Micheál Carrigy (Fine Gael)
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The Minister of State is very welcome to the Chamber. There is just one hospice bed for the whole of County Longford. I am raising this matter on behalf of all the people in our county and all the families who have been affected. I compliment Longford Hospice Homecare, a voluntary organisation that has been operating throughout my lifetime. People have done tremendous work in volunteering their time and fundraising for hospices. I also compliment the fantastic hospice nurses on the job they do.

I raised this issue on the Order of Business in March, May and, most recently, October. In 2019, I, a number of my colleagues and members of the Longford hospice met the then Minister for Health, Deputy Simon Harris, at St. Joseph's care centre. We received agreement that two beds would be incorporated into the €5 million redevelopment plans being proposed at the time and which are being followed through. However, the HSE has not been prepared to follow through on that agreement. According to the most recent correspondence I received from the HSE, which can only be described as outrageous, it is now putting a price on providing an extra palliative bed. It is putting a cost on people and families who just want their loved ones close to them before they pass away.I would like to read a couple of sentences from the letter I received a number of months ago. It states:

Any decision to re-designate one or more beds in St Joseph's, Longford will have to be made by the HSE at national level. The decision to re-designate any beds in St Joseph's Care Centre will reduce the number of beds available to clients requiring the level of care provided by long stay units. Such a decision will also have a financial impact on the unit, reducing the income to the unit through the Fair Deal scheme and increasing the cost of care.

Any commitment to increasing the number of Palliative Care Support Beds at the expense of a long stay bed would have to be accompanied by an appropriate budget allocation to compensate for the fair deal income reduction in order to maintain services for the current and future residents in St Joseph's Care Centre.

That is a ridiculous reply, to be honest. However, it is the reply that was given, through me, to a voluntary committee that has fundraised hundreds of thousands of euro over the past number of years. The bed occupancy rate since 1 January is 85%.

I will now outline some of the figures relating to deaths in Longford. There were a total of 92 deaths, 60 of which occurred at home, seven in the level 2 bed in St. Joseph's and the remaining 25 deaths occurred in nursing homes and acute hospital settings. In 2021, 11 patients were placed on a waiting list for level 2 beds in Longford, but were unable to avail of them. Four patients received beds in Athlone, three were discharged from hospital to home and four died in nursing home and acute hospital settings. The number of hospital palliative care home visits in Longford is much higher than in any other county. The number of deaths in the Midland Regional Hospital, Mullingar, is higher than in other hospitals. Many of these patients at end-of-life have no other choice but to die in an acute hospital. This is not acceptable and cannot continue.

The availability of a second bed in Longford would allow hospital discharges for people who do not wish to die in the Midland Regional Hospital and who want to be closer to home. Unfortunately, clinical nurse specialists need to hold the bed vacant to ensure that a particular patient with the highest level of need can access it. The availability of a second bed in Longford would mean this would not happen. It would also allow for respite for the families who need that extra support and the opportunity of having a break while looking after a loved one. In Westmeath, there are seven palliative care beds, which includes two community beds in Mullingar, for a population of 80,000. In Longford, we have one bed and a population of 40,000. The following is the Longford Hospice Homecare mission statement: "To provide appropriate physical, emotional and spiritual support to palliative care patients and their families enabling them to manage life-limiting illness and bereavement with fortitude and dignity."

I appeal to the Minister of State and the Department of Health to meet with this committee locally, reverse the decision in question immediately and make sure that we have that second bed for families in County Longford.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Carrigy for raising this important issue and for outlining the position in such a comprehensive manner. Palliative care can be highly emotive for people because it is end-of-life care. We all accept that.

The Government is strongly committed to providing high-quality, evidence-based palliative care in Ireland. The Department of Health, in line with the national palliative care policy introduced in 2001, is committed to ensuring that the hospice sector is sustainable and that specialist palliative care services are provided in every region of the country.

As stated by Senator Carrigy, St. Joseph's Care Centre, Longford, provides 24-hour nursing care for up to 68 residents. It is an invaluable service that is imbedded within the community. These beds can be used to provide care to a range of needs, including dementia care and cognitive impairment, acquired brain injury, palliative and palliative respite care. A newly refurbished lodge at St. Joseph's Care Centre includes one bedroom allocated for palliative care use, as stated by the Senator. The nub of the issue is the occupancy rate for this palliative care bed, which was 54% for 2020. I understand that in 2020 the numbers relating to palliative care were down everywhere. We were in the middle of Covid and there were situations whereby a person might be admitted but could not have a visitor for two weeks, until the 14 days passed and that was following by a restriction under which no visitation was allowed. As I said, all over the country numbers decreased as people preferred to receive palliative services at home because they were surrounded by their families.

The occupancy rate at St. Joseph's has risen to 64% to date in 2021. The figures I have show that the demand to date has been 64%. The HSE in the region also has a consultant-led specialist palliative care team that supports individuals in their homes. They engage with community nursing staff, GPs, out of-hours services and the Midland Regional Hospital to support patients and families.Current plans do not include an increase in the number of beds available for palliative services and any decision to redesignate one or more beds in St. Joseph's, Longford, will be made by the HSE based on local need. This Government will continue to work with the HSE and hospice organisations to ensure people with life-limiting conditions receive the level of palliative care they require.

I know the Senator will be disappointed with the response. As he said, it is one bed for 40,000 people. The Minister would have looked at the 54% capacity in 2020, which was an unusual year, and the 64% capacity in 2021 to date. Those figures would determine that one bed seems to be sufficient.

Micheál Carrigy (Fine Gael)
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I am disappointed. The response stated "based on local need". The facts are there about the local need and the numbers. This year alone, until the end of October, 11 patients and their families looked for the palliative bed but it was not available. In some cases, the bed was being used and in others it was being held for someone who might have had a higher need. It is not the case that there was not a need there. The figures I have got for this year differ on the percentages in the response. I believe it is higher. The facts are there of the number of patients and their families where it was not available. As I mentioned earlier, it is important to note there is a large number of families looking after elderly people at end-of-life in their homes and they need a break too, if it is for a prolonged time. The opportunity for a break is not there. I appeal to the Minister of State's better judgment. We are not dealing with people who have not been prepared or have not invested into this service. There has been a huge contribution from the people of Longford through Longford Hospice to support this service.

Mary Butler (Waterford, Fianna Fail)
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St. Joseph's care centre provides 24-hour nursing care. The newly refurbished room allows palliative and palliative-respite care to be provided. The HSE is committed to a continued review of the occupancy of the palliative-care supported bed with the option to increase the number of designated beds required, which is welcome. I imagine it will examine the statistics at the end of the year.

The programme for Government aims to improve access to specialist palliative inpatient services through the development of a hospice to serve every region in the country. The midlands has been identified as a region for the development of a new specialist inpatient palliative care service. The Department of Health is actively engaging with the HSE to progress plans for this development. The development of this unit will ensure that those with palliative care needs and their families living in the midlands counties, including Longford, can access the services they need to improve their quality of live. The Government's commitment to improving palliative and end-of-life services is laid out in its programme for Government.

From my perspective, we have a new unit in Waterford, the Dunmore wing, in University Hospital Waterford. It was completed two years ago but was used for Covid. It opened recently for palliative care. It is led by a consultant for people at end-of-life. It is a fantastic facility. Other beds were closed in different areas. This is acute care for end-of-life. I take comfort from the statement that there is commitment to a review of the occupancy of the palliative care supported bed with the option to increase the number of designated beds if required.

That is probably the best the Senator is going to get at the moment. The statistics say 54% and 64%. I am happy to talk to him again because I know how important these beds are.