April 2013 Update

There has been an enormous amount of activity this month.  The first and most pressing issue has been to try to get some action on the problem of Federal COAG funding, which was given to palliative care in 2009 which will cease on 30 June 2013. In NSW this funding led to the employment of 53 wonderful palliative care specialists – doctors (mostly registrars), nurses, social workers and other allied health and one solitary counsellor employed to help parents of dying children in NSW. These are all slated to lose their jobs on June 30 unless the Federal Government and State Government act. Already some have had to leave and take up other positions!

I was able to have a question asked on Q&A last week 22 April. You will see from the following transcript that at least the governments are talking about it but although both the Federal Health Minister, Tanya Plibersec and Shadow Health, Peter Dutton, made the right noises about palliative care no promises were made.

GILLIAN LLOYD: When we are facing death, palliative care improves our quality of life by controlling pain and other symptoms and by supporting us and our families through all the difficulties associated with approaching the end of life. In 2009 the Rudd Government gave extra money to all the states to enhance palliative care services. In New South Wales this led to 53 much needed new jobs in palliative care: doctors, nurses, social workers and one counsellor for the whole of New South Wales for the parents of dying children. Is the Commonwealth going to pull the plug on dying people and their families when this money runs out on 30 June this year? I hope not

TONY JONES: Tanya Plibersek? Thank you. Tanya Plibersek?

TANYA PLIBERSEK: Thank you for that question. I think palliative care and end of life planning are some of the most important issues that face us, not just in my line of work but as all of us have had family members, people that we know who have faced what you’re talking about. We’re working very well with the New South Wales Government on the subacute bed and the issues that you’re talking about. That funding was intended to be one off in 2008/9, as you know, but I am very concerned to see that the services continue. We don’t want to see any diminution of services and, indeed, we’ve invested very substantially in other palliative care measures. We’re working, for example, with the Cradle Coast and later with the whole of Tasmania on advanced care directives so that people can express their wishes to their families and to their carers about the way they want to be treated in their last days when they’re very sick.

TONY JONES: So was that a – just on the June 30 question when the money runs out, was this a guarantee it won’t run out or a hope that it won’t or…

TANYA PLIBERSEK: Well, I’m saying that we’re working very constructively with New South Wales at the moment but it’s a broader issue than just New South Wales. There are the specific services that you’re talking about but there’s the systemic changes we need in our health system so that we are not doing treatments that are difficult and invasive when people want to be made comfortable sometimes.


TANYA PLIBERSEK: Giving people choice and autonomy in their sickest days is very important.

TONY JONES: Peter Dutton?

PETER DUTTON: Well, there’s lots for Tanya and I to argue about tonight and I think this is one of those issues where we can remove the battle gear, particularly around children and juvenile palliative care, it’s incredibly underfunded and I think both sides of politics need to do more in this area, both at a State and Federal level. We’ve certainly had…

TONY JONES: Can I – sorry. I wouldn’t normally do this but can I interrupt you because we actually have a question on the issue that you just raised.


TONY JONES: I’m going to g0 to our next question. It’s from Kristina McColl.


KRISTINA MCCOLL: Bear Cottage is the only children’s hospice in New South Wales, one of only two in Australia. Bear Cottage allowed my daughter to die with dignity, compassion and love, offering care and support not only for her but also for our family throughout her 13-month fight against an aggressive brain tumour. Bear Cottage is solely devoted to children’s palliative care, staffed by trained palliative doctors, nurses, social workers and therapists. We know we’re one of the lucky families who were able to access this vital service. Sadly, many families miss out. It currently costs more than $2.9 million a year to keep the doors open at Bear Cottage and with no recurrent government funding, Bear Cottage relies entirely on community support to raise these funds. When will our government devote some of the medical budget towards children’s hospices and is one children’s hospice in New South Wales and one in Victoria adequate to meet the needs of our children with life-limiting illness in our country?

TONY JONES: Peter Dutton, I interrupted you to bring that question in so you can go ahead first.

PETER DUTTON: Well, Kristina, I’ve met a couple of times with some of your partners in Queensland where there are just no services at all and they’re trying to base a potential service on your very successful model in New South Wales. So, as I say, there’s a responsibility between the State and Commonwealth to fund additional services and we’re looking at ways in which we might be able to provide for that funding and, as I say, we’ve had a couple of meetings already and looked at some financial projections and I hope that, again, it’s a bipartisan issue that perhaps we can work with the Government on and certainly with the State and Territory governments on to try and find a better solution for families who find themselves in an impossible situation like you did.

TONY JONES: Tanya Plibersek?

TANYA PLIBERSEK: Like Peter says, I’m so sorry for your loss and if there are more things that we can do around palliative care for children I’ll have a look at that.

TONY JONES: Basically the question is about funding and once again it’s one of those tough issues for a minister with a tough budget coming up. Treasury looking to cut money.

TANYA PLIBERSEK: Well, yeah, but we always – I mean there are – investment in health is an investment. So when we’ve got pressing needs like the sort of palliative care needs that you’re describing, it means we have to find room for them by jettisoning some of the things that don’t give us as good value for money in the health budget. One of those is the private health insurance rebate for very high income earners. So that’s why we make those difficult decisions in other areas of the budget. I mean look at our investment in a whole range of areas. We invest tens of thousands of dollars in very late stage cancer medicines that might extend life for six weeks or six months. Tens of thousands of dollars. But we’re happy to pay that as Australians because we understand the value of caring for every Australian well.

TONY JONES: So you’re guaranteeing that you would look to fund those kind of palliative care operations?

PETER DUTTON: As I say, Tony, I mean, we’re already in discussions and have been for some time around what the best model is, what the best funding arrangement might be. Sometimes it’s hard from Opposition because obviously we can’t have discussions like the Government might be able to at a Health Minister’s meeting or at a COAG meeting.

TONY JONES: Sure, but sometime between now and the election you’ve got to put forward some policies…

PETER DUTTON: Sure. And it’s…

TONY JONES: …and you’re are saying that will be one of them, are you?

PETER DUTTON: Well, I’m saying that we’re meeting with and we have met on a couple of occasions now already with groups do look at home nationally we might be able to provide more support.

Both the Cancer Council and Health Consumers NSW are helping to put pressure on both governments. It would be a scandal if these jobs were lost at a time when we are 41 palliative care specialists short of the average of the rest of the States! The cost in additional unwanted hospital admissions will be far more than the cost of continuing the funding.

Meanwhile we continue to collect signatures and now have nearly 5,000 collected this year. When I have 10,000 I will take them to Barry O’Farrell again.

At the same time I am getting around the country areas, meeting with PC clinicians, GPs, pollies, media and bureaucrats in an effort to show that properly funding PC can save at least twice as much as the extra funding will cost to provide equitable and appropriate palliative care services State-wide. So far I have spent time in Bega, Coffs Harbour and Port Macquarie.

Do, please keep agitating, contacting me with ideas and collecting signatures. If you haven’t already joined the Palliative Care Network (free) within ACI please do join. It gives you a voice and expands the reach of people interested in palliative care. To join contact me at yvonnemcmaster1@gmail.com or email the Network Manager, Rob Wilkins <rob.wilkins@aci.health.nsw.gov.au>.

Yvonne McMaster


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