‘Palliative Care Services: A Five-Year Development Framework 2009-2013’, which has still to be published by Health Minister Harney, says 272 extra full-time staff and 203 new specialist inpatient beds are ‘urgently’ needed to care for dying patients. The plan will require €308.8m–€237.3m for new capital projects and €71.5m in extra current spending until 2013, but the current freeze on recruitment in the HSE is likely to delay implementation.

The Framework document highlights wide variations across regions in the availability of specialist inpatient units and specialist palliative care. Three areas have no specialist inpatient units at all, no access to specialist inpatient beds for patients most in need, and no palliative day-care centres.

Currently, there is also no specialist inpatient palliative care service provided in Wicklow, which is identified as an area of immediate need for home-care provision. The HSE has made its submission to the Department of Health and finalisation of the Framework is subject to ongoing discussions.

There are significant waiting lists for admission to some specialist palliative care inpatient units, the document says, and current home help and public health nursing capacity is often insufficient to meet the needs of patients. Renal failure and heart disease do not have the same access to night-nursing services as those with advanced cancer.

There are significant variations in the staffing levels of specialist palliative care teams in acute general hospitals.

There should be at least eight to ten specialist palliative care beds per 100,000 population, the Framework document urges. It says there should be a minimum of one specialist palliative care nurse per 25,000 population, a minimum of one specialist palliative care nurse per 150 beds in each acute general hospital and that there is a significant gap in inpatient hospice care in the north east, midlands and south east. Some 12 counties have no access to this specialist inpatient service. There is an urgent need for a hospice in Waterford, Tullamore and Drogheda, said Dr Liam O’Síoráin, Chairman of the Irish Palliative Medicine Consultants Association. Units are also needed in Kilkenny, Castlebar, Wicklow, Roscommon, Tralee, Blanchardstown and Cavan.

“Certain areas of the country have limited or no access to specialist palliative care hospice beds,” Dr O’Síoráin said.