Imelda Henry (Fine Gael)
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I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House to deal with the motion. It is almost two years since the publication of the independent Trinity College report, There's No Place Like Home, a cost outcomes analysis of alternative models of care for young children with severe disabilities in Ireland. It recommended that the HSE fill the estimated gap of almost €2 million to enable the expansion of Jack and Jill Children's Foundation care provision to children aged six, the age at which children begin to receive care through expanded Government programmes, rather than cutting off this service to children when they reach the age of four years. Apparently, there are cases where children have finished with Jack and Jill services but where the HSE is neither willing nor able to provide the vital home care plan required for these children and their families. One case has gone all the way to the Ombudsman for Children.

It is hard to believe that the State has no national budget for pediatric home nursing care. This is shocking in this day and age when we all know it makes sense to care for children with life-limiting conditions at home, thereby saving millions of euro for the taxpayer by keeping the children out of hospital where they might unnecessarily block beds. Now is the time to reconsider the recommendations from the Trinity report and to further analyse why it makes sense for the Jack and Jill programme to extend its age criteria. When one sits down and calculates the return from investing in the Jack and Jill Children's Foundation by extending its age criteria to children aged up to six years, and the resulting money and hassle that would be saved to the State, the answer must be a resounding Yes. The main beneficiaries of such a move would be, of course, the children. The State must stop looking at the Jack and Jill Children's Foundation as an annoying little children's charity looking for a handout. It provides a vital service in the home within every community in Ireland. It gets a five-star rating from parents and saves the State millions of euro every year by keeping babies out of hospitals.

The Trinity report showed the cost effectiveness and quality of the Jack and Jill service. The foundation is ready, willing and able to provide what parents want and has the reach, flexibility and know-how to design care plans for children up to the age of six. This is something the HSE has not shown itself capable of doing in a consistent and acceptable manner across the country.

I appeal to the Minister of State to meet with the Jack and Jill Children's Foundation, which has a proven expertise in this field. It is a voluntary body that saves the State millions of euro. It would cost the State €40.5 million per annum if the 275 children currently under the wing of Jack and Jill landed back in hospital beds. That is based on the Trinity report figure of €147,000 per annum for hospital care. The foundation provides a service, indeed a lifeline, to families with the most desperately ill children. In an age where we are more than conscious of fiscal constraints, we must give this the most serious consideration and do what is best for the children and families involved.

Kathleen Lynch (Cork North Central, Labour)
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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.

Denis O'Donovan (Fianna Fail)
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I call Senator Reilly, who has four minutes. I have been told to be very strict with times because too much latitude is being granted. I welcome the Minister for Communications, Energy and Natural Resources, Deputy Pat Rabbitte.