Palliative Care Services

Wednesday, 3 November 2010

Seanad Éireann Debate
Vol. 205 No. 7

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Senator Pearse Doherty: Information on Pearse Doherty Zoom on Pearse Doherty Yesterday morning, the people of County Donegal were shocked by what they learned on Highland Radio, the local radio station. The shock did not come from the news that former Deputy James McDaid had resigned from the Dáil but from an announcement by Dr. Donal Martin, the consultant in palliative medicine at Donegal Hospice, in which he informed the listeners to the “Shaun Doherty Show” that Donegal Hospice would close its doors to new admissions from 21 December onwards. I did not hear the interview but have had the opportunity to speak to Dr. Martin in recent hours. He has informed me of the reasons he made such a statement and I understand he also issued a letter that was published in The Irish Times yesterday.

Dr. Martin claims the HSE has been running down funding of Donegal Hospice over a number of years. He informed me that since 2003, Donegal Hospice has seen a reduction in its nursing staff of 50% from 18 to nine. Recently, it has had its secretarial services scaled down to one day per week and its receptionist, who is on sick leave at present, has not been replaced. In addition, catering and cleaning staff numbers have been reduced at the hospice. He spoke about the need for savings and about how it is important for the Government to find savings in the budgetary environment in which we find ourselves. He mentioned how in the past there were empty beds that could not be filled because the rooms in which they were located were not cleaned because of the absence of cleaning staff.

The reason for the most recent announcement is that the HSE is refusing to fill the vacancy that will arise as a result of the expiration of the contract of one of the hospice’s junior doctors in December. Dr. Martin informs me and has claimed on the radio show that he cannot operate Donegal Hospice at a safe level without three junior doctors and one consultant. Moreover, he states this is not simply his own view but is grounded in the recommendations of a committee that was established in 2001, namely, the National Advisory Council on Palliative Care. The Government has endorsed this council and its recommendations, one of which was that to be run safely, hospices should be run on the basis of one consultant and three junior doctors. I note the Minister for Health and Children has withdrawn services from the north west on the grounds that they could not be run safely. This news has been met with outrage and anger, much of which has been focused on the consultant himself for stating on Highland Radio that this facility was to close. He, in his defence, will say he cannot operate it safely and that it is within the HSE guidelines that he forms that opinion.

We need clarification. First, will Donegal Hospice be able to continue to function for new admissions after 21 December 2010? With that in mind, I ask the Minister of State to refer to the fact that the consultant is the only person who can allow new admissions. If he says he will not allow admissions to happen because the hospice cannot operate safely, how do we get beyond that point? Second, can an eight-bed hospice run safely and provide services with only two junior doctors? I understand the HSE is talking about negotiations with staff and that there are issues about pay bills and so on. We have launched the Sinn Féin pre-budget submission and we have made it clear that public sector workers should not earn in excess of €100,000.

[481]The Government must take decisions in terms of the budget but my concern is not about what doctors are paid. It is whether new admissions to the hospice will be allowed after 21 December and how that will be brought about if the consultant, who is the only person with authority to receive new admissions, is refusing to do so, not on a whim but because he cannot operate the system safely. Who in their right mind would allow a system to operate for people at their most vulnerable time if it could not be operated safely? Those are the questions we need to ask. I am sure the Minister of State is aware of the importance of a functioning palliative care service that reduces hospital inpatient stay by 25% and emergency department attendance by 40%. It is crucial that we continue to have this service.

I refer to my earlier point. The number of nurses has been cut by half from 18 to nine, the secretary’s hours have been cut to one day a week, the receptionist has not been replaced, the catering staff have been scaled back and that only cooked chilled food is served, the cleaning staff have been reduced to the extent that some rooms cannot be occupied because they are not clean, and now the number of junior doctors has been reduced. Is there an agenda for the HSE to downgrade Donegal Hospice and force its ultimate closure? I hope the Minister of State can give positive news and allay the fears of the people of Donegal.

It would be remiss of me not to mention the huge work done by people in Donegal and by people from Donegal in other countries who have raised money for Donegal Hospice, and the committee at the heart of Donegal Hospice which has done Trojan voluntary work. Without their work the hospice would not be where it is today. I look forward to hearing the Minister of State’s reply.

Deputy Áine Brady: Information on Aine Brady Zoom on Aine Brady I thank Senator Doherty for raising this issue. It provides me with an opportunity to update the House on this matter.

Government policy in relation to palliative care is contained in the 2001 report of the national advisory committee on palliative care. The provision of modern, quality services remains high on the Government agenda and is reflected in various significant policy and service developments in recent years. In this context, more than 4,000 patients received palliative services in 2009, with overall expenditure by the HSE on these services last year being in the region of €79 million. Expenditure this year will be in the region of €74 million when public service pay cuts, etc. are taken into account. The investment being directed to palliative care, in the context of the HSE national service plan for 2010, allows for the provision of a wide range of supports, including specialist inpatient beds, other palliative supports in acute hospitals and the provision of community-based services. These include 25 palliative care consultants and 26 home care teams nationally.

While robust financial management systems are an essential feature of any health service, our primary focus obviously must remain on patients. The range of professional and other essential staff involved in each hospital or local health area must aim at all times to provide the best possible service for patients and other clients, in line with available resources. In addition to this, the palliative care services five-year medium-term development framework was published by the HSE in July 2009. It details the actions and initiatives necessary to address the gaps in palliative care service provision, thus adopting a more a patient-centred approach overall in the future.

The HSE recently established an implementation and development committee to monitor progress on the strategy at national level. It is chaired by the HSE and membership includes representatives from organisations previously represented on the National Council for Palliative Care, including the Irish Hospice Foundation and the Irish Association for Palliative Care. The quality standards for end-of-life care in hospitals were launched in May this year. These were advanced as part of the hospice friendly hospitals programme. The standards aim to [482]support and enhance the provision of quality patient-centred end-of-life care within all hospital settings, especially in acute care facilities.

There are several other initiatives under way at national, regional or local levels. These include, for example, extending the access programme being undertaken by the Irish Hospice Foundation and the HSE which focuses on life-limiting conditions and involves pilot projects to develop best practice models in relation to chronic illnesses; the establishment of a bereavement support service in each HSE region; the inclusion of palliative care as one of the initial national programmes under the HSE directorate of quality and clinical care; and a specific standard in the national quality standards for residential care settings for older people relating to end-of-life care.

Donegal Hospice is an eight-bed unit in Letterkenny. The Health Service Executive has provided funding of slightly in excess of €2 million towards the service this year. The facility is staffed with one consultant in palliative care and three non-consultant hospital doctors, NCHDs. The medical staff is rostered Monday to Friday, with out-of-hours service provided through on-call and overtime. The estimated occupancy figure for the hospice is 70%, with no weekend admissions. The HSE is reviewing current medical pay costs at the hospice. A significant portion of pay costs are associated with issues such as overtime and on-call arrangements.

The HSE has indicated that options to provide some of the out-of-hours services via NorthWestDOC or other doctors at Letterkenny General Hospital are the subject of detailed and ongoing consideration. I understand a meeting has been arranged next week between the HSE and the Irish Hospital Consultants Association, IHCA, to advance matters. While discussions are ongoing regarding restructuring the service, no decision has been made to suppress posts. I stress that the HSE has no plans to close the hospice inpatient unit in Letterkenny. The suggestion of closure is without foundation and caused regrettable concern for families and patients in the county.

It will be clear to this House from what I have just outlined that the Government’s commitment to palliative care is obvious. The Senator will appreciate, however, that the HSE has operational responsibility for delivering and supporting specific services at local level, including those at the Donegal Hospice.

Senator Pearse Doherty: Information on Pearse Doherty Zoom on Pearse Doherty I welcome Minister of State’s statement that no decision has been made to suppress posts. I understand Dr. Donal Martin’s statement on Highland Radio yesterday was made on the basis that the HSE had decided not to fill the vacancy. The clock is ticking. The post has not been advertised and a replacement needs to be put in place if we are to work within the guidelines of the National Council for Palliative Care, to which the Minister of State referred.

The Minister of State’s assurance will come as a relief but there are other serious questions. If the post is suppressed and the consultant is the only person who can take admissions, the service could be closed by default. As someone said yesterday, that will happen over our dead bodies in Donegal because so much effort and time has been put into ensuring the service is up and running and maintained. I welcome the Minister of State’s statement which will come as some relief and I wish everybody involved in next week’s talks well.

The Seanad adjourned at 8 p.m. until 10.30 a.m. on Thursday, 4 November 2010.

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