One of the greatest challenges for palliative care in aged care is the varying responsibilities across the Australian and state and territory governments. The level of palliative care funding and support varies across states and territories, with no clear national picture of what services are available. This can result in silos and system issues that impact aged care recipients and their ability to receive the palliative care services they need in aged care. It can also affect the transition between the primary health, hospital and aged care sectors and have a significant impact on emergencies. The independent review into the Newmarch House COVID-19 outbreak found that the emergency response was characterised by a lack of clarity in relationships and hierarchy among government agencies[1].

A priority for all governments

Making palliative care a priority for all governments will ensure greater oversight, national consistency and better relationships between the health care and aged care sectors. This could be further enhanced with the appointment of a National Palliative Care Commissioner to engage with the palliative sector and facilitating improved communication across jurisdictions by encouraging consistent approaches across all settings, including primary health, community health, tertiary health, aged care and disability.

Currently, there are several National Commissioner roles that the Palliative Care Commissioner could be modelled on including National Rural Health Commissioner, National Data Commissioner, National Threatened Species Commissioner and National Skills Commissioner.

It is not intended that the Palliative Care Commissioner would be a fund holding body or provide services; get involved in individual cases or advocate for individual people; or undertake dispute resolution, handle complaints or undertake investigations.

Improving the interactions between governments

On 22 October 2020, the Royal Commission into Aged Care Quality and Safety’s Counsel Assisting presented 124 proposed recommendations to the Commissioners. PCA welcomes these recommendations to improve the aged care system, including the following recommendations relating to government priorities and interactions between governments:

• Recommendation 77: Ongoing consideration by the Health National Cabinet Reform Committee: this proposes that the Committee require the Australian Health Ministers’ Advisory Council to:
  • Consider the full suite of the Royal Commission’s recommendations related to the interface of the health care and aged care systems and report back to the Committee; and
  • Include a standing item in all future meetings of the Council on the aged care system and its interface with the health care system.
• Recommendation 75: Clarification of roles and responsibilities for delivery of health care to people receiving care: this proposes that the National Health Reform Agreement be amended to include an explicit statement on the respective roles and responsibilities of aged care providers and State and Territory health care providers.

An aged care commissioner

Additionally, Recommendation 3 proposes the establishment of an Australian Aged Care Commission overseen by an Aged Care Commissioner, supported by at least five Assistant Commissioners with dedicated portfolios. PCA believes that palliative care and aged care policy can be further reinforced by the appointment of a Palliative Care Commissioner as one of the Assistant Commissioner. Portfolio responsibilities would include:

• receiving from the Commonwealth and each jurisdiction an annual update of actions taken under the National Palliative Care Strategy Implementation Plan to assess and report on progress made on the goals and priorities of the Strategy by the Commonwealth and the jurisdictions;
• identifying systemic shortfalls in the provision of palliative care in Australia and recommend options for change; and
• other functions as conferred.

[1] Professor Lyn Gilbert & Adjunct Professor Alan Lilly (20 August 2020).  Newmarch House COVID-19 Outbreak Independent Review – Final Report.  Commissioner by the Department of Health.

Link to the media release