Palliative care services in Australia

The Australian Institute of Health and Welfare’s (AIHW) Palliative care services in Australia online report describes the activity and characteristics of Australia’s palliative care services. As well as the data presented in the various webpages there is detailed data for current and previous years in the Microsoft ® Excel workbooks. Data are progressively published twice a year as it becomes available.

Overview of palliative care services in Australia

A number of different terms may be used interchangeably with palliative care across sectors, including ‘hospice’ and ‘end-of-life’ care (DoH 2017). The World Health Organization (WHO) describes palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

• provides relief from pain and other distressing symptoms
• affirms life and regards dying as a normal process
• intends neither to hasten or postpone death
• integrates the psychological and spiritual aspects of patient care
• offers a support system to help patients live as actively as possible until death
• offers a support system to help the family cope during the patient’s illness and in their own bereavement
• uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
• will enhance quality of life, and may also positively influence the course of illness
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications’. (WHO 2017)

In January 2014, the WHO and the Worldwide Palliative Care Alliance released Global Atlas of Palliative Care at the End of Life—a tool to advocate for including palliative care in the global, regional and national health agendas (WHO 2014). This tool supports countries to develop palliative care policies and services that integrate palliative care into their health systems. The WHO regard palliative care as a human right in high demand, with an estimated 20 million people needing end-of-life care each year. In May 2014, the World Health Assembly unanimously passed a resolution to strengthen palliative care as a component of comprehensive care throughout the life course.

Palliative care in Australia

In Australia, and many other parts of the world, the demand for palliative care services is increasing due to the ageing of the population and the increases in the prevalence of cancer and other chronic diseases that accompany ageing (WHO 2014).

Palliative care is provided in almost all settings where health care is provided, including neonatal units, paediatric services, general practices, acute hospitals, residential and community aged care services, and generalist community services. Specialist palliative care services operate from a variety of settings, including specialist inpatient consulting services, specialist inpatient settings, hospices and community-based specialist services (DoHA 2010).

The exact model of care provision differs across Australia, with each state and territory having specified an approach to providing palliative care-related services (Senate Community Affairs References Committee 2012). The states and territories have different approaches to planning and delivering publicly funded services, different local service delivery practices and differently structured health-care systems. They also have varying demographic and remoteness profiles, and varying demands for particular types of services. In recent years, there has been a focus on expanding the practice of specialist palliative care teams to support primary palliative care providers, often through consultative or consortium arrangements (AIHW 2010).

While palliative care can be provided to patients in a variety of settings, a distinction is commonly made between care provided in hospitals (includes hospices or dedicated palliative care wards) and care provided in the community (such as in the patient’s home or in residential aged care facilities).

National policies for palliative care

Australian Governments have committed to addressing the palliative care needs of Australians through the National Palliative Care Strategy 2010: supporting Australians to live well at the end of life (the Strategy) (DoHA 2010). The Strategy was endorsed by Australian Health Ministers in 2010 to promote a coordinated and consistent approach to the delivery of high-quality palliative care across Australia. The Strategy outlines a number of priority ‘goal areas’ and ‘measures of success’ which aim to meet the identified demand for high-quality palliative care services across Australia. These ‘goal areas’ encompass building and enhancing the capacity of all relevant sectors to provide quality, appropriate and effective palliative care to all Australians who need it.

The National Palliative Care Strategy acknowledges that responsibility for providing palliative care services ultimately rests with the states and territories, and that each state and territory has specified an approach to providing palliative care-related services (DoHA 2010). The Strategy aims to enhance and build on the work occurring within jurisdictions. In October 2012, the Senate Community Affairs References Committee released its report into palliative care in Australia (Senate Community Affairs References Committee 2012). The Committee made 38 recommendations, including the need for improved access to information on services. Noting the lack of comprehensive palliative care data, the Committee highlighted in its report the need for consistent data collection practices to become fixed in the clinical environment and for systems to be set up to enable palliative care data to be accurately collected, analysed and reported. The Productivity Commission recently released the draft report Introducing Competition and Informed User Choice into Human Services which also recommended that the Australian and State and Territory Governments should ensure that sufficient data are available to enable governments to monitor how well end-of–life services are meeting patient’s needs across care settings (Productivity Commission 2017).

The Strategy was recently evaluated, with the findings published in 2016 (Urbis, 2016). A draft update to the Strategy was published in 2017 (Urbis, 2017). In addition to the Strategy, each state and territory has a range of initiatives in place to improve the delivery of palliative care services. For example, a 2015 Victorian Government consultation ‘Greater say for Victorians: Improving end-of-life care’ generated a diverse range of views and demonstrates the importance given to ensuring that palliative care services reflect and meet the community’s needs.

Better palliative care data will assist policy makers, palliative care providers, researchers and the general public to better understand the amount and nature of palliative care activity in the Australian health-care sector. Reliable, accurate and comprehensive data about health-care services can improve the quality of care and lead to better health outcomes through:

• highlighting areas in need of more or different types of services
• highlighting inequalities and inequities in access to and outcomes of care
• helping to assess the uptake of guidelines and evidence-based practices and to evaluate the effects these practices have on patient outcomes, as well as other consequences
• helping to detect barriers to and facilitators of the uptake of best-practice patterns of care
• helping to recognise changes in practice and consequent changes in outcomes
• informing evidence-based policy and strategy decisions
• providing practitioners with information and the ability to make appropriate decisions and to provide high-quality care (AIHW 2008).

References

AIHW 2008. Review and evaluation of Australian information about primary health care: a focus on general practice. Cat. no. HWI 103. Canberra: AIHW.

Australian and New Zealand Society of Palliative Medicine (ANZSPM) 2011. Workforce Strategy: Meeting the palliative medicine needs of patients in Australia 2011-2015 and beyond. Canberra: ANZSPM.

DoHA 2010. Supporting Australians to live well at the end of life: National Palliative Care Strategy 2010. Canberra: DoHA.

DoH 2017. Palliative Care and planning for End-of-Life Care. Canberra: Department of Health. Viewed 15 January 2018,

Productivity Commission 2017. Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services, Draft report. Canberra: Productivity Commission.

Senate Community Affairs References Committee 2012. Palliative care in Australia. Report to the Senate, Australian Government. Canberra: Senate Community Affairs References Committee.

Urbis 2016. Evaluation of the National Palliative Care Strategy 2010 Final Report. Sydney: Urbis.

WHO 2014. Global Atlas of Palliative Care at the End of Life. Geneva: WHO.

WHO 2017. WHO definition of palliative care. Geneva: WHO. Viewed 12 January 2018,