Will this report improve palliative care? Does it mean we’re about to get some big changes that’ll have an impact on everyone? The Productivity Commission’s Reforms to Human Services Inquiry Report went to the Government in October 2017.
It looked at palliative care in Australia, which needs urgent attention.
Seventy per cent of us want to die at home
Back in 2000, a South Australian study of cancer patients showed 70% wanted to die at home. That figure has been quoted endlessly in Australia ever since. It’s remarkably similar to the rate the whole way around the world.
But in Australia the productivity commissioners state the bleedingly obvious, all these years later.
“Few of those who would prefer to die at home are able to do so,” it says.
We’ve made little progress on this, even though many other western countries have.
How involved should general practitioners be?
Australian Institute of Health and Welfare stats were published in October 2017. Under the heading “Palliative care services in Australia” they show only 1 in 1000 “GP encounters” were for palliative care. This ratio has been the same for years.
So an extremely valuable resource, a general practitioner who knows the patient, is not being utilised. Is this because palliative care is managed so well in our community that general practitioners just aren’t needed?
I don’ think so. But I look forward to researching the answers and maybe one of my readers can tell me.
I won’t find the answers in the AIHW stats, which are accompanied by the blithe comment: “(GPs) play an important role in palliative care as well as the health-care system more broadly. However, there is no nationally consistent, routinely collected primary healthcare data collection that enables reporting on the provision of palliative care by GPs.”
How can a government that doesn’t measure a service as crucial as general practitioner visits to the dying know what it has or hasn’t got?
Is hospital the best place for most people to die?
The productivity commission’s report goes on to say: “Available evidence indicates that the savings from avoiding a single hospital admission for palliative care, costing about $11,000, would more than cover the cost of providing community-based care over a period of months.”
The commission says in order to achieve improvements, state and territory governments need to: “substantially increase the availability of community-based palliative care, and to fund that increase” since theirs is the level of government that has the money to do it and the power to channel funds in that direction.
What about nursing homes?
The report raises serious questions about palliative care in nursing homes.
“Four out of five residents of aged care facilities die in them but the lack of palliative care expertise and qualified staff to administer pain relief mean residents often make traumatic (and costly) trips to hospital to receive medical care that could have been provided in surroundings that are familiar to them,” it says.
This wouldn’t surprise anyone who has felt the impact of this personally, or watched the impacts on someone they love who is dying. This problem isn’t caused by – but is exacerbated by – recent federal and state changes.
In recent years the Commonwealth merged the categories of high and low care facilities into one blurry bundle, making targeting resources harder to do. And in 2014 the NSW government relaxed the requirement for a registered nurse to be on duty in residential aged care facilities at night.
The way the situation stands now, nurses report there is often one worker only on duty at night, who could be looking after up to 50 patients. This person doesn’t need to be qualified to administer scheduled drugs such as morphine. So this means patients who need pain relief in the middle of the night when they are dying, are sent off to the emergency departments of hospitals – the worst time this could be done to them.
And then we need action
The productivity commission report says: “A good first step would be for the Australian Government to ensure that all of its aged care publications — both for consumers and for policy makers — explicitly acknowledge that one of the core roles of residential aged care is to provide end-of-life care.”
And then we need the second step: to put this into action.
And then the third step: to monitor it, to keep people safe.
For further reading
To read the productivity commission’s October 2017 report, go to:
For an overview of palliative care services in Australia, (including the 1-1000 ratio of GP palliative care encounters), go to:
To follow nurses actions on 24/7 rostering, go to:
To read the last posting in Good Grief!, go to: