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Budget threat to care for the dying

THE hospice movement says it fears that health cutbacks could have a devastating effect on its services.

There are approximately 6,000 people using hospice care at any one time in Ireland. Many of those receive support services in their homes. Following the confirmation from Minister Mary Harney last week that the 70 per cent of the health budget which comprises pay cannot be touched because of the Croke Park deal, the fear now is that the cuts will come in the remaining 30 per cent, which covers services -- including a promised increase in hospice beds.

Yet the hospice movement believes that money could actually be saved and hospice services protected if the cuts are configured in a strategic manner.

But the worry now is that in an effort to cut non-pay- related health costs, the strategic plan to develop hospice care will be deferred, reduced or cancelled, with the result of higher costs overall to the health system in future years.

In June 2009, the HSE published a five-year plan for hospice and palliative care which provided for creating 200 beds. It has been suggested that this plan is no longer affordable. But the short-term saving would result in longer-term costs and poorer results for patients.

End-of-life care, for people in their last year of life, accounts for 10 per cent of the overall HSE budget, or €1.4bn. This represents 30 per cent of the HSE hospital budget.

The total number of acute beds in Ireland is 11,000. There are also 8,000 public long-stay beds and approximately 16,000 private long-stay beds. The total number of hospice beds is 151, and there is a deficit in this area of 239 beds. The five-year plan would create 200 more hospice beds.

This could be done within the current reconfiguration programme of the HSE, which envisages changes in hospital-based provision of services and moving some services to primary care.

Because patients in hospice care spend more time at home being cared for by their families, have fewer hospital admissions and shorter lengths of stay, they cost the health system less money.

Eugene Murray, CEO of the Irish Hospice Foundation, has pointed out that where integrated hospice services exist, the cost to the state is more than 25 per cent less than the 'usual care'.

There is, for example, a good integrated service in Milford, Limerick. Its hospice has 30 beds, and is the hub in a service which supports 400 patients being cared for by the home care service.

But, in the midlands, dying patients occupy expensive acute beds because of the scarcity of hospice services in that area. As a result, the costs to the system of hospice care in the midlands is significantly greater than in Limerick.

It has been found that 40 per cent of hospital inpatients could be treated outside an acute hospital and that if the current way of doing things (ie referring patients to acute hospitals who don't need acute care) were to continue, there would need to be an increase of 7,104 hospital beds on today's requirement -- at enormous cost to the Exchequer.

"All the international evidence says that where you provide good hospice services you save money," says Mr Murray -- adding that hospice care, whether at home or in a hospice, is also better for the patient.

Sunday Independent