OPINION:Cuts in funding for the expansion of palliative care services will cost the taxpayer more in the long run, wrties Eugene Murray
IF YOU were dying and in pain, would you be satisfied if you were told you would have to wait a few weeks for the specialist help needed? The reality is that Government funding for the cancer-control programme has abandoned the commitment to "comprehensive palliative care services" in each cancer-control network. The Health Service Executive has prepared a five-year plan to deliver integrated hospice services in places such as Waterford, Mayo, Wicklow, Drogheda and west Dublin. But the funding earmarked for 2009 has not been provided.
Such crude cutbacks in plans to deliver hospice care on a more equitable basis actually wastes taxpayers' money. Most importantly, the most vulnerable patients and families will needlessly suffer.
There is overwhelming international evidence that investment in comprehensive hospice services saves money. The Government should not, therefore, use the economic downturn as an excuse to renege on many commitments to eliminate the regional inequity in hospice services.
Healthcare costs are highest at the end of a person's life. Studies show that more than 25 per cent of a person's lifetime health expenditure will be consumed in the last year of life. A 2002 UK study found that, while people in the last year of life comprised only 1 per cent of the population, they accounted for 29 per cent of hospital expenditure.
Spending on patients in the last year of life is estimated at between 10 and 15 per cent of the total healthcare budget in a range of countries. In Ireland this would amount to €1.6-€2 billion of a total health budget of €16 billion.
There is compelling evidence that investment in comprehensive palliative care services across all care settings yields significant savings. In particular such investment reduces lengths of stay in hospital and expensive medical interventions. It also enables patients to spend more time at home.
Many international studies also indicate savings when patients access hospice programmes. They also show improved length of life, symptom control, and patient and carer satisfaction.
In parts of Ireland with comprehensive hospice services, multidisciplinary hospice teams are co-ordinated across different care settings. The vast majority of hospice care patients are supported at home by family members backed by their GP, community nurse, home helps and a palliative care nurse.
Many patients are first referred to palliative care in hospital before being discharged. The unit of care thereafter includes not just the patient but also the family and carers. Multidisciplinary palliative care teams provide not just direct care but also support and expert guidance in symptom control, rehabilitation and emotional, psychological and spiritual support.
Acute episodes can entail crisis medical and therapeutic intervention in the home, day-care, or indeed short stays in hospital or the hospice. Education, guidance and shared care with other specialists, general practitioners, public health nurses and nursing homes improves patient care, reduces inappropriate admissions to hospitals and unnecessary intensive medical procedures.
Most studies, including a recent US Medicare report, illustrate average savings of 25 per cent when patients enter hospice care programmes. In the Barcelona region the use of hospital resources fell 61 per cent following the implementation of a palliative care programme. Length of hospital stays were reduced by 25 per cent and use of emergency hospital rooms was reduced by 42 per cent.
A 2007 study in San Francisco compared a group of patients in palliative care and a group in "usual care". The palliative care group had an average 50 per cent shorter length of stay and daily care costs were lower by 33 per cent. Cost savings also extend to hospitals that offer palliative care. Several studies have reported lower use of acute beds, aggressive therapies and intensive care units by patients in the care of specialist palliative care teams. A 2003 study in Richmond, Virginia, concluded that patients admitted to the hospital's palliative care unit had 57 per cent lower care costs compared to other terminally ill patients. A 2006 study in New York found significant savings in end-of-life care costs for palliative care recipients.
All of these studies showed that patients in the care of palliative care teams lived longer, with greater comfort and dignity. In summary, hospice care saves money at all levels.
In Ireland, the Social Partnership Agreement, Towards 2016, the National Development Plan, the Cancer Control Programme and the programme for government all commit to comprehensive hospice services in all regions.
The HSE has finalised its National Action Plan for Palliative Care Services 2009-2013, which involves almost doubling the HSE's current budget of €75 million annual spending on hospice care. The plan includes commitments to increase the number of hospice beds from 153 to 356 and to build nine new hospices. Additional hospice beds are also planned. There is compelling evidence that this investment will save money.
Increased spending on these services would be more than offset by the savings in the €2 billion we currently spend on caring for the 30,000 people who die in Ireland each year. But we must remember: how we care for the dying is fundamentally an ethical issue. We need to take the right decisions.
• Eugene Murray is chief executive of the Irish Hospice Foundation