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PCWA Response to the Joint Select Committee for Palliative Care Final Report

In general, the Board and staff at Palliative Care WA were satisfied with most of the key findings and recommendations outlined in the Final Report of the Joint Select Committee on Palliative Care in Western Australia.

In particular, we are very supportive of recommendations to improve access to homecare assistance; provide culturally appropriate resources and services for Aboriginal community members; progress scoping of a palliative care navigator model; and fund volunteer led services such as Compassionate Communities.  These were all issues raised during our sector-wide and community consultation process and have been consistently championed by Palliative Care WA as of benefit to the WA community. However, there are some gaps and areas of concern.

Advance Care Planning

One area of concern is the continuing view that Advance Care Planning is out of scope and therefore separate from Palliative Care. In reality, Advance Care Planning is a critical first step in the palliative care process and empowers people to determine their end-of-life choices. This decision-making process may also involve family and friends, as well as the healthcare team and assists in activating appropriate resources and ensuring clarity for everyone involved.

We note that the Joint Select Committee on End of Life Choices established an Expert Panel on Advance Health Directives however has given little, if any, profile to the critical importance of Advance Care Planning, which is underpinned by two of the eight aged care standards (Standard 1 – Consumer dignity and choice and Standard 2 – Ongoing assessment and planning) as well as two of the eight National Safety and Quality Health Service Standards.

Availability of frontline palliative care services

While we have been pleased with the investment in rural palliative care and subsequent improvements in governance and service availability since the My Life, My Choice report was released in 2018, there has been little noticeable improvement in availability of frontline palliative care services for people in the metropolitan area. Palliative care services are stretched beyond capacity and they are having to turn away or discharge patients due to lack of resources. This was evident in multiple submissions from consumer organisations to the Joint Select Committee. In particular, with an increasing number of people not able to receive in-home community palliative care services in WA, it was disappointing that there was no imperative within the report to quantify the increase in funding needed, nor the timeline. Without access to community palliative care, the default for many people in crisis due to unmet palliative care needs is to turn up to emergency departments, even though they would prefer to be managed at home.

Palliative care is not just for the last days or weeks of life. It can be of benefit from the time of diagnosis with a life limiting illness, and be received alongside life-prolonging treatments such as surgery or dialysis. With Voluntary Assisted Dying becoming available in July there is a strong need to ensure people to do not access VAD only because they can’t access suitable palliative care services.

Other concerns

  • The terms of reference were very limited, focusing solely on the progress in relation to the Joint Select Committee on End of Life Choices and the associated funding announcements.
  • There appears to be considerable contention with the health and palliative care sector regarding the proposal for hospice beds in the northern suburbs and the announcement regarding 10 inpatient beds.
  • There was no recognition of the importance of supporting people in grief and bereavement as part of a continuum of care approach.
  • There was little reference to the increasing focus that will be required on people with dementia requiring access to palliative care.

 


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