Palliative
Care:
A
Policy
Perspective
CHA PowerPoint Template:
A
whirlwind
tour
A template for use by CHA Caroline Chisholm Centre for Health Ethics
3rd October 2013
www.cha.org.au
Palliative Care –A Policy Perspective
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What is meant by policy?
History of palliative care in Australia
Role of Commonwealth & jurisdictions
Current issues:
– Senate inquiry into Palliative care
– Regional Cancer Centres
– Specialist palliative care and advance care planning
advisory services
– Advance care planning
– Private Health insurance and palliative care
• Emerging issues
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Catholic Health Australia
• Catholic Health Australia is the largest nongovernment provider grouping of health,
community and aged care services in
Australia, nationally representing Catholic
health care sponsors, systems, facilities and
related organisations and services.
• Established to promote and strengthen the
organised expression of the Catholic health
ministry
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Director of Strategic Policy
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What is policy?
• Policy world is the theory and practice of
politics and government
• Public policy – how issues and problems come
to be defined and constructed and how they
are placed on the political and policy agendas.
• Studying public policy tells us how and why
and to what effect government pursue
particular courses of action AND inaction
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Public Policy
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History of Palliative Care in Australia
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History of palliative care in Australia
• Over past twenty years in Australia Palliative
care has moved from informal networks that
were sporadically funded to fully funded and
recognised.
• In this time there has been increase in terms
of knowledge, improvements in symptom
control, understanding the physical,
emotional and social journeys of dying people
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History of palliative care in Australia
• In UK by the 1980s, there were 100 new
hospices came into being during that decade most of these were in the voluntary and
charitable sector.
• In Australia in 1988 Professor Ian Maddocks
was made the Foundation Professor of
Palliative Care at Flinders University, the first
such post in the world.
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History of palliative care in Australia
www.cha.org.au
New government
• New government
• New ministers
• Sport will move to the
Department of Health
• New department will
be known as ‘Health’.
• Responsibility for
Ageing will move to
the new Department
of Social Services
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Commonwealth through the
National Palliative Care Program:
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• Through use of funding
What palliative care
• Through agreements
is
with states and
Who receives it
territories
Where services are
• Through consideration of
provided
issues by the Palliative
Who provides it
Care Intergovernmental
Forum
• Input from stakeholders
www.cha.org.au
National Palliative Care Strategy
• The National Palliative Care Strategy 2010 –
Supporting Australians to Live Well at the End
of Life (the Strategy) represents the combined
commitments of the Australian, state and
territory governments, palliative care service
providers and community-based
organisations.
• It guides the development and
implementation of palliative care policies,
strategies and services
across Australia.
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National Palliative Care Strategy
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Palliative Care Intergovernmental
Forum
• Have developed four nationally agreed
performance indicators
• These high-level performance indicators were
agreed by the Palliative Care
Intergovernmental Forum (PCIF) in 2003 and
are designed to assist in the evaluation of
progress against the objectives of the National
Palliative Care Strategy, in relation to the
planning and delivery of palliative care
services.
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Palliative Care Data Working Group
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National Palliative Care Program sources of funding
• Palliative Care in the Community – to
improve the standard of palliative care in the
community;
• Palliative Care National - $14 million over
four years; and
• Strengthening Palliative Care Services (Local
Palliative Care Grants) –to help healthrelated services provide better support to
people needing palliative care, and their
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families.
National Palliative Care Program sources of funding
• In addition, the Australian Government
provided $500 million to States and Territories
for the enhancement of sub-acute care
services (including palliative care) under the
Council of Australian Governments (COAG)
significant National Partnership Agreement on
Hospital and Health Workforce Reform – this
expired June 2013.
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National Palliative Care Program
• Offers support in four broad areas:
– support for patients, families and carers in the
community;
– increased access to palliative care medicines in
the community;
– education, training and support for the
workforce; and
– research and quality improvement for palliative
care services.
www.cha.org.au
1. Support for patients, families and carers
in the community
– grants to local groups, health and aged care providers
and church and charitable organisations to support
patients and their families receiving palliative care.
Eg: Local Palliative Care Grants Program , Rural Palliative
Care Project , Respite care, Carer information brochures ,
Community Attitudes Towards Palliative Care,
Bereavement - literature review on complicated grief ,
Paediatric Palliative Care
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2. Increased access to palliative care
medicines in the community
• the Palliative Care Clinical Studies
Collaborative (PACCSC) manages multi-site
clinical drug trials in order to gather the
scientific evidence required to register
palliative care medicines on the Australian
Register of Therapeutic Goods and possible
listings on the PBS.
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3. Education, training and support
for the workforce
– Program of Experience in the Palliative
Approach (PEPA)– a work placement training program for health
professionals in a specialist palliative care service
of their choice
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4. Research and quality improvement for
palliative care services
Australian Palliative Care Outcomes
Collaboration (PCOC)
– supports services to consistently compare and measure
the quality of their outcomes, and through this ensure
continued quality improvement.
• The consortium is divided into the following four zones:
– Centre for Health Service Development, University of Wollongong (PCOC
Central)
– Institute of Health and Biomedical Innovation, Queensland University of
Technology (PCOC North)
– Western Australian Centre for Cancer and Palliative Care, Curtin University of
Technology (PCOC West)
– Department of Palliative and Supportive Services, Flinders University (PCOC
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South)
4. Research and quality improvement for
palliative care services
• PCOC provides a national network for palliative care services
to assist with the collection of information and reporting
outcomes. PCOC supports services to consistently compare
and measure the quality of their output in order to facilitate a
process of continuous service improvement. This is achieved
through:
– education, training and support to services in the use of
data to improve service quality, including information
technology training, establishment or modification;
– collaborating with participating services on analysis and
data, including the development of data subsets that will
be the basis of benchmarking; and
– a program of continuous
improvement.
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4. Research and quality improvement for
palliative care services
Palliative Care National Standards Assessment
Program
The NSAP enables specialist palliative care services to
undertake consistent self-assessment against the
national Standards for providing quality palliative care
for all Australians.
The standards are aimed at enhancing workforce skills,
improving coordination across the continuum of care
and developing and implementing best practice.
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4. Research and quality improvement for
palliative care services
• The Palliative Care Research Program, managed
by the NHMRC, aims to improve the quality of palliative care,
inform policy development, improve clinical practice and
develop researcher capacity, by funding priority driven
research grants, training awards and research development
grants.
• The Palliative Care Knowledge Network
(CareSearch) is a web-based one stop shop of
information and practical resources for clinicians, other
health care professionals providing palliative care,
researchers, patients and carers.
www.cha.org.au
4. Research and quality improvement for
palliative care services
Australian Institute of Health and Welfare
(AIHW)
• involved AIHW has also released its report into the
development and trial of community-based client
data collection, to ensure the use of nationally
agreed definitions and mechanisms in collecting and
measuring palliative care information.
www.cha.org.au
National Performance indicators
1. The proportion of administrative health
regions that have a written plan for palliative
care which incorporates palliative care
elements.
2. The proportion of palliative care agencies,
within their setting of care, that routinely
undertake or undergo formal assessment
against the Palliative Care Australia
Standards.
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National Performance Indicators
3. The proportion of palliative care agencies,
within their setting of care, that actively collect
feedback from clients and staff (within the
workforce) relating to services and service
delivery.
4. The proportion of palliative care agencies,
within their setting of care, that have formal
working partnerships with other service
provider(s) or organisation(s).
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Performance indicators -results
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Role of Commonwealth &
jurisdictions
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Senate Inquiry into Palliative Care in
Australia
Reported 10th October 2012. TOR:
• the factors influencing access to and choice of appropriate palliative care
that meets the needs of the population,
• the funding arrangements for palliative care provision, including the
manner in which sub-acute funding is provided and spent;
• the efficient use of palliative, health and aged care resources;
• the effectiveness of a range of palliative care arrangements, including
hospital care, residential or community care and aged care facilities;
• the composition of the palliative care workforce;
• the adequacy of standards that apply to the provision of palliative care
and the application of the Standards for Providing
• advance care planning;
• the availability and funding of research, information and data about
palliative care needs in Australia.
www.cha.org.au
Senate Inquiry into Palliative Care in
Australia
• 38 recommendations
• Normal time frame for government response
3 – 6 months
• Commonwealth currently re-writing their
response for the new government, few
months away.
• Commonwealth has been challenged in
writing a response to such a sizeable report
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Regional Cancer Centres
• Australia-wide network of 26 regional cancer centres
and associated accommodation facilities
• $556 million was committed in the 2009-10 Budget
to establish a network of best practice regional
cancer centres and associated accommodation
facilities
• The aim of the Regional Cancer Centres initiative is
to help improve access and support for cancer
patients in rural, regional and remote Australia, and
to help close the gap in cancer outcomes between
the city and the country.
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Regional Cancer Centres
• Has not been an absolute requirement that
these cancer centres have palliative care
embedded as an approach.
• It is an option for consideration
• Need to individually check and advocate
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Specialist palliative care and advance care
planning advisory services
As part of the Living Longer Living Better aged
care reform package, the Government has
invested $19.8 million over five years from
2012-13 to establish specialist palliative care
and advance care planning advisory services for
aged care providers and GPs caring for clients of
aged care services.
www.cha.org.au
Specialist palliative care and advance
care planning advisory services
Aligns with the National Palliative Care Strategy
through the following goals:
• Goal 2 – to enhance community and professional
awareness of the scope of, and benefits of timely
and appropriate access to, palliative care services.
• Goal 3 – appropriate and effective palliative care is
available to all Australians based on need.
• Goal 5 – to build and enhance the capacity of all
relevant sectors in health and human services to
provide quality palliative care.
www.cha.org.au
Specialist palliative care and advance
care planning advisory services
• Also announced at the same time was
investment of $1.9 million over five years to
expand the existing Program of Experience in
the Palliative Approach to provide palliative
care training for staff in residential aged care
facilities and Home Care package services.
www.cha.org.au
Specialist palliative care and advance
care planning advisory services
The objectives of the advisory services are to:
• provide specialist palliative care and advance care planning
advice to aged care providers and GPs caring for recipients of
aged care services;
• improve linkages between aged care services and palliative
care services;
• improve the palliative care skills and advance care planning
expertise of aged care service staff and GPs caring for
recipients of aged care services; and
• improve the quality of care for aged care recipients, prevent
unnecessary hospital admissions and shorten hospital stays.
www.cha.org.au
Specialist palliative care and advance
care planning advisory services
Funding is provided for:
• innovative palliative and advance care
planning advisory services that operate in, and
provide full coverage of, all states and
territories; and
• the delivery, at a minimum, of these services
from Monday to Friday, 09:00 – 17:00
inclusive, in the time zone of the respective
state or territory.
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Specialist palliative care and advance care
planning advisory services
The establishment of the services will deliver the following
outcomes:
• the empowerment of GPs and aged care providers with
knowledge of palliative care and advance care planning
relevant to their situation;
• the creation of links between aged care and palliative care;
and
• the provision of advice about palliative care, advance care
planning and advance care directive resources, processes,
legislation and accountabilities in the state or territory in
which the aged care provider or GP is located.
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Specialist palliative care and advance care
planning advisory services
• Consortium – RPC, PCA, ACSA, LASA, QUT
• Currently undertaking scoping study to see
what support exists
• ACP support wont be provided as a 24hr
hotline
• Support will also be provided through web
based tools
• Desk top audit looking at linkages between
spec pall care & aged care (QUT)
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Advance Care Planning
• From 2013-14, the Government is investing $10 million to
enable Advance Care Directives to be stored on the Personally
Controlled Electronic Health Record (PCEHR)
• Australian Government is also providing an additional
$800,000 over two years for the evidence-based Respecting
Patient Choices advance care planning project. This is aimed
at developing nationally consistent advance care planning
practice guidelines, expanding advance care planning in
general practice and contributing to the development of
advance care directives for PCEHRs.
www.cha.org.au
Advance Care Planning
• Member of PCEHR Advance Care Plan
Steering Committee
• Member of the PCEHR Advance Care Plan
Consultation group
• ACP & PCEHR due March-May release 2014
• Concession made that ACP can be uploaded
as a PDF
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Advance Care Planning & PCEHR
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Advance Care Planning
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Inadequacy of private health
insurance to cover palliative care
• Has long been an issue recognised by the
Commonwealth, but not acted upon
• Private Health Insurance Act 2007 - introduce
innovative service delivery of treatment and
services –traditionally delivered in hospital –
to holders of private health insurance outside
the hospital setting.
• Broader Health Cover
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Inadequacy of private health
insurance to cover palliative care
• Private health insurance to provide coverage
for home based community palliative care:
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Maximise choice for consumers,
increase demand for home based services
Decrease pressure on hospitals and hospices
Offer opportunity & incentives for private
practice (medical, allied health)
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Inadequacy of private health insurance
to cover palliative care
• Most funding models do not recognise the
role of Specialist Palliative Care services in
supporting primary care services.
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Inadequacy of private health insurance to
cover palliative care
• 9mths ago AHMAC tasked the PCIF to write a
business case for the budget that investigates
the issue of PHI and palliative care.
• Was not taken up
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Emerging issues
• What burning issues do you have?
• What hasn’t been mentioned today?
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