Motion
HON JIM CHOWN (Agricultural) [1.08 pm]: I move — That this house —
(a) notes that access to inpatient specialist palliative care is limited and that this state has the lowest number of publicly funded inpatient palliative care beds per head of population;
(b) acknowledges that access to hands-on inpatient and community-based specialist palliative care is limited for metropolitan and non-metropolitan patients;
(c) considers that access to specialist palliative care in the early stages of a diagnosis might improve remaining quality of life, mood, resilience and symptom management, and allow for death in the patient’s preferred location;
(d) observes that more can be done to promote understanding of palliative care in the community to ensure that all patients who could benefit from palliative care are receiving it, and that community palliative care is easily accessible for all patients at end of life who wish to die at home; and
(e) calls on the government to ensure palliative care is funded to meet demand.
Comments and speeches from various members
HON ALISON XAMON (North Metropolitan) [2.18 pm]: I rise to indicate that the Greens will be supporting this motion, and thank Hon Jim Chown for bringing this important topic to this chamber. Members in their contributions have spoken a fair bit about the report of the Joint Select Committee on End of Life Choices, “My Life, My Choice”, for very good reasons. This motion is timely, because it is most likely that we will be debating legislation pertaining to the issue of end-of-life choices and its intersection with palliative care. I note from the report that palliative care was the single largest issue that was examined in the course of the inquiry. It is clearly an imperative that we have a robust palliative care system, irrespective of current deliberations around the issue of end-of-life choices. The report provides a thorough analysis of the current state of palliative care services within Western Australia and, sadly, found it to be wanting on many fronts.
With an ageing population and an increasing number of people dying from life-limiting conditions, as compared with accidental deaths, more and more people will need access to palliative care. The report showed us that, even now, many Western Australians do not have access to palliative care services, and this is particularly aggravated for people living in rural and remote Western Australia. It is appalling that we are bringing Aboriginal people off country to die far away from their homes. There is also a problem with providing appropriate services for people from culturally and linguistically diverse backgrounds. People with life-limiting conditions that are not cancer were also found to be at a disadvantage, compared with those with cancer, in access to palliative care. It has already been quoted by others, but of particular concern is the committee’s finding about the provision of palliative care in the regions, and the extraordinary admission from the Western Australian Country Health Service that there is limited oversight, coordination and governance of medical palliative care services across Western Australia’s country health services. The report goes on to discuss barriers to access across the state, which need to be urgently addressed by government. That is really important to emphasise. It was not unsurprising to many of us, but it is very important that it is there in black and white. This means that we do not even know how much money is really currently being spent on palliative care.
On a more positive note, the report found that the model operated by Silver Chain, which is integrated specialist community provision of palliative care with primary healthcare infrastructure, is recognised to be best practice, but even then the committee recommended that its services should be expanded, so that more people can be reached. The model involves three specific service offerings—a metropolitan community palliative care service, a palliative nurse consultancy service and the palliative rural telephone advisory service, all guided by the principles of building capacity within families so that they are better able to care for their own. It also uses an approach around integrated and coordinated services, interdisciplinary and multidisciplinary care planning, and evidence-based, client-centred care. The report went on to provide a number of other recommendations for improving palliative care in Western Australia. The challenge is now for the government to translate this attention into adequate resourcing and effective team-based care, and sufficient support for care outside hospitals, to ensure both an efficient use of funds and also effective support for people’s wishes to die well, and often to die at home or in an appropriate non-hospital setting, because that is part of what constitutes choice.
There is a need to look at palliative care also in the broadest sense—that is, looking at community education and addressing the underlying barriers to entry. Consideration of how to ensure that more Western Australians are able to access palliative care in a timely manner extends further than the simple provision of services. Generally speaking, death and dying in our culture are uncomfortable to contemplate. The result is that, realistically, often people do not come to understand the role of palliative care until they themselves are seriously unwell. This means that people may not access palliative care until the very end, and that means they are not being as well supported as they might have been if they had had the opportunity, or had been aware earlier that they needed to access palliative care. This discomfort extends beyond the patient, unfortunately, and can often exist in the treating clinician themselves. Often, a clinician’s desire to cure is coupled with frustration over futility and a patient’s desire to live is balanced with a desire for comfort, and these competing goals can create tension amongst the patient, the family and the clinician. We know this to be the case, and if we want to improve access to palliative measures, we will have to look at strategies such as including earlier palliative care given in conjunction with curative therapy as part of a broader guideline-directed management strategy as one way of ensuring that we are more effectively balancing these tensions. Organisations such as Palliative Care WA are playing an invaluable role in our community by increasing awareness around end-of-life considerations. Since 70 per cent of deaths are expected, one of PCWA’s key areas of focus is that of advance care planning. Advance care plans give people the opportunity to be clear about what they do and do not want, and this process helps care providers enormously.
Another key consideration in the provision of palliative care is the presence of a skilled workforce to deliver these services, and this is becoming increasingly apparent as our population ages and more and more people enter aged care. In 2012, Wendy Porter, the residential care manager in WA for Aged and Community Services Australia, told a Senate committee looking into palliative care in Australia that the aged-care workforce would need to treble over the next 30 to 40 years, and a large proportion of that workforce would need generalist skills in a palliative approach to care. Given that we are failing to meet demand now, it is difficult to overstate the imperative that we act now to address increasing demand in the future. The strength of palliative care should be the multidisciplinary approach to supporting people, and this means that we need the full range of appropriately trained health providers. In this vein, I am deeply concerned about the government’s recent response to a question I asked about the number of psychiatry trainees who attained certification to become consultant liaison psychiatrists. Consultant liaison psychiatrists specialise in that interface between general medicine and psychiatry, and, among other areas, they work with patients who may not have a psychiatric disorder, but are experiencing distress related to their medical condition. As would be expected, mental distress is common in people with life-limiting illness and, as such, access to a consultant liaison psychiatry service is an important aspect of minimising that the stress. Unfortunately, when I asked the minister how many psychiatry trainees had attained consultant psychiatrist certificates over the past three years, the answer was one. We are going in the wrong direction, so that needs to be addressed.
I also want to briefly touch on the palliative care needs of people with pre-existing severe and persistent mental illness. There is overwhelming evidence that people with severe and persistent mental illness are dying 15 to 20 years younger than the general population, due to a range of medical conditions. In addition to their mental illness, people with a comorbid life-limiting illness often also suffer from the compound issue of social isolation. They often have declining physical abilities and live with physical pain. Even though we know this is an issue, there is a lack of research and an evidence base on palliative care for people in the mental health system. These people are some of the most vulnerable people in our community, and they have greater barriers to accessing palliative care than the general community, and arguably need the most support. This is an area that needs greater attention.
I am aware that others wish to speak on this motion, so I may leave my comments at that point. I want to again thank the member for moving this motion. Death and dying are universal experiences, and supporting people to die well should be at the core of the priorities we have as a community. We are not doing well in this area. We need to do far, far better. Particular parts of our community are not receiving anything close to what we would expect to be a basic standard. I absolutely concur with concerns that to enable people to have genuine choice about what happens at the end of their lives, one of the choices that needs to and must be made available to people is the right to die without having their lives terminated early, but also to die with appropriate palliative care support.
Comments and speeches from various members
Amendment to Motion
Hon Dr SALLY TALBOT: With that, I move — To delete —
this state has the lowest number of publicly funded inpatient palliative care beds per head of population;
and substitute —
Western Australia needs more publicly funded inpatient palliative care beds;
Comments and speeches from various members
Amendment put and passed.
Motion, as Amended
Comments and speeches from various members
Question (motion, as amended) put and passed.