A Snapshot of Palliative Care Services in Australia
The current debate on voluntary assisted dying (VAD) naturally prompts a discussion of the current state of palliative care in Australia, which should be an important aspect of consideration in the debate on VAD. Just as with healthcare as a whole, ensuring that the social justice principles of access and equity underly the provision of palliative care is essential. This means that palliative care should not only be available to everyone who needs it, but also available to members of society who are more disadvantaged than others.
The PM Glynn Institute has produced a new report on palliative care services in Australia. The report explores some key trends and gaps in palliative care service provision, and makes a number of recommendations to address them.
In conjunction with the release of the report, a series of podcasts have been published exploring different insights and perspectives from palliative care experts:
- Dr Richard Chye, Palliative Medicine Specialist, St. Vincent's Hospital, Sydney
- Dr Maria Cigolini, Head of Department, Palliative Medicine, Royal Prince Alfred Hospital, Sydney
- Dr Anthony Herbert, Director, Paediatric Palliative Care Service, Children's Health Queensland Hospital
- Prof. Bernadette Tobin, Director, Plunkett Centre for Ethics, St Vincent’s Hospital, Sydney and Reader in Philosophy, Australian Catholic University
- Dr Cris Abbu, the PM Glynn Institute's Policy and Project Manager and author of the report, discusses some of the key findings in the report.
The report’s findings
The report’s recommendations, drawing on an analysis of the published data from agencies such as Palliative Care Australia, the Department of Health and Ageing, and the Australian Institute of Health and Welfare, include:
- An increasing rate of palliative care hospitalisation, growing at an average rate of 5% each year since 2003. Significantly, the burden of this increase has been borne by the public health system, with 86% of all palliative care hospitalisations in 2017-18 occurring in public hospitals. Given an ageing population and an increase in the incidence of chronic illnesses, both of which imply increasing need for palliative care services, the burden on public hospitals is also likely to increase in the future.
- Increasing palliative care hospitalisations for children and young adults, with double-digit rates of annual increase in hospitalisations since 2011-12 for those under 15 years old. This highlights the increasing importance of paediatric palliative care, which is often overlooked because the number of hospitalisations is small in comparison to older cohorts.
- A low uptake of palliative care training by physicians and nurses. Despite an ageing population and increasing palliative care hospitalisations, rates of full-time equivalent (FTE) palliative medicine physicians and palliative care nurses have remained unchanged since 2013 (at 0.9 and 12.1 per 100,000 population respectively). Palliative care remains one of the least preferred specialisations of medical students for future practice.
The report’s recommendations
In response to these findings the report makes several policy recommendations, including:
- Develop integrated models of palliative care service provision to reduce the burden on hospitals, using community-based care to support people in their homes and in aged care, as well as people in boarding houses and the homeless. This requires strengthening the knowledge and role of GPs in palliative care provision, and making Advanced Care Planning for future treatment a basic part of clinical care.
- Develop a national policy framework or strategy for paediatric palliative care, similar to existing frameworks and strategies for general palliative care. Despite the comparatively small numbers involved, double-digit annual increases in hospitalisations and the unique characteristics of paediatric palliative care — which can be for a very short period or for many years until adulthood — warrant a dedicated policy focus in this area.
- Actively encourage increased uptake of palliative care training among physicians and nurses. Palliative Care Australia recommends 2.0 FTE palliative care physicians per 100,000 people. A range of options including government subsidies for training, university scholarships for students, and larger numbers of fellowships for graduates should be considered to meet this benchmark, and to encourage specialisation in palliative care nursing. It is also important to significantly increase the skills of aged care staff in palliative care.
Better palliative care as common ground
Ensuring that everyone can access high-quality and effective palliative care when it is needed should be common ground on all sides of the debate over VAD. The report is intended as a resource for discussing how this might be achieved.
Download A Snapshot of Palliative Care Service in Australia here (PDF, 3.4MB)