Senate raises importance of palliative care in new report

The Senate Community Affairs committee has tabled a report on palliative care with 38 recommendations covering funding, training, workforce, research and end of life planning issues.

Aged care Insite highlighted funding and end-of-life planning: "According to a report released by the Senate, palliative care should be funded under a separate category to other sub-acute services. The committee made 38 recommendations in total including a call for the development of a national framework to support people to make choices about their end of life carers and for activity based funding to deal with complexities of palliative care."Media coverage on the tabling of the report last week included Australian Ageing Agenda highlighting the personal stories behind the policy and strategy: "A host of intense, harrowing stories which detail how Australians are dying in pain, without adequate care, has moved the federal parliament’s upper house to recommend an overhaul of the nation’s palliative care system."

Meanwhile main-stream media reporting included Sky News with this lead: "The federal government should create a separate health funding category for palliative care, a Senate inquiry has recommended."

HammondCare input features strongly

HammondCare featured prominently in the report along with other leading palliative care organisations such as Palliative Care Australia.

In chapter 3 of the report covering funding, HammondCare's General Manager of Residential Care, Angela Raguz, said that while the Productivity Commission's report on aged care had developed a good understanding of relevant issues, it had not necessarily given an answer to workforce problems which particularly affects delivery of palliative care: "...it is about getting it within undergraduate training, looking at training people on the ground in the nursing homes across a broad scale. And it is not just about setting up distinct units, even though that is an ideal. It is about lifting the bar across the whole of aged care, be it in people's homes or in facilities."

In chapter 4 on state palliative care services, HammondCare's submission was quoted at length including: "Sub-acute funding from the NSW Government for inpatient palliative care services has not kept up with demand. Activity targets for sub-acute hospitals have remained unchanged for too long, despite an increase in the number and acuity of palliative care patients as the population ages, and there is no mechanism for adjusting ongoing funding to meet these challenges."

Overcoming workforce stigma

In chapter 6 on professional workforce, Ms Raguz addressed the stigma sometimes associated in working in fields such as aged or palliative care: "It is about how we get those experts to come on board and to move beyond that view: 'Oh, it's aged care—that's a bit daggy. I don't want to spend time in aged care.' For young doctors and nurses it is not the sexiest part of the industry to select."

She also commented on the challenge in finding GPs with palliative care skills: "...we do struggle to get GPs who have the knowledge and the expertise to be able to deal with people at the end of their life well."

Likewise HammondCare's Chief Medical Officer, A/Prof Andrew Cole, who is also Presiding Member of the committee overseeing phase two medical training at UNSW, raised concerns about how little of the curriculum for health professionals is devoted to end-of-life care:

"All of us are most concerned about the very small amounts of clinical teaching time given to healthcare students—medical, nursing and allied health—as they learn about end-of-life care compared with, for example, the time given to learning about the care of infants and children. In my own university [University of New South Wales], the medical students would spend a term in each of first, second and third years learning about beginnings, growth and development and they would spend about a week learning about palliative care and care at the end of life. At Sydney University, they spend about half a day."

Lavender suite highlighted

It was in chapter 7 which addresses models of service delivery that HammondCare's Lavender Palliative Care Suite at Bond House, Hammondville, was of particular interest to the committee.

Retired Palliative Care Physician, Dr Yvonne McMaster, first highlighted Lavender in her written submission to the inquiry noting 10 ways in which it differed to the usual aged care model. Details were also included in HammondCare's written submission and when HammondCare representatives appeared before the committee.

Ms Raguz explained the care imperative behind the establishment of Lavender, which does not attract government funding:

"The facility has two options: either do our best to be kind and caring to a person, which we all know is not enough, or send the person through to the acute system via the accident and emergency department, and we all know that is not ideal either. So what we have tried to develop is a process and expertise level that circumvent that time issue. We have acquired a drug licence for that unit, which means we are able to hold stock within the residential aged care facility of medications that is not the norm.... That meant we could have medication on site. Specialist support and a dedicated GP that has been working with the specialists to make sure the GP is actually aligned with the treatment plans.

"We have known for a long time that the care of older people, particularly in nursing homes, during the dying phase is not done universally well. A lot of aged care providers will say that they do palliative care really well. That really is based on a lot of good people who care but it is not necessarily technically competent. As I said, being an organisation that had the benefit of schedule 3 hospitals, palliative care hospitals, it was an opportunity to say that the purpose of acquiring those hospitals was... 'We want to provide older people with the right care throughout the various stages of their life and we need to make sure we can cross over those areas of expertise."

Ms Raguz explained to the Senate committee the Lavender unit costs an additional $50,000 a bed per year on top of any aged care subsidies received and that despite HammondCare's application for funding being declined, it had decided to "do it anyway" to demonstrate "not just the cost-effectiveness, but the better outcome for the people and their families."

HammondCare is hopeful the report will not only stimulate community discussion but government action towards better resourcing and targeting of palliative care in Australia.