Gaps in hospice services, including an absence of inpatient units for terminally-ill people in three regions in the State, have been identified in a new report.
The Irish Hospice Foundation's study also highlights continued inconsistency in accessing hospice/palliative care services.
There was a wide divergence in the range of services and care options available in different parts of the country, it shows. Needs assessments were carried out in the former health board areas during 2004.
A significant shortfall in Government funding has resulted in lack of progress in the development of services, the report notes. The baseline study confirmed significant regional variation, based on per capita spending by the State on hospice/palliative care. It ranged from €1.50 per capita in the former midland health board area, to €31 in the then north-western health board area.
At the end of 2004, seven of the former health board areas had inpatient units for hospice specialist palliative care. But the remaining three in the midlands, northeast and southeast, which cover 12 counties, had none.
Even health board areas with existing inpatient hospice units were experiencing bed deficits. Several counties in health board areas with inpatient units had an identified need for satellite units: notably Cavan, Mayo/Roscommon, Kerry, Wicklow, Kildare and Dublin west. Counties with inpatient units are Dublin, Cork, Limerick, Galway, Sligo and Donegal.
The report says significant progress had been made in almost all areas in the provision of specialist palliative care in the home and community. "However, State funding for services varies from location to location, from almost 100 per cent in south Dublin, Cork, Kerry, Wicklow, Kildare, to 25 per cent or less in Galway, Mayo, Roscommon, Wexford, Waterford, Carlow, Kilkenny, north Dublin," it notes.
There was also a wide variance in home-care service delivery - with a dependence still on voluntary contributions for one-third of home-care staff costs.
Acute main general hospitals were the primary source of referral of terminally-ill patients to hospice/palliative care. It is Government policy that all acute general hospitals over 150 beds should have a full, consultant-led specialist palliative care team, but only eight had approved a team.
Many recommendations in the report of the National Advisory Committee on Palliative Care endorsed by the Government in 2001 were unfulfilled, including the requirement of at least one inpatient unit in each health board area and a national total of 390 hospice inpatient beds. In December 2004, there were 131 inpatient beds, a deficit of 254.
Unveiling the report, Minister for Health Mary Harney said: "The whole purpose of what we're doing today is to try and put in place a system of palliative care support both in the home and at hospital level." About €60 million was being spent but there was a need to double that sum, as care was patchy in some parts of the country, she said.
Foundation chief executive Eugene Murray said: "There should be a separate protected budget for specialist palliative care services at health board level." A world-class hospice/palliative care service throughout the State could be provided at half the cost of running a large acute hospital for one year.
Chairman of the study steering committee Kevin O'Dwyer said: "There are populations within the State for whom an extraordinary and concentrated planning and development programme will be needed before they can benefit from a level of services already available to many of their fellow citizens in other regions."