continued development of palliative care services is reflected in the funding of these services in recent times. In 2009 in the region of €79 million was made available, with approximately €66.5 million of this being provided to the main voluntary organisations. It is accepted that these organisations do an extraordinary job. The overall budget provision in 2010 was €76 million and €74 million was provided in 2011. The HSE reports that specialist palliative care is provided to 3,600 people each month, and it is understood that the admission rates - waiting times - to palliative care beds over all regions is 90% to 100% within seven days of active referral.

A palliative care services medium-term development frameworkwas published by the HSE.This sets national priorities, which have been agreed by all stakeholders. In line with recommendations of the framework, the HSE established in July 2010 the national steering group on palliative care services to monitor progress on the implementation of the framework at national and regional level. As the Senator is aware, the Health Act 2004 provides the Health Service Executive with responsibility for the management and delivery of health and personal social services. As a statutory body the provision of these services, including progressing palliative care services at local level, is therefore an operational matter for the executive.

There are a number of developments ongoing in the south east with regard to palliative care services. In the south east, including Waterford, specialist palliative care is delivered through hospital and community-based consultant-led multidisciplinary teams. These teams consist of consultants, non-consultant hospital doctors, senior occupational therapists and a principal social worker. Acute and primary care services in the south east have access to specialist palliative care teams 24 hours a day, seven days a week.

The Irish Hospice Foundation established a national programme to mainstream hospice principles in hospital practice. It focuses on four key themes generated from a pilot project: integrated care; communication; dignity and design; and patient autonomy. Waterford Regional Hospital is participating in this programme.

The management team at St. Luke's General Hospital in Kilkenny continues to work with the Susie Long Hospice voluntary group on the plans to develop outreach inpatient palliative care beds for Kilkenny. In liaison with the Susie Long Hospice Group it is planned, during 2011, to upgrade ward areas to provide improved accommodation for patients currently in receipt of palliative care and other related services.

The integrated oncology unit and 20-bed palliative care unit at Waterford Regional Hospital to which the Deputy refers, like all potential capital projects, must be submitted through the HSE's capital steering committees for approval to be included in the HSE multiannual capital programme. I must inform the Senator that this project has not been included in the draft HSE capital plan 2011-2015, so it will not be considered for progress in the current plan. I understand the HSE has just appointed a project team to design a business case for the development.

The estimated total cost of all potential projects is always greater than the capital funding available. Health care is a labour intensive activity and hospices are one of the most labour intensive services. Therefore, sufficient revenue and current funding to staff and operate new facilities is one of a number of critical factors considered in such a project's appraisal. Given the level of contractual commitments already in place, there is limited funding available for new contracts before 2014. The executive is required to prioritise capital infrastructure projects within its overall capital funding allocation and within the multiannual commitment thresholds notified by the Department of Public Expenditure and Reform.

I reiterate the strong and real commitment of the Government to progressing the highest possible standards of palliative care nationally. However, all future developments, including capital projects, must be considered within overall budgetary and economic constraints. I know Cork has a very good and accessible palliative care programme so I understand fully where the Senator is coming from and why it would be a significant addition to the region. There is no dispute in that manner and it is an incredible service to be available to everyone. Unfortunately, I am sure the Senator understands the country's Government does not have the money to progress the project. If he continues with pressure, it will eventually come about.

David Cullinane (Sinn Fein)
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I thank the Minister of State for her response in reiterating the Government's commitment to palliative care, which is very important. The funding could and must be provided for. Despite the downturn, there is still money available for the Government and cancer care and provision of cancer treatment services is very important. A private facility has been built in Waterford, the Whitfield Clinic, which provides some form of radiotherapy. It is important in terms of international best practice that all modalities of treatment be provided on one site. For this to happen we need an oncology unit and the 20-bed palliative care unit.

As the Minister of State indicated, the local hospice movement has campaigned and raised funds for this project. I know the HSE is designing a brief now so I hope that when it is submitted, it will have the Department's full attention. I hope that at some point the Government will be in a position to allocate capital funding to deliver on this very important project.