Mattie McGrath (Tipperary, Independent)
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400. To ask the Minister for Health to outline the steps he has taken to ensure appropriate care pathways are in place to improve cancer services and invest in end-of-life care, including the provision of hospice and end-of-life care during the perinatal period, infancy, childhood and adulthood as promised in the programme for Government; the steps he has taken to improve access to perinatal hospice care in all maternity hospitals throughout the country; and if he will make a statement on the matter. [32323/17]

Jim Daly (Cork South West, Fine Gael)
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In December 2009 the Department of Health published Palliative Care for Children with Life Limiting Conditions:a National Policy.The Policy provides clear direction for the development of an integrated palliative care service for children and their families, across all care settings. It aims to address the deficits identified in a national needs assessment undertaken in 2005. Following the publication of the Policy, the National Development Committee for Children’s Palliative Care (NDC)was established by the HSE to oversee the implementation of its recommendations. The Policy contains 31 recommendations under 19 headings and places significant emphasis on supporting families and health care professionals to care for children in their own homes.

The HSE National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death were launched last year. The Standards provide that clinical and counselling services should be in place to support women and their families in all pregnancy loss situations, from early pregnancy loss to perinatal death, as well as situations where there is a diagnosis of foetal anomaly that may be life limiting or fatal. Each hospital will be required to have systems in place to ensure that bereavement care and end-of-life care for babies is central to the mission of the hospital and is organised around the needs of babies and their families. The Standards will be implemented on a phased basis by a dedicated Bereavement Standards Implementation Group in association with the National Women & Infants Health Programme.

To support the implementation of the children's palliative care policy, a programme of care for children with life-limiting conditions has been established including the appointment of a Paediatric Consultant with a Special Interest in Palliative Care, based in Crumlin. As well as supporting other paediatricians, the Consultant also provides clinical support and advice to maternity hospitals and neonatologists. The programme also included the appointment of 10 Children’s Outreach Nurses (CONs) whose role is to ensure that children being cared for at home by their families have access to co-ordinated and supportive services. The nurses liaise closely with statutory and voluntary service providers including local GPs, Public Health Nurses, Disability Services, the Jack and Jill Foundation and LauraLynn etc. A recent independent evaluation of the Children's Palliative Care Programme recommended that the children's outreach nursing service be strengthened, both to meet increased demand and to address geographical inequities in service provision and work has commenced on this. The Irish Hospice Foundation has also agreed to fund a second Consultant post for a one-year period after which the post will be funded by the HSE.

A national programme of structured continuing professional education on caring for children with life-limiting conditions has been developed in partnership with Our Lady's Children's Hospital Crumlin. The programme has been delivered in locations around the country and is available to all health care staff. Integrated websites for parents and health care professionals has been developed through the All Island Institute for Hospice and Palliative Care.

The HSE continues to make progress on other recommendations including the development of the model of care, the development of a model for ‘Hospice at Home’, clinical and governance protocols, standards and pathways, and bereavement care. The HSE's Primary Care Division provides homecare packages to facilitate children with complex care needs to be cared for at home.

With regard to adult palliative care services the HSE in partnership with a number of voluntary organisations provides community palliative care (home care) in every county across the country.

For the first five months of this year 91.6% of accepted homecare referrals were seen within seven days. Specialist palliative care inpatient beds (IPU) are provided in 11 locations and 96.4% of accepted referrals were admitted within seven days. There are plans in place to open an additional seven hospices within the next five years.