Palliative Care - Question Time

22nd February 2017

Mr GREG PIPER ( Lake Macquarie ) ( 15:02 :58 ): My question is directed to the Minister for Health. Given that the desirable ratio of palliative care physicians is one per 100,000 people and that home-based palliative care is known to reduce the burden on our stretched health system, what is the Government doing to fund the current shortfall, particularly in regional areas?

Mr BRAD HAZZARD ( WakehurstMinister for Health, and Minister for Medical Research) (15:03:29): I thank the member for Lake Macquarie for the question. It is great to have a question that addresses such a pertinent issue for the entire Australian community. It is always great when I go to the member's area to see his association with his community. Whether we are visiting Aboriginal communities or other groups, he has a connection and I am sure that is where this question comes from.

This is a challenging area. The health budget right across the country, let alone in New South Wales, sits at around $100 billion. Of that $100 billion, $5 billion, one-twentieth, is spent on people in their last year of life and, of that, just $100 million right across the country is spent on the sorts of services that members in this place know we need, that is, good end-of-life support. That in itself indicates that across the country we have an issue. I will say in a few minutes what good work we are doing in New South Wales. It is not enough; obviously we have to do more, but we are doing some good work here.

I strongly suggest to all members who have an interest in this that they should look at this report. In 2014 the Grattan Institute put together an excellent report called "Dying well". The concept that it sets out is fascinating because it talks about the fact that 100 years ago the majority of people died in their own homes. But we have now institutionalised it, hospitalised it and sterilised it, and that is an issue. If I asked any one of us here—and we would be a fairly typical group—about 70 per cent of us would say that we want to die at home. That makes sense because people want to be with their family, friends and support network and want to die in that environment knowing they have love and care. In reality only about 14 per cent of people currently die at home so we have a lot to do because the entire medical area has become so institutionalised. I have an interesting quote from that report, which said:

The concept of a good death has been superseded by the concept of a managed death, one that requires support and knowledge … and takes place in a hospital, or more rarely a hospice, resulting in modern death becoming 'cellular, private, curtained, individualised and obscured'.

I met in the last couple of weeks with the Cancer Institute and the Cancer Council—both in the same room—to talk about these sorts of issues. Professor David Currow made the point that one of the great challenges we have is that while we focus on trying to bring a much more community-based capacity to die well, we are still very short of trained nurses and doctors in this palliative care area. We have some control over this issue but not a lot because much of it is in the Federal sphere through the universities. I say to members in this place and to the universities that they need to think about this because unfortunately what they are doing is training people for yesterday and not for our future. In the next 25 years, with the baby boomers coming through, the number of people who will die will double. It is a serious issue.

When the Coalition came to government—and I direct this to the member for Lake Macquarie particularly—in that first year, 2012, we put in $86 million plus. We then loaded on another $32 million and another $35 million in subsequent years. That is aimed at working with community care, trying to make sure that we get that connection through the community. In fact, a review was done which led to a blueprint being published. That blueprint was through one of the clinical study groups and that identified the sorts of focuses we needed to make through the local health districts right across New South Wales. I remind members of what I said at the outset: $100 million right across the country. In the first year of the Liberal-Nationals Government coming to office we allocated $86 million, followed by another $32 million and another $35 million. We are doing better than probably any other State or Territory but we are not doing enough. That is an issue I will certainly be discussing— [Time expired.]

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