July 2022
The NSW Government’s recent budget announcement of $743m to fund palliative care services is to be welcomed. Palliative care is an essential component of any health system, providing integrated and holistic care to people with life-limiting illness, their families and loved ones.
Australia has some of the best palliative care provision in the world, ranked by the Economist as second only to the United Kingdom. However, there is not enough of it. In Australia, service utilisation has increased each year, as more people live longer with chronic and life-limiting conditions. Globally, approximately 14% of the estimated 40 million people who need palliative care actually receive it.
There are many barriers to adequate palliative care provision, beyond the availability of trained workforce and appropriate analgesics, including misconceptions about palliative care and fear of discussing impending death. We need to reframe our thinking about dying and accept that it is a part of life. Palliative care, started early, can reduce symptoms, improve wellbeing and prolong quality of life.
The NSW Government’s increased investment will lead to improved palliative care for residents of NSW but it will take time to meet demand. According to a recent report on the economics of palliative care, the NSW Government needs to double the number of palliative care medical specialists to meet the national estimated benchmark, while the number of palliative care nurses has declined relative to the population. This is at a time when health workforce shortages loom across Australia.
Research I conducted in the United Kingdom in the early 1990s examined palliative care in the community for those who wished to die at home. In addition to pain and symptom relief, good communication and support for family carers was essential. In addition, clarity of roles and understanding of palliative care by health providers was critical. Several decades later, these same elements are not always available and yet the need for palliative care is expected to double by 2050. Governments and universities have important roles to play in increasing knowledge and understanding of palliative care across the entire health workforce, as well as training the next generation of palliative care specialist nursing, medical and allied health providers.
Palliative care principles are about ensuring that everyone can live as well as possible until the very end of life. Surely that is an investment worth making.