Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Tuesday, 5 Mar 2013

Vol. 221 No. 10

Adjournment Matters

Hospice Services

With your permission, a Leas-Chathaoirligh, I might allocate a minute of my time at the end to my colleague, Senator Mullins.

Is that agreed? Agreed.

The Minister of State is welcome to the House. I raise the important issue of funding for Galway Hospice because as I have said here in the Seanad previously, I believe there are some promises that ought to be kept in politics, and one of those promises was that given by the Taoiseach to the late Mr. John Cunningham, the former editor of The Connacht Tribune, when he said that the shortfall in funding for Galway Hospice Foundation would be addressed and that there would be support for expansion of the hospice in Galway. That commitment was given by the Taoiseach to the late Mr. Cunningham before his death in November 2011, and it was renewed by him some months later when he stated:

In due course you can take it that John Cunningham's words meant a lot to me that night when I was out there ... I tend not to forget things like that. If you like, in a personal sense to me, it was his last request and it is one that I'd like to see we can stand over.

That was not an election promise, and I have no doubt that the Taoiseach was sincere when he made that commitment, but the language is specific, and it is a particularly sensitive situation when a commitment like that is made.

I want to put on the record that Galway Hospice has done tremendous work. It has not expanded since its initial development in terms of its inpatient services, yet the demand for its services has increased greatly. Funding from the Health Service Executive, HSE, covers approximately 70% of its funding. Approximately €3.4 million was received last year, and I understand another €1.5 million is raised by the hospice to do its important work, apart from inpatient care, home care and so on.

It is a tribute to the Galway Hospice Foundation that it managed to raise so much money from a relatively small catchment area of about 250,000 people. It is a success story. It is true there are great needs across the country in terms of hospice care. However, the specific needs of Galway need to be emphasised at this point. There is talk of a funding cut of between 1.6% and 5% but that simply must not happen. There has already been a cut of about 10% in funding since 2009. More and more pressure is being put on a service which is giving much added value to the State, considering what it would cost to care for people in hospitals where the care would not be as good and as targeted. Thinking smart and working smarter and not harder, as the saying goes, would suggest that this particular effort needs to be made.

The Galway Hospice Foundation which has plans to develop to a 26-bed facility wants to get moving on its interim plan to add six beds to its current 12-bed inpatient facility. It needs to be assisted now. I realise the difficulty we face in terms of funding, even for very good causes, given the current crisis. The nature of that promise was such that it has to be honoured. These promises have to mean something. I know that concern is shared by the family of the late Mr. Cunningham and by the people of Galway Hospice and others people in Galway.

I welcome the Minister of State, Deputy Alex White. If a promise had never been made to Galway Hospice Foundation for funding I would want to support a call that the facility be adequately funded and that the moneys required for its expansion would be made available as it provides an incredible service, with limited resources, to the community and surrounding areas. We all know families whose loved ones would not have coped in their final weeks and months without the support of Galway Hospice Foundation and its team of nurses. It would make economic sense to expand the Galway Hospice facility as it would free up many beds at University College Hospital, Galway, and take care of patients who should be treated in a hospice setting as distinct from a general hospital setting. There is a need for a broader debate on funding for hospice care. It is not right that Galway Hospice Foundation should be so dependent on fundraising and the goodwill of organisations and the relatives of patients who die in the hospice for the ongoing funding of the facility. I hope the Minister of State will have positive news. I understand we are in difficult times but I have reason to believe the news for Galway Hospice in the future is likely to be positive. We would like the funding for the expansion to be provided sooner rather than later.

I thank the Senators for raising this important issue. The Galway Hospice Foundation is a voluntary organisation. It was established in 1986 when a group of local doctors and nurses developed hospice services for Galway city and county. At present, the Galway Hospice provides inpatient, home care and day care services. Its activities are funded by a combination of public donations and moneys received from the HSE.

Galway Hospice provides significant community services which are not funded from the HSE allocation. The HSE funds a 12-bed inpatient unit in Galway Hospice for which the allocation was €3.5 million in 2011 and €3.4 million in 2012. Funding allocations for 2013 have not been made yet by the HSE. However, the allocation identified for palliative care in the HSE service plan for 2013 has been reduced by 1.6% and a proportionate increase would, in the normal course, fall across the whole spread of service providers.

The HSE National Service Plan 2013 provides funding of €73 million for palliative care. Approximately 75% to 80% of this is provided to the main voluntary organisations. The palliative care priorities identified in the HSE service plan in 2013 are to support the delivery and improve the quality of generalist and specialist palliative care services in line with strategic policy direction and improve resource utilisation, including systematic assessment of need, access and referral, and progress the development of paediatric palliative care services.

The HSE commits in 2013 to the following access targets: 92% of specialist inpatient beds provided within seven days; and 82% of home, non-acute hospital, long-term residential care delivered by community teams within seven days.

A baseline study on the provision of hospice-specialist palliative care services in Ireland 2004 confirmed, on an objective basis, that there are regional variances in the provision of hospice-specialist palliative care in all care environments. The HSE accepts that the counties of the former Western Health Board, namely, Galway, Mayo and Roscommon, have a low per capita spend on palliative care services, but correcting this in present circumstances presents obvious difficulties, and other regions also face significant challenges. While funding is under pressure right across the health system, the HSE will actively engage with Galway Hospice to consider issues arising, including core funding deficits, service planning and regional palliative care requirements in HSE west. It is expected that further meetings between HSE management and Galway Hospice will occur in the next couple of weeks.

Galway Hospice has presented a discussion paper to the HSE regarding the future development of palliative care services in the Galway, Mayo and Roscommon areas. The discussion paper envisages a number of capital developments including: the building of a 12-bed specialist inpatient unit in Castlebar; an eight-bed intermediate bed unit in Roscommon; the provision of six additional interim inpatient beds at Galway Hospice; and an enhancement of the outpatient facilities and of the home care and day care services for County Galway.

Apart from the capital costs of these projects there would be a requirement for significant additional revenue allocations. Galway Hospice has held some preliminary discussions with the HSE in Galway on these matters and the expectation is that these discussions will continue in the coming months.

Through ongoing engagement and discussions between the HSE and the Galway Hospice and other stakeholders in the coming months, I would hope that progress can be achieved towards an optimal outcome.

I thank the Minister of State for his response. I would hope that something positive and substantial will come out of those meetings between HSE management and Galway Hospice. In the context of the budget for palliative care, will it provide for the expansion plans of Galway Hospice over and above the question of core funding?

I do not think I can go any further, except to reassure the Senator that these matters are being addressed. I would certainly hope that positive progress can be made on the issues the Senators have raised. I take the point raised at the outset in respect of what was said by the Taoiseach and his commitment. That reflects all our commitments in the context of the sad death of John Cunningham, whom I knew well as it so happens. Both Senators referred to the contact that people have with the hospice service in Galway. In recent years I have had close contact with the hospice service in Galway in respect of a family member, therefore, I know and value very highly the work of that organisation. Anything I can do, certainly that would be the case for the Minister of State, Deputy Kathleen Lynch, the Taoiseach and all of Government, to address the issues raised by the Senators will certainly be done.

Hospital Services

I thank the Minister of State, Deputy Alex White, for coming in to take the matter. I ask him to outline the up-to-date position on the provision of urological services for children who have spina bifida and hydrocephalus and, in particular, if arrangements have been made for a consultant paediatric urologist to travel from the United Kingdom on a monthly basis to provide the necessary clinical support in Ireland. The issue arises from the fact that there is only one paediatric urologist in Crumlin hospital. Children attending Temple Street Hospital do not have the services of a urologist and this consultant attends only for children with spina bifida in extreme cases. The paediatric urologist consultant in Cork reviews children in the south west region and is not in a position to see any Temple Street patients in the interim.

All children with spina bifida have a continence issue as a result of the condition but are being denied an important service which can assist in improving their quality of life. Children with spina bifida are in a high risk category for irreversible kidney damage which, in time, can lead to end-stage renal failure and, possibly, death if not monitored on an ongoing basis. As I understand it, the job was advertised and one applicant was interested but subsequently decided not to take the post. It appears that it will be difficult to fill the post as it is a very specialist area and it was suggested that we would engage the services of a UK-based consultant who would attend here on a regular basis to provide the service to these children. It is an important issue which needs to be dealt with.

I thank Senator Colm Burke for raising the matter. Ireland has the highest incidence of spina bifida in the western world so it is important that this issue be raised in the Chamber and highlighted.

Spina bifida is a very complex physical disability and children with the condition have multiple problems as a result. The majority of children and adults with spina bifida have hydrocephalus. Best practice is that there are multiple professionals involved on a spina bifida team. We know that on average 30 children per year are born in Ireland with open spina bifida, which is the most severe form. I am aware that early intervention by a specialist and local team is essential to optimise long-term functioning for these children and to prevent medical complications later in life. The Children's University Hospital, Temple Street, is the national tertiary care centre for spina bifida and hydrocephalus. All infants born in Ireland with spina bifida are transferred to Temple Street after birth for ongoing neonatal management. Children with spina bifida are seen by a multidisciplinary team at Temple Street which includes a consultant paediatrician with a special interest in spina bifida, a spina bifida nurse specialist and neurosurgery input. The model of care being developed by the HSE is to share care between the specialist team in Temple Street and local teams. While the best care should be provided nearest to the patient's home with guidance and support from the specialist team, it is acknowledged, as adverted to by Senator Colm Burke, that there are complex issues which are best managed by the specialist team.

The multidisciplinary spina bifida clinic was established in Temple Street in February 2011 but I am advised that there has been no dedicated urological input to date. A recruitment process was under way in 2009-10 through which the hospital hoped to recruit a consultant urologist but, unfortunately, no suitable candidate was found. A new recruitment process for the post is in train and is currently at interview stage. The HSE is hopeful that this new recruitment process will succeed in hiring a suitable candidate. While awaiting the appointment of a consultant urologist, spina bifida patients are being reviewed by a consultant surgeon. As an interim arrangement, those children requiring urgent urological input are prioritised clinically and seen in the UK under the treatment-abroad scheme. I am advised that all patients are being kept under regular review and are referred on a case-by-case basis to the UK for treatment pending the appointment of a permanent urologist. Arrangements are also being made to establish a regular clinic with a UK paediatric urologist to cover clinical priorities here.

The Government is acutely aware of the challenges faced by patients with spina bifida and their families in managing their condition and is committed to providing them with the best possible health service. The Government will continue to work with the HSE to ensure the best possible outcomes for these patients.

I thank the Minister of State for his response and I hope he is right that the position will be filled. My understanding is that it will be difficult to fill the position given that it is a very specialised post and the number of people specialising in the area is small. I note that the Minister of State said arrangements are also being made to establish a regular clinic here with a UK paediatric urologist. When is that likely to be in place? Even if the HSE is successful, as I sincerely hope it will be, in recruiting a paediatric urologist, he or she may not take up the position for nine to 12 months. That 12-month gap must be covered.

The best outcome is a permanent appointment here. There is a focus on achieving that now through the interview process. It is hoped a person can be appointed from the process in train. I will have to revert to the Senator on the timing in respect of obtaining the services in the interim of a UK-based paediatric urologist to provide a clinic here.

The Seanad adjourned at 5.45 p.m. until 10.30 a.m. on Wednesday, 6 March 2013.