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Study reveals wide variations in access to Specialist Palliative Care services

Author: Rebecca Kelly
20 August 2015

Wide variations in the availability of Specialist Palliative Care (SPC) services across three Irish regions have been revealed in a report compiled by researchers at Trinity College and ESRI Ireland.

The study found that all areas have access to specialist community palliative care/home care teams but not all have access to a SPC in-patient unit, specialist palliative day care centres or outpatient clinics attached to SPC units. There are also differences in service availability with some offered seven days a week, twenty four hours a day and others during office hours only.

Researchers investigated the cost and effectiveness of models of specialist palliative care across the HSE Midlands (Laois, Offaly, Westmeath and Longford), HSE Mid-West (Clare, Limerick and North Tipperary) and HSE South-East (South-Tipperary, Waterford and Wexford but excluding Carlow/Kilkenny).

In each area, the quality of SPC services (hospice and community) rated very highly despite the diverse range of care available. The quality of inpatient hospital care was lower, particularly in terms of emotional support for families. However, such hospital care was not restricted to SPC services with researchers concluding it may reflect both underlying problems in the experience of hospital care, and a more general perception of the inappropriateness of the acute hospital setting for many people nearing the end of life.

Most individuals and their carers reported that getting access to community SPC or hospice care (where it was available) was ‘fairly easy’ or ‘very easy’, while those attempting to access a hospital bed found this much more difficult, particularly in the Mid-West and Midlands. In the Mid-West, the only area where both inpatient hospice and inpatient hospital services were available, the hospice scored much higher than hospital care on every quality measure.

The study also shows that older people make up the bulk of primary informal carers of those who are unwell, except in the South-East where adult children provided the largest proportion of care.

Speaking following the release of the report yesterday, CEO of the Irish Hospice Foundation (IHF), Sharon Foley said: “We welcome this particular study into Specialist Palliative Care in Ireland. The findings reflect a number of issues the IHF has been highlighting for a number of years. We know, given the opportunity, most people would prefer to die at home and community services are pivotal in that regard. When you consider the grand scheme of healthcare spending, what this report really demonstrates is, that the difference in cost of providing a fully comprehensive palliative care service and having no service at all, is very little. Also, we would have major concerns that there are still no dedicated specialist palliative care in-patient units in the North East, Midlands and South East, although plans are continuing to move forward for such a unit in Waterford.

You can read the report here.

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