Palliative care resources ‘distressingly low’ in Canberra

By Katie Burgess– Canberra Times

13 July 2018 — 6:19am

Staff at Canberra’s Clare Holland House are under pressure to push dying patients in and out as quickly as possible, while dealing with bottlenecks in referrals.

Canberra Hospital’s palliative care service is also stretched, with a distressingly low number of specialists, a parliamentary inquiry has heard.

Doctors, former politicians and peak health bodies appeared before an ACT Legislative Committee examining the end-of-life choices available to dying Canberrans on Thursday.

While the inquiry has dwelt on the ACT’s inability to legalise voluntary assisted dying due to Commonwealth restrictions, it has also heard evidence of shortcomings in the territory’s palliative care system.

The Canberra Hospital’s director of palliative medicine, Dr Michael Chapman, was called to give evidence again, this time in a personal capacity.

Dr Chapman restated there were just four full-time palliative medicine specialists in the ACT, a number he described as insufficient and “arguably less than half” what was needed, given the hospital looked after the wider Canberra region.

He also said his personal belief was the number of trained palliative nurses – rather than nurses who happened to work in palliative care – was insufficient, as too was the number of allied health staff in the sector.

“Our pressing priority to provide end-of-life choices in the ACT requires people to have real access to quality palliative care which is currently not always the case for many and not always the case when we need it. People often receive too little or too late or no services at all,” Dr Chapman said.

“This isn’t a unique issue in the ACT and … I think also it’s important to recognise that this isn’t an issue that’s being ignored in the ACT, nor that there haven’t been steps to try and meet it.”

Catholic Health Australia chief executive Suzanne Greenwood described the number of specialist palliative care physicians as “distressingly low”.

She appeared with the manager of Clare Holland House, Jane Etchells, who said while the biggest gaps in palliative care remained in the aged care and community sectors, the hospice was under pressure.

“The fact of the matter is we have 19 beds, we are under the restrictions of activity-based funding so we can’t have people that come to Clare Holland House that stay for months and months and months,” she said.

“We have to use our admission criteria to say either ‘this person has a high symptom burden and they need to come over because they need our expertise’ or ‘this person is reaching the last two to three weeks of their life and they can’t be managed at home’ and so they need to come to Clare Holland House.”

Ms Etchells said the average length of stay at Clare Holland House was 11.7 days, although it could range from just hours to 12 months.

“With an activity-based funding model the pressure is very much to keep the length of stay as short as possible …  because that’s what makes the health system money and so therefore the pressure is on us to make sure we are constantly talking to people about what we do if you stabilise, if you’re in here, you’ve come in with acute symptoms and those symptoms stabilise where will the next place be?” she said.

“Because being stable in Clare Holland House is not going to be, unless someone has clearly reached the end of life, being stable in Clare Holland House is not what the government wants. They want us to have throughput.”

Ms Etchells also said for a long time, Canberra Hospital made many of its referrals on a Friday afternoon, which made it difficult to admit patients as Clare Holland medical staff worked 8am to 5pm Monday to Friday.

“Obviously it’s a significant cost burden to bring someone in on-call so we try not to do that and we don’t have a multidisciplinary team on staff 24 hours a day either so if someone comes over from another hospital and requires some counselling from a social worker or a lot of care from pastoral care and they come in after-hours we can’t give them the best service,” Ms Etchells said.

Dr Chapman acknowledged that had been a problem in the past, but extra government funding had meant extended hours for consultants to assess and refer palliative care patients.

He said while the service could be improved by even more funding for the consultancy team, a palliative care ward could help dying patients who were too acute to be referred to Clare Holland House a better quality of life in their final days.

“Unfortunately, my personal impression of palliative care services in Canberra Hospital is they’re stretched, they’re under pressure and some kind of additional resourcing for those services is quite sorely needed,” Dr Chapman said.

The inquiry continues.