Palliative Care: A Policy Perspective A whirlwind tour Caroline Chisholm Centre for Health Ethics 3rd October 2013

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Palliative Care A Policy PerspectiveA whirlwind
tourCaroline Chisholm Centre for Health
Ethics3rd October 2013
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Palliative Care A Policy Perspective

• 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
  non-government 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
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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

• Through use of funding
• Through agreements with states and territories
• Through consideration of issues by the Palliative
  Care Intergovernmental Forum
• Input from stakeholders

• What palliative care is
• Who receives it
• Where services are provided
• Who provides it

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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 health-related
  services provide better support to people needing
  palliative care, and their families.

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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.

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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 South)

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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.

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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.

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National Performance indicators

• The proportion of administrative health regions
  that have a written plan for palliative care
  which incorporates palliative care elements.
• 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.

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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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(No Transcript)
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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.

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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.

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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.

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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.

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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, 0900 1700 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.

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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
• 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 hasnt been mentioned today?