Today the
NSW Parliament will debate Palliative Care provision in response to a petition
that, at the time of writing, had collected more than 58,000 signatures across
the state. Not quick clicks on an
advocacy website but real signatures from concerned citizens. The Minister for Health is expected to
respond positively and speak to the newly released NSW Government plan to increase access to palliative care 2012-2016
and also point to the extra
$35million that has been promised over four years. On the face of it, this must be evidence of a
government listening to its people and responding. Surely the Palliative Care Community will be
pleased with this.
The exact use of this “new” money is yet to be seen, with
the closing date for proposals being early January. However, the language around this funding has
centred on filling gaps in community palliative care provision, and especially
initiatives that will support home deaths.
Like several other Health initiatives of recent years, hospital
avoidance is a key theme. Again, this
cannot be lightly dismissed as there are certainly inadequate resources
committed to this purpose and the community will rightly applaud such an
initiative.
Of course,
this sets up problems for clinicians, peak bodies and advocates who may wish to
discuss uncertainties and even deficiencies in the government’s response, for
here is a health minister who is more engaged with this issue than many of her
predecessors. Yet, at the risk of
seeming ungrateful, words of caution and uncertainty must be spoken for there
is a deep concern that the Government’s response is at best incomplete, and at
worst a risk to Palliative Care itself.
NSW Specialist
Palliative Care services have been historically underfunded . Specialist clinician numbers are well below
national averages, and Specialist Palliative Medicine physicians are very rare
outside of the Newcastle to Wollongong corridor. The Australian Institute of Health andWelfare reports that NSW has the lowest ratio of specialist palliative
care physicians per 100,000 population of the mainland states and has reduced the
number of hospice (palliative) care unit in public acute hospitals from 47 in
2008/9 to 40 in 2009/10. NSW has a lower
ratio of palliative care nurses per 100,000 population than many other jurisdictions. These figures indicate that in 2009/10 NSW
would have needed an additional 22 FTE palliative care physicians and more than
200 additional palliative care nurses to be on an average national playing
field , and that is before the particular demographic and health
infrastructural challenges in NSW are considered. The demand for Specialist Palliative Care
input for persons with non-cancer end stage conditions is estimated to be up to 40% of all referrals, yet the cancer based funding model for Palliative Care
services has not been amended to enable this to be addressed. A consequence of “advances” in treatment
options for cancer and other conditions has also seen an increase the
complexity of end of life symptom management for many, and again, palliative
care funding models have not adequately responded to this.
In addition to this, more than 40 palliative care positions
are scheduled to be lost across the state on July 1st 2013 when one
particular stream of sub-acute funding under the National Partnerships
Agreement between the Commonwealth and NSW runs out. The NSW Ministry for Heath has made clear
that the new “$35 million” will not be used to address this gap. Further, new Cancer / Radiotherapy centres
are opening up in regional NSW and there are reports of Treasury declining to
fund additional Palliative Care staff to provide service within and to these
Commonwealth / State funded initiatives.
It is against this past and present reality that this
petition has been achieved, and the concern for many is that the government is
overplaying the death at home factor, while not addressing the role Specialist
Palliative Care also plays across the NSW public hospital system (where more
than 55% of NSW citizens currently die) nor addressing the funding shortfalls
for those services in relation to the work they already seek to do in community
settings.
By not showing how these needs will be met the government
runs the risk of short circuiting its own initiative, as it is a requirement
that these new community proposals will have formal links with Specialist
Palliative Care Services, the very services that are struggling to meet
existing demand and to provide a just level of equitable access to their care,
support and expertise. To attempt to
leverage off a crumbling fulcrum is to risk clinical harm and/or service
collapse.
So, while the Palliative Care community cautiously welcomes
the intent of this new funding as it waits to see the reality of it, we must
also ask when the existing Palliative Care Services and clinicians will be
resourced to address the unmet and upward demand that the petitioners have responded
to.
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