Update from Dr. Yvonne

Last month the NSW Government announced that funding for palliative care would receive a $100m boost over the next 4 years – a win indeed, testament to the hard work of the Treasurer, Health Minister, NSW Cancer Council, CanAct Community, Push For Palliative advocates, PCNSW and many supporters.

But as important as it is to celebrate success, we must also be careful not to rest on our laurels. If you aren’t intimate with the details of the announcement, the crux of it is more funding for additional palliative care physicians in rural areas, 30 additional specialist nurse positions across NSW, palliative care training and scholarships for health staff, and around $41m quarantined for use in accordance with the findings of the now completed roundtables. All very positive.

That said, there are certain elements of the package we wish to shine a light on and push in a certain direction, which will largely dictate our efforts from here. It’s not over yet.

Clarification needed: Parts of the package are somewhat unclear or open to interpretation – we would like to see them fulfilled in very specific ways. The first concerns the selection of the rural and regional areas to benefit from the six additional palliative physician positions, and ensuring that the strongest possible efforts are made to recruit physicians. We recommend, in order of urgency, Tamworth, Dubbo, Wagga, Port Macquarie, Taree, and Lismore – but Coffs Harbour and Newcastle each need at least one additional physician. Secondly, we want to ensure the scholarships and training on offer to nurses will qualify them (and see them employed as) specialist palliative care nurses, with more funded positions for them across NSW.

Boots on the ground: Put bluntly, six additional specialist palliative care physicians are not enough to bear the load for all of NSW. For the state to have sufficient palliative physicians, we need additional Advanced Trainee positions in each metropolitan LHD ideally participating in FiFo arrangements for rural areas, plus additional physician positions in every metro LHD. Central Coast is most urgent, needing two additional positions. Additionally, 3 Transitional Supportive and Palliative Medicine Physician positions are needed for NSW, for adolescents transitioning from paediatric services to adult supportive and palliative care services. These positions should have conjoint appointments at the adult and paediatric hospitals at Westmead, Randwick, and the John Hunter Hospital in Newcastle. Their omission to date has been disastrous for patients, and costly for the Government. Moreover, every LHD is in need of more palliative physician positions and more allied health.

Not quite a silver lining: Media critique of last month’s announcement focused rightly on the takeover of community palliative care in the Western Sydney LHD by Silver Chain, an NGO. The organisation has operated in Perth for over 100 years, with a model which relies heavily on GPs and Registered Nurses. The GPs in Perth have grown up with the service (which includes education for those GPs), and it’s questionable as to whether the model will translate among GPs in Western Sydney. Under Silver Chain, Western Sydney’s community palliative care will concentrate only on the last three months of life. It is still unclear as to how those patients receiving active treatment for life-limiting illnesses (such as cancer, end stage cardiac, respiratory and renal disease) will be supported through that transition.

On that note, we are very pleased to announce that Dr Philip Lee, who recently retired after many years as Director of Western Sydney’s Supportive and Palliative Care Service, has now joined our Push for Palliative. Details soon, but needless to say we’ll be watching the outcome in Western Sydney closely.

Hearts and minds: Perhaps the pricklier challenge we face is to change public perception about what palliative care is. Still in 2017, patients’ and families’ hearts drop when they hear they’re being referred to palliative care – the same can be said for many politicians and bureaucrats who picture only hand-holding and morphine. The truth is that a modern and able palliative care service is diverse, holistic, and can help patients who are nowhere near the end of life.

It’s these four areas we approach with renewed purpose as we continue our campaign. I hope you will keep pushing with us for world class palliative care in NSW and across Australia!