Voluntary hospice calls for guaranteed minimum State funding

The Government should move to guarantee a fixed level of funding in return for specified levels of services from the voluntary hospice sector to meet the growing needs for palliative care as people are continuing to live longer, according to a leading figure in the sector.

Dr Sandra McCloskey, chief executive of Marymount Hospice in Cork, urged the government to extend the Section 38 provision of the Public Health Act 2004 to include all hospices in the Voluntary Hospice Group (VHG) which provides palliative care for terminally patients around the country.

Dr McCloskey explained that the HSE currently funds 3,000 service providers under either Section 38 or Section 39 of the Public Health Act with some €2.44 billion of the annual €3 billion spend going to some 44 Section 38 agencies, primarily in the acute hospital and disability sectors.

Section 38 organisations are funded to provide a defined level of service on behalf of the HSE and their employees are classified as public servants whereas under Section 39, agencies are funded to varying degrees for services and employees are not classified as public servants.

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Dr McCloskey said the Voluntary Hospice Group is made of the North West Hospice in Sligo, Milford Care Centre in Limerick, Galway Hospice, Marymount University Hospice in Cork, Our Lady’s Hospice, Harold’s Cross and St Francis Hospice in Raheny and Blanchardstown.

“These hospices provide a hub from where specialist palliative care services are delivered, both on site and through outreach clinical programmes. They also host education and research facilities, which are essential for wider health care education.”

Dr McCloskey said that Our Lady’s Hospice in Harold’s Cross is currently funded as a Section 38 agency and she believed that the same funding model should apply to other hospices in the group, given that they are all part of integrated hospice system catering for community needs.

Becoming Section 38 agencies would assure the hospice movement of full funding for all its continued provision of services which are growing dramatically as people are living longer and the number of people needing palliative care is increasing all the time, she said.

Dr McCloskey instanced the experience of Marymount, which in 2008 was treating some 1,500 people a year, either in the hospice or in the community, but has since seen an exponential increase in those needing its services and it is now treating 3,000 people a year.

“We now know that palliative care is much more than end of life care - it aims to assist people with life limiting illnesses and research shows that early introduction of palliative care services, alongside active treatments, not only improves the patients’ quality of life but also results in longer survival.

“Our population is ageing and, as a nation we are living longer with higher levels of chronic illness with full inclusion into palliative care. Our ageing population will drive a large increase in the number of new cancers leading to increased need to access specialist palliative care,” she said.

She pointed out that by 2021, the number of people aged 65+ in Ireland  is projected to grow by 36 per cent and, with 80 per cent of total deaths in Ireland occurring in people who are aged 65+, the demand for palliative care looks set to grow significantly.

Dr McCloskey said the inclusion in the Slaintecare plan of a Palliative Care Development Framework agreed in 2017 between the HSE and the VHG was welcome as it will address the financial deficits faced by the VGH which currently receives some 70 per cent of its funding from the state.

“The hospices are genuinely indebted to patients, families, volunteers and the wider community for their ongoing support. Public support has enabled hospices to grow over the years and deliver specialist palliative care,” said Dr McCloskey.

“Gaps in funding, in some cases as much as 30 per cent, have been raised through public efforts and long-term support . . . each hospice currently raises a minimum of between €2 million and €4 million each year for operations alone and without reaching this target, services would have to be curtailed.”