Question: Are New Zealand’s palliative care services equipped to cope with rising demand?
Written by Dr. Tom Varghese
New Zealand’s population is ageing and an increasing number of people are living longer. In the health sector, our system needs to change to meet the growing demand for palliative care, which is projected to increase by 51% over the next 22 years. It is projected that the number of older people 75+ years needing palliative care will almost double by 2038, from an estimated 1,632 in 2016 to 3,069 in 2038.
Some hospitals have specialist palliative care services, others don’t. Many communities have hospices, others don’t. In many ways, there's no clear model for how palliative care is or should be delivered. There's also no clear model of how it is funded. NZ’s 32 hospices look after about 20,000 patients and their whānau a year, or about 30% of dying Kiwis. But of their 2021 running costs of about $176 million, only $88 million came from the government.
Palliative care is care for people of all ages with a life-limiting or life-threatening condition, which aims to optimise an individual’s quality of life until death and support the individual’s family, whānau and other caregivers. High-quality palliative care is people-centred and responsive, offering clinical, physical, psychosocial, spiritual and cultural aspects of care and support. Open communication and a clear patient pathway for this journey as it progresses are other characteristics of a high-quality experience.
In 2013 almost one-third of deaths across New Zealand occurred in public hospitals, one-third in aged residential care facilities, 23% in private homes and just under 7% in hospice inpatient units. The hospice service extends well beyond inpatient beds. In the year to June 2015, 74% of people using hospice services had no admissions to an inpatient facility and 69% of people who died supported by hospice, did so in the community.
There are barriers to integration however. These include uneven distribution of palliative medicine specialists, meaning there are shortages in some rural areas,, differences in funding and reporting arrangements between providers, IT barriers and inconsistent criteria for referral from primary care, all of which can lead to variability of access.
The future way of working will facilitate a coherent and seamless patient journey through the palliative care system. There will be improved collaboration and sharing of knowledge, expertise and resources across the system to create opportunities for operational efficiency and collective wisdom. A future model will ensure that a palliative approach is made available to palliative care patients and their whānau from the time it is first identified end of life is approaching.
Evidence in New Zealand shows that what matters to people at the end of life is being accompanied by significant others, friends and family, control of symptoms especially pain, and not being a strain on family and whānau members.