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Legislative Council - Fifty-Fourth Parliament, First Session (54-1)
2018-07-04 Daily Xml
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Palliative Care

Adjourned debate on motion of Hon. F. Pangallo:

That this council—

1. Recognises Palliative Care Week was held from 20 to 26 May;

2. Recognises that access to appropriate pain and symptom management, and being surrounded by family and loved ones, are most important to people who are dying;

3. Acknowledges that the Productivity Commission's draft report into human services, released in June 2017, argued that more community-based palliative care services are needed to enable more people who wish to die at home to do so, and that end-of-life care in residential aged care needs to be better resourced and delivered by skilled staff;

4. Notes that there are just 213 palliative medical specialists across Australia, equating to one specialist for every 704 deaths each year;

5. Notes that Palliative Care Australia estimates that while 70 per cent of Australians wish to die at home, only around 14 per cent do so;

6. Recognises Palliative Care Australia's call for a national palliative care commissioner who would examine existing palliative care services and programs nationally to assess their efficiency and effectiveness in supporting terminally ill individuals and their families to live as well as possible, right to the end of life; and

7. Urges the federal government to make palliative care a health priority and appointing a national palliative care commissioner.

(Continued from 30 May 2018.)

The Hon. I. PNEVMATIKOS (17:33): I rise today to speak about the motion brought to us by the Hon. Frank Pangallo and to thank him for moving this important motion. This year's national Palliative Care Week shone a light to recognise what matters most. What does matter most to people is family, health, community, dignity and independence. How can we best ensure that these concerns are applied in palliative care to help people with a life-limiting illness have a high quality of life, right to the end of their life?

The answer starts with discussion—discussion with loved ones and health professionals to ensure that what we want to happen, in terms of our end-of-life care, is known. Because for many, one's journey to the end of their life is hopefully not alone; it is with family and friends within the community and it is being surrounded by those who, over time, have become an integral part of the life that we live. Palliative care is about more than our final moments. It is about the range of services and programs that assist us at any age, should we be diagnosed with an incurable, serious illness, to have a high quality of life right to the end of our life.

Prior to its formalisation in the 1980s, palliative care was conducted through hospices which were run predominantly by religious orders to provide care to people who were sick and dying. Post 1980, we have seen the movement evolve and develop to provide expertise, advocacy, information and support in this area for individuals, young and old, and their families.

It is through organisations such as Palliative Care SA that we have been able to develop various initiatives to increase quality of life outcomes for people with palliative care needs. The government must do what it can to ensure support services are in place to assist with the implementation of what matters most.

Good palliative care services mean the right to choose the palliative care option that best suits the individual and include the involvement and support of family and friends. Many of us would not wish to spend our final days in an institution, though that is sadly often the case, as we either do not know that we have a choice or there are not enough resources to provide for home care. The Australian Institute of Health and Welfare's recent statistics on the high rate of palliative care-related hospitalisation in South Australia is evidence that there is still much we can accomplish in this area.

One initiative that has been highlighted by Palliative Care SA for us to be able to move forward on this issue is through increased focus on community care. This makes sense. Palliative care is about more than physical symptoms. It is about the emotional, spiritual and social symptoms as well. It is about being available to all people with serious illness, whether young or old, and their families and support base. Improved quality of life is bigger than the individual. It is about community support and awareness. We need appropriately funded palliative care services, including more community-based palliative care services, so that people are afforded a choice in their end-of-life care.

Everyone's priorities at the end of life are slightly different, but we deserve the choice and dignity of living our final days with quality and respect. Whatever form palliative care takes, services must be properly resourced with skilled staff to provide end-of-life services in a loving and supportive environment that is community focused.

This month, Palliative Care SA will be holding its annual palliative care conference on 20 July. I am very interested to hear more about their productive discussions on community care. Labor has a sound track record of improving palliative care services across our state. As recently as September last year, Labor met its commitment of $185 million for upgrades to the Flinders Medical Centre, which included a new hub for palliative care services. I am proud to stand with my colleagues on this issue. It was Labor's priority in government, and it will remain our commitment to support further increases for palliative care services. I commend the motion to the house.

The Hon. M.C. PARNELL (17:38): I too rise to support the motion, and I congratulate the Hon. Frank Pangallo for putting it on the agenda. It is an important issue. It is an issue we do not talk about enough and we should talk about more. It can be very uncomfortable for people to talk with family and friends about end-of-life decisions, but if we are going to do the best we can for people in the community who are dying, which is going to be all of us eventually, then we need to have those conversations and, most importantly, we need to have resources in place to give people the best possible care in that difficult end-of-life period.

I met with Palliative Care SA back in February, in the lead-up to the state election, and they presented a great deal of information, some of which is very similar to what the Hon. Frank Pangallo has put on the Notice Paper in terms of the wording of his motion. What Palliative Care SA remind us is that three out of four South Australians are not getting the care they need at the end of their lives. Given that 13,337 people died in 2016—and the numbers would be similar in other years—that is a lot of people who are not getting the care and the services they need.

Also, as I was hunting through my paperwork in preparation for this debate today, I noted that many of us in state parliament, and certainly I on behalf of the Greens, signed the palliative care funding pledge, promising on behalf of our party to support $24.5 million dollars of funding for palliative care. I note that the honourable member's motion calls on the federal government to take certain steps and to make it a priority. I understand exactly why he has done that: that is where the bulk of the funds are. They are with the federal government, and they have a lot of responsibility in this area, but the state too needs to make sure that palliative care is a priority.

The only other thing that I would say very briefly is that often in this debate there is a furphy trotted out to say that there is some form of competition between palliative care and voluntary euthanasia. I want to put on the record again that there is no such dichotomy. The vast bulk of people want to live as long as they can, they want to live as well as they can and they want to have a death that is as dignified and pain-free as it can be.

Given the thousands of South Australians who are going to die every year and who should be entitled to the best possible palliative care, the people for whom voluntary euthanasia might be available are just a drop in the bucket. It is a handful of people who would meet that very strict test of dying from an incurable condition with unbearable suffering that not even palliative care can alleviate. There is no conflict; in my view, we need to support both initiatives.

Certainly, the vast bulk of South Australians want improvement in palliative care options and improvement in funding to allow the bulk of people to die at home. That is what 70 per cent of us say we want, yet only 14 per cent of people get the chance to do that, largely because there is not the palliative care in-home services available. With those brief words, I congratulate the honourable member for putting this on the agenda and fully support the motion.

The Hon. D.G.E. HOOD (17:42): I rise to indicate the government's position on the motion put by the Hon. Mr Pangallo, and I indicate that the matter went to our party room earlier this week. The Hon. Mr Pangallo will be pleased, I am sure, to hear that the Liberal Party will support his motion wholeheartedly. I say at a personal level that I was particularly pleased to see this matter raised and I think it is something that is long overdue.

The Marshall Liberal government regards palliative care services as critical in helping people with a life-limiting or terminal illness to live their life to the fullest and to be treated with the dignity and respect they deserve. The government welcomed National Palliative Care Week, held from 20 to 26 May, as an opportunity to raise awareness about the importance of these services and to pay tribute to the staff of the specialist palliative care teams, who not only provide excellent care but also support colleagues such as general practitioners and hospital staff with their various experience.

This year, the theme for National Palliative Care Week was, 'What matters most?' This theme highlighted the need for members of our community to plan ahead and discuss their wishes with loved ones and health professionals in preparation for their death. By talking with their families and their health professionals about what matters most to them, people are more likely to receive the care and treatment they desire. Indeed, that is the purpose of this motion.

South Australia has made good progress in supporting advance care planning, including the Advance Care Directives Act, which passed under the previous government but was supported by the entire chamber, as I recall. It allows adults to record their preferences and wishes in a legal document and appoint someone to make decisions at a later time on their behalf. I would urge all members in this chamber to take steps to complete an advance care directive if they have not yet done so, and perhaps it would also be wise to talk to their loved ones about that.

Development of a clinical tool known as the 7 Step Pathway that records decisions about treatment and resuscitation that are aligned to a person's wishes is also one of the steps that has been taken to advance progress in supporting palliative care and the advance care directives. The Planning Ahead community awareness campaigns that encourage people to take control of their future and record their wishes are another example of progress that has been made in supporting advance care planning.

With respect to demand for palliative care services, currently the government provides high-quality specialist palliative care services to people in hospital and community settings across metropolitan and country areas. However, it is recognised, it must be said, that there will be greater demand for specialist palliative care services in the future, and that these services are best provided in community settings to enable more people in South Australia to be cared for and, ultimately, to die in their own homes, which is the wish of many.

This need has been echoed in the Productivity Commission's Report into Reforms to Human Services, which was released in March this year, and planning to increase services has commenced under a new end-of-life care strategy. There was an election commitment made by the Marshall government, which has committed $16 million to more effectively support people in the final stages of their life and which will allow services to be increased and available more generally, and for the increase to happen more rapidly.

This year a statewide workforce analysis, and also an assessment of unmet need, will be undertaken to inform the planning for the expansion of adult community-based specialist palliative care services to support people 24 hours a day, seven days a week. At the same time, SA Health will also commence delivery of additional services to country, including palliative medicine, specialist outreach visits and telehealth services.

It is through a coordinated approach under the end-of-life care strategy that we aim to continue to improve the quality of services for people who are at the end of their life, as well as their loved ones and carers. The Marshall government has taken this seriously. There are a number of initiatives I have outlined: an extra $16 million being made available in this space in order to put our money where our mouth is, if I can put it that way at least, and add some substance, too. It is not just words being said here—there is money available and extra programs actually in place.

It is recognised that palliative and end-of-life care is a complex area of health care, particularly due to the interplay between state and commonwealth-provided services. For this reason the Marshall Liberal government is supportive of efforts to make palliative and end-of-life care a national health priority to continue to drive the reform.

This is just the beginning; it is something the government takes seriously. We commend the Hon. Mr Pangallo on bringing this motion before the chamber. It seems with government support that it is unanimous, and we welcome its passage through this chamber this evening.

The Hon. F. PANGALLO (17:46): I wish to thank all the honourable members who have spoken on this sensitive, yet vitally important, topic. As our ageing population continues to grow, palliative care for our loved ones will be increasingly in demand, and our governments need to be quite progressive to ensure the community's needs and expectations are met. I would hope this new government recognises that it needs to be a priority and that adequate services and programs are provided and delivered.

As I pointed out in my address on this motion, there are considerable savings to be made to the ballooning health budget if resources are redirected to encourage more community-based palliative care services for those wishing to die at home and improving the standards of end-of-life care in residential aged care. So it is commendable that the government is actually taking it seriously and is expanding funds for this issue. I commend this motion to a vote.

Motion carried.

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