Thursday, 27 June 2013
I welcome the Minister of State to the House. My Adjournment matter follows a presentation yesterday and the publication of a report by the Irish Hospice Foundation entitled, Access to Specialist Palliative Care Services in the Place of Death in Ireland. The figures in the report reflect the need for action to be taken. I am not blaming the Minister or the Department because this is a policy that was developed over 12 years ago. Unfortunately, when times were good, not a lot of progress was made, and we must now look at that plan in 2001 and what we can do now taking into account that there are far greater financial restrictions. There is also an issue of demands.
It was striking that more than 2,500 patients are denied access to hospice inpatient care every year. There are 155 hospice beds in the country, with another 44 beds ready, 20 of them in Cork, along with an extra 36 staff. The number in Marymount will increase from 24 to 44. The figures, however, that frighten me are those stating that by 2016, around 12,500 will require hospice care of some degree during the year.
The report also highlighted that only 7% of home care patients in the better resourced hospice services in the mid-west die in acute hospitals in contrast with 32% in the north east. Where there is hospice care and support services in place, there is less need for acute hospital attendance, which leads to a huge saving. Now we have this detailed research available, how can we work towards planning for the future?
On behalf of the Minister of State, Deputy Kathleen Lynch, I thank the Senator for raising this issue as it gives us an opportunity to outline the current position.
Palliative care in Ireland is being developed on the basis of the following national strategic documents: Report of the National Advisory Committee on Palliative Care, published by the Department of Health and Children in 2001; Palliative Care Services - Medium Term Development Framework, published by the HSE in 2009; and Palliative Care For Children With Life-Limiting Conditions In Ireland - A National Policy, published by the Department of Health and Children in 2010.
Notwithstanding current budgetary difficulties, in 2012, approximately 35,738 people received specialist home care palliative services and 4,274 people received specialist inpatient care. There are currently 157 specialist inpatient palliative care beds in ten locations across the country. In 2012, there were 2,808 admissions to this service, a 4.4% improvement on 2011 figures.
That said, it is acknowledged that there is a wide regional and intra-regional variation in the availability of care and three geographic areas have no specialist inpatient units, namely, Wexford-Wicklow, the midlands and Cavan-Louth-Monaghan. All HSE areas have community specialist palliative home care teams in operation. Last year, 2,978 people accessed these services each month, which was a 4% improvement on 2011.
There are 38 acute hospital specialist palliative care teams. Again there is variability in service availability and composition of these multidisciplinary teams. Specialist palliative day care is provided in seven locations and an average of 330 patients used the service per month in 2012.
Some 817 new patients attended the service in 2012, which equates to an increase of 7.5% on 2011. There are over 170 palliative care support beds across approximately 80 locations. In 2012 the average number of patients per month in receipt of care was 150.
The 2013 HSE national service plan budget allocation for palliative care is €72 million, which does not include spending on palliative care provided in acute hospitals, approximately 170 palliative care support beds or home care packages. Furthermore, regional services continue to be developed. In HSE South, an additional 20 beds will be opened in 2013 in Marymount Hospice, to which the Senator referred. In Dublin-mid-Leinster, collaboration with primary care teams is being progressed to improve access to out-of-hours services and a plan for the provision of specialist inpatient beds for the midlands is being developed. The HSE has also met stakeholders to develop a specialist service in Wicklow. In HSE west, the HSE is engaging with Galway Hospice to discuss the expansion of capacity and is exploring the development of inpatient beds in counties Mayo and Roscommon. An additional consultant in palliative care medicine is also being appointed. In Dublin north-east, a business case and implementation plan are being developed for a 12 bed specialist inpatient unit at Our Lady of Lourdes Hospital in Drogheda. Meetings have also been held with St. Francis Hospice on the opening of beds in the unit at Blanchardstown.
While we are facing significant challenges overall in the health budget, the Minister is satisfied that every effort is being made to retain and improve palliative care services.
I thank the Minister of State for his very detailed reply. In view of the projected figures given for 2016 and the fact that when people are being cared for and supported under the hospice care and home care packages, significant savings are made, in real terms, in hospital services, is it time to look at the plan in view of the changes that have taken place to see how we can further improve it? I wonder if that could be done.
I will certainly relay those insights and comments to the Minister of State, Deputy Kathleen Lynch. The Senator referred to a presentation which I understood would be made this week, but I now know that it took place yesterday. I am sure the Minister of State would welcome an opportunity to consider it, as I am sure she has seen it and will have an opportunity to study it. I am sure it will be of assistance to her.
I have outlined for Members the outcome of a survey across the county, which is useful. Even in the present context, it shows that a good effort is being made. Some progress also is being made, notwithstanding the difficulties encountered.
I will pass on to the Minister of State the Senator's point on savings made elsewhere in the system as a result of having well developed palliative care services. I thank him again for raising the matter.