More palliative care services needed for rural and regional Australia

Leading palliative care specialist, Professor Rod MacLeod, has called for more palliative care funding and equitable access to palliative care services in rural and regional areas, on the eve of his departure from Australia.

“Until adequate palliative care services are provided throughout Australia, it makes no sense to talk about the need for euthanasia or Physician Assisted Suicide (PAS),” he said.

Prof MacLeod, who has around 30 years' experience working in palliative care medicine in Britain, New Zealand and Australia, is returning to his homeland of New Zealand. Speaking before he left, Prof MacLeod said there would be less focus and less call for euthanasia in Australia, if people understood what good palliative care can do.

“Palliative care is about supporting the living – its aim is to improve the quality of life for the person who is dying. Good palliative care attends to the psychological, spiritual and physical needs of the person and their family.

“It is about living well – not waiting to be dead. In palliative care, we try to rekindle hope. People often first come to us feeling hopeless – but everybody can have something to hope for.”

Prof MacLeod said specialist palliative care services in many rural and regional areas of Australia were inadequate and the provision of around the clock services was limited despite many people trying hard to get improvements funded.

“Where you live should not determine the quality of palliative care you receive when you die. But many rural areas throughout Australia rely on GPs and community nurses for after-hours care, many of whom are not appropriately trained in the provision of palliative care.”

He said Australia could do better in the provision of palliative care for indigenous people and that services needed to adapt to cater to people of different faiths and cultures.

“New Zealand does this better than Australia – and we can learn from them.”

Prof MacLeod said Australia also fell behind when compared to many international countries on having the choice to die at home.

“Australian home deaths occur at less than half the rate of countries like Ireland, France, the USA and New Zealand, yet many Australians would prefer to die at home if they could.”

He said the Palliative Care Home Support Program (PCHSP), that has run since late 2013, has delivered some tremendous results helping more than 1991 people and teaching over 750 care workers about palliative care throughout NSW.

“I am truly proud of the work that we have done in growing palliative care over the past five years. But there is more to do.”

And his advice to someone who has a relative or close friend dying: “Try not to be afraid – sit down and give them time."

Recommendations for better palliative care services nationally

1) Provide education in palliative care training for all relevant health professionals.

“There should be more education in palliative care for all relevant health professionals, and palliative care training modules should be included in all relevant university courses. Ensuring proper training about palliative care among health professionals makes for a far better experience in palliative care.”

2) Promote the uptake of advance care planning across all sectors (primary, acute and aged care) and address any barriers to its uptake.

“It is essential to promote the uptake of advance care planning across the health system so that people can give this important time of their lives due consideration. Writing a will, planning for how and where you want to die – these are all issues that require thought, time and courage.”

3) Develop and implement a national public awareness campaign, funded by the Federal Government, encouraging people to talk about how they would like to die.

“A national conversation on how we want to die needs to happen to help us make better informed choices about the end of life. The Federal Government should fund a public awareness campaign encouraging people to talk about how they would like to die, which would also lead to a better national dialogue around issues of euthanasia and physician-assisted suicide (PAS).”

4) Ensure there is sufficient funding and resources to support palliative care initiatives and programs.

“Funding for palliative care programs and integration of existing services is crucial – so all Australians have access to the same services. A good example is the NSW PCHSP program which provides assistance for people wanting to die at home – this should be made available in all States and Territories.”

Professor Roderick MacLeod, is a Senior Staff Specialist in Palliative Care with HammondCare and Conjoint Professor in Palliative Care Medicine at The University of Sydney. Prof MacLeod will remain as a consultant with HammondCare.

HammondCare provides palliative care services in the community, hospitals, aged care homes and through the home support program. It also provides and education and training on palliative care and hosts an online educational resource:

Last financial year, HammondCare supported 2,600 people through its palliative care services.