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Dáil Éireann debate -
Wednesday, 31 May 2000

Vol. 520 No. 2

Adjournment Debate. - Palliative Care Services.

I thank the Ceann Comhairle for allowing me to raise this important matter and the Minister of State for his presence in the House to respond positively, I hope.

Donegal, with a population of almost 130,000 people, urgently requires a hospice centre. The Donegal Hospice Movement was established in March 1988 by a small group of committed and dedicated people. The first home care sister commenced working in January 1989. There are now four home care sisters working throughout County Donegal, providing palliative care for patients whose disease is non-responsive to curative treatment. Control of pain, other symptoms and physical, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families. No patient is charged for hospice service. The provision of this service, Hospice At Home, enables patients to remain at home longer. The cost of home care service in Donegal is raised voluntarily and in excess of £666,000 has been collected and spent from 1992 to date.

The North Western Health Board provides £20,000 per annum from lottery funding, which is forwarded to the Foyle Hospice in Derry to help defray the cost of the salary of home care sisters who cover the Inishowen area. In addition, Donegal Hospice pays Foyle Hospice £15,000 per annum as a retainer so that Donegal patients can get a bed in the Foyle Hospice when required.

In view of the very high number of people requiring hospice care, it was decided in December 1997 that Donegal Hospice Limited should build a hospice in Letterkenny for the people of Donegal. Over the past two years, many meetings have taken place with the North Western Health Board, which is providing a site at Knocknamona, Letterkenny, free of charge. Many plans were drawn up before the final plans were agreed and launched in April 1999. At that time the building cost was estimated at £980,000 so it was hoped the overall cost would be £1.3 million. However, in October 1999 the quantity surveyor provided a revised costing of £1.3 million so the Hospice Movement expected the project could be finalised for a total of £1.5 million.

Tenders were forwarded to five building contractors who expressed an interest in the project. The tender approved by the hospice directors was for £1.404 million, which is a further £300,000 higher than the estimated figure which the quantity surveyor had outlined in October 1999 and it is envisaged at this stage that work on the project will commence in August of this year.

At this point, the hospice building fund has at its disposal £1.05 million. The breakdown of the figure is a contribution from the Government millennium fund of £100,000; North Western Health Board, £300,000 and Donegal Hospice, £650,000. The VAT outlined in the approved tender amounts to £157,847 which will go to the Department of Finance, thus the millennium grant of £100,000 is more than eroded. The balance of the VAT will have to be raised from the voluntary contributions of the people of Donegal. To finish the project it is envisaged the hospice directors will have to borrow at least between £700,000 and £800,000 unless further funding can be obtained from the Government through the national lottery or from some other source. Donegal Hospice has raised £650,000 to date and continues to fund raise. This is in addition in having to raise funds for the homecare service which has been provided in the county for the past 11 years. All members of the committee of Donegal Hospice are giving their time free of charge and in many cases at great financial cost to themselves.

To defer this project is not an option as building costs continue to escalate, so the building project must now proceed without further delay. I am asking the Minister to favourably consider the application for national lottery funding submitted last February by the Donegal Hospice Committee. They have already shown their dedication and commitment to the project. A similar response from the Government is absolutely necessary to bring this much needed project to completion.

Finally, it should not have been necessary for me to raise the lack of funding for the Donegal Hospice. The funding should have already been delivered by the Minister for Tourism, Sport and Recreation, Deputy McDaid, who sits beside the Minister for Health and Children at the Cabinet table and who is a founder member and a director of Donegal Hospice. As a director and a doctor he is aware of all the needs and facts as I have outlined them. Deputy McDaid is doing a good job in his official capacity as Minister for Tourism, Sport and Recreation. He must now use his influence with his ministerial colleague and deliver this much needed and indeed overdue facility for County Donegal.

I thank Deputy McGinley for raising this matter on the Adjournment. The organisation and development of palliative and hospice care services in the Donegal area is a matter for the North Western Health Board. I assure the Deputy I have been made well aware of the situation pertaining to Donegal Hospice by my colleagues in Donegal, not least by the Minister, Deputy McDaid, who can be regarded as one of the founders of hospice in Donegal, as was said by the Deputy.

I understand from the board that it has contributed a site to a value in excess of £300,000 and a further sum of £300,000 to date to the Donegal Hospice movement in respect of the development of hospice accommodation. Building work on the residential unit is due to commence in September 2000 with an anticipated completion date of late 2001. Tenders have now been obtained for the work and it is understood that costs exceed the estimates of the design team. The board has been in touch with the hospice directors with a view to discussing the shortfall of funds currently available and the revised costs. I understand that preliminary discussions have already taken place and the board expects to satisfactorily conclude these in the coming fortnight. The outcome will involve an increased contribution from the board. The board has indicated that it is most anxious to see this project proceed in partnership with Donegal Hospice.

In relation to palliative care services in general, there is a commitment in the programme for Government to develop a national hospice plan. Given this commitment, the nature of the development of palliative care services to date and the wide ranging issues involved from both statutory and voluntary and national and local perspectives, the then Minister for Health and Children, Deputy Cowen, established the national advisory committee on palliative care services in September 1999. The committee will prepare a report recommending a comprehensive national policy for the strategic planning and development of palliative care services nationally. I expect to be presented with the report at the end of the year.

A development programme for palliative care services was funded as part of the action plan 1997-9 under the national cancer strategy. The allocation in 1997 was £2.2 million, in 1998 it was £2.45 million and in 1999 it was £1.8 million. This funding has been used to establish new consultant posts in palliative care medicine in the Mid-Western, South Eastern and Western Health Board areas. Additional nursing, para-medical and administrative staff have also been appointed.

In order to maintain momentum on service developments and in preparation for the publication of the report of the national advisory committee on palliative care, a further £3.3 million has been allocated to palliative care services in 2000. This will provide six additional posts of consultant in palliative care medicine. There will now be a consultant led service in each health board area and additional nursing staff to expand the homecare and day care services.

I am anxious to strengthen the working relationship between the statutory and voluntary agencies in the palliative care area in order to provide the best possible level and quality of services to patients and their families. For this reason £300,000 has been allocated to the North Western Health Board in 2000, £125,000 of which is for a consultant post in palliative care. The remaining £175,000 is for the development of palliative care services in the health board region. I hope this meets with the approval of the Deputy.

The Dáil adjourned at 11.35 p.m. until 10.30 a.m. on Thursday, 1 June 2000.

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