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Palliative Care Australia calls for more funds, cites huge savings potential

A new report has called for a yearly additional investment of $365 million for palliative care to “bring the system up to speed” and address significant “service gaps, meet future significant demand and reduce avoidable costs”.

The report, which was commissioned by Palliative Care Australia (PCA) and prepared by KPMG, states that the investment would yield savings of $464 million a year to the healthcare system.

Dr Chris Schilling, KPMG health economist and report author, said his team looked at the way palliative care is currently set up across three areas – home and community, aged care and hospitals – and found that using multidisciplinary palliative care teams that included GP or palliative care specialists could help people to be more comfortable in their own homes and to live well and stay in their homes longer in their later years, as well as save on costly, avoidable hospitalisation.

KPMG estimates that the cost of death in Australia is $7.8 billion each year, with approximately $4 billion of that in hospital costs.

The report recommends that $240 million be invested to increase funding and access to home and community palliative care, and $50 million to increase palliative care services in hospitals.

They also recommend a $75 million investment in specialist palliative care and support across residential aged care.

The KPMG team set up a trial across 12 care homes, which placed a palliative care nurse practitioner in the home, and found that this reduced hospitalisation days by 12 days per month per facility.

“I knew what palliative care was, but I hadn’t researched it in detail. And when I went to the literature and consulted with Palliative Care Australia and our steering group, and just heard firsthand of what palliative care can do for people with a life-limiting condition, it really was an eye opener to me,” Schilling said.

“The other thing that really surprised me the most was that we weren’t providing, as a society, the level of funding for palliative care, particularly in aged care settings.

“The way that it’s funded under the current system, under the ACFI funding arrangement, was really only providing palliative care in literally the last day or two of life.”

This week, the aged care minister Richard Colbeck spruiked $57.2 million in palliative care funding – already announced in previous years’ budgets – “to help reduce physical and emotional distress for individuals and their families”.

PCA’s chief executive Rohan Greenland said that any funding is welcome, but stressed that more needs to be done to keep up with an ageing population.

“There are gaps in the existing approach, and with an ageing and growing population, unless we address those gaps now, we will have no chance of meeting the future demand for palliative care services,” he told Aged Care Insite.

“As the population ages and grows, and people are living longer with more complex and chronic conditions, the demand for and the need for palliative care is going to go through the roof. So we’ve got to get our house in order now. And if you overlay a COVID-19 pandemic on top of that, it’s really important.

“One of the lessons about being well prepared for health emergencies and pandemics is that if you manage your palliative care needs well, you will help keep pressure off the front end of hospitals in a way that will ensure that you not only meet the needs of people who have life limiting conditions and their families and carers but you also make sure that you’ve got the capacity in your health system to meet emergency situations.”

Greenland and PCA are also calling for a national agreement on palliative care between the Commonwealth and the states and territories, and a new full-time palliative care commissioner to advocate on the behalf of patients.

“It’s just a way of oiling the wheels to make sure things happen,” he said of a commissioner position.

“And to really help connect up systems and to break down silos, if you like, and to improve collaboration and make sure people are on track to meet agreed benchmarks and targets,” Greenland said.

“And oil the wheels of government in particular, particularly the difficulties we often experience with a federated structure so that we can get to better coordination across jurisdictions to achieving agreed priorities and targets.”

Greenland argues that Australia is successful when administering palliative care but now needs the funding to give access to those who miss out.

“When I first arrived at Palliative Care, one of the people I spoke to was Professor Stephen Duckett from the Grattan Institute. And he made the point saying, “The greatest challenge confronting palliative care is actually a failure of policy, more specifically funding policy. And he really, I think, hit the nail on the head,” he said.

“We have very good outcomes data in Australia through the work of the Palliative Care Outcomes Collaboration at the University of Wollongong; we know that when people get access to palliative care, they tend to get very good outcomes and we’ve got consistent data over many years that demonstrates that.

“It’s the problem of access. And if we invest in services to make sure those services are available to people when and where they need it, it means that they will get better quality of care, and palliative care is all about quality of life through providing holistic care approaches. And we can achieve that. And particularly for those who are missing out on that care now, that’s the key thing. I think the report is really important for governments because it actually shows that when they invest in palliative care, it’s not just cost effective, it’s actually cost saving. And the report makes that incredibly clear.”

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