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Palliative Care 2030: Working Towards the Future of Quality Palliative Care for All

Speakers at the launch event for Palliative Care 2030. L-R Rohan Greenland, John Chapuis, Stephen Duckett, Jane Fischer, Nola Marino, Catryna Bilyk, Amanda Walker.

Palliative Care Australia is looking to the future and has articulated what we envisage high quality palliative care should look like in 2030.

This week I was proud to formally release our document Palliative Care 2030: Working Towards the Future of Quality Palliative Care for All at our Parliamentary Friends of Life Group lunch box event at Parliament House on Tuesday 12 February 2019.

So what do we already know about 2030?

  • Australia’s population will be over 30 million.
  • There will be over 200,000 deaths each year, up from the estimated 160,000 deaths this year
  • There will be a greater proportion of people aged 65 years and older.
  • The rates of dementia and deaths from dementia will have increased dramatically.
  • Care will be more complex due to multi-morbidity, people with chronic progressive illnesses with longer disease courses, and diseases with complex symptoms and burdens.
  • Major medical advancements and technological developments will have and this will have significant implications for palliative care.

Of course there will be other changes by 2030; these are just a snapshot some of the headline issues based on current projections. But these changes will have a major impact on palliative care – what our community will expect and what we, as health professionals involved in palliative care, can offer.

The challenge our politicians, policy shapers and health professionals must now face is how to address these changing needs to ensure a sustainable future for palliative care across the country.
As a priority, legislation should be introduced to strengthen every Australian’s right to palliative care – including provisions regarding a right to information, carer support such as adequate leave entitlements, and flexible and responses care and location of care options.

We know that there is inequitable access to palliative care across Australia and with the introduction of voluntary assisted dying in some Australian jurisdictions, we want to ensure that an individual choice to request voluntary assisted dying is not a choice based on a lack of access to palliative care. Enshrining the human right to palliative care as recognised by the World Health Organisation in our health system will go a long way to ensuring that people have a real choice.

By 2030 we expect that the individual receiving palliative care and their family are actively engaged in treatment decisions and are able to move seamlessly through services regardless of where the funding for that service comes from or the location of care options.

Achieving this will require action across a number of areas.

Palliative care as a national health priority

Palliative care should be a national health priority. Following the release of the National Palliative Care Strategy in the coming months we need a whole of government approach to robust population and needs-based planning and adequate funding of palliative care and specialist palliative care services. This will need to be underpinned by the National Health Reform Agreements and the National Palliative Care Strategy Implementation Plan.

By 2030 when an individual requires palliative care, this need will be assessed in a timely manner, and funded seamlessly through jurisdictional services and within systems such as My Aged Care and the National Disability Insurance Scheme.

Benchmarks for specialist palliative care workforce

By 2030, we hope to see a workforce strategy implemented, with benchmarks of two full-time equivalent specialist palliative medicine physicians and three full-time equivalent palliative care nurse practitioners per 100,000 population reached. To achieve this, PCA want the government to provide investment in the specialist palliative care workforce, which needs to include support for career pathways as well as modelling of future demand.

Further we expect to see all health and aged care professionals across primary care, community care, aged care and disability to have an understanding of palliative care. To achieve this by 2030, PCA is calling for palliative care units to be incorporated into all Australian undergraduate degrees in medicine, nursing and pharmacy and included in all relevant aged and community care certificate level qualifications.

Community awareness and mobilisation

By 2030, we will all be death literate! We expect people to be talking openly about death and dying, just like they do now about organ donation and having a will. There will be widespread and appropriate advanced care planning and development of Advance Care Directives. These documents will be embedded within interoperable systems such as My Health Record, eHealth solutions and patient records so that all relevant healthcare professionals and nominated people are able to access them as needed, especially in emergency situations.
Further, the population will know what palliative care is and what it can offer an individual and their support network. PCA is calling for funding to support a palliative care community engagement campaign – this is necessary at a time when there is confusion regarding what palliative care can provide, and when specialist palliative care can be accessed along a person’s illness trajectory.

Great funding flexibility

The provision of palliative care does not fit well within the current MBS items and PCA expects there to be a review well before 2030. As an example, palliative care specialists are unable to access the same MBS items for inpatient case conferencing and family meetings as rehabilitation specialists and gerontologists. We also need changes to enable GPs and nurse practitioners to facilitate family meetings, advance care planning discussions and support home visits, after-hours support and the needs of residents in aged care facilities.

On the journey to 2030, PCA wants private health insurance providers to have mandated specialist palliative care in all levels of coverage, and have introduced a range of innovative models of care to support individuals and their family and carer.
More flexible funding models are essential for the seamless patient journey we are aiming towards.

National Grief Awareness Day

By 2030, PCA would like to see a greater understanding and awareness about the impact of grief and bereavement and well accepted processes for all providers of palliative and end of life care to assess where family members and carers sit along a continuum of need for bereavement support and refer if required. PCA is calling for the establishment of a National Grief Awareness Day to provide an opportunity to raise awareness of the impact that death and loss can have on individual, families and the broader community.

Safe access to appropriate medicines

And lastly but by no means less important, by 2030 we expect that individuals and their carers are able to access appropriate medicines as and when required within a quality use of medicines safety and regulatory framework, but without the red tape and systems issues we have now. This will require a review of the PBS and appropriately funded models to support community pharmacy, general practice and other practitioners to safely provide opioids and other medicines including off-label indications.

In conclusion, there is much to be done!

Palliative Care 2030 sets out a platform for the discussions we need to have –we need collaboration, commitment and innovation if we are to meet the palliative care needs of our community in the future.

Underpinning all of this is the assumption of ongoing commitment by governments to appropriately invest in, and plan for the delivery of palliative care, in co-design with specialist palliative care and the broader health and aged care sectors.

Australia has the capacity to be the world leader in the provision of high quality palliative care for all. I have every confidence that with the support of our parliamentary friends and health care colleagues we can meet the nation’s palliative care needs by 2030.

The full copy of Palliative Care 2030: Working Towards the Future of Quality Palliative Care for All is available here to read and share.


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