Neglect is killing hospices
Assisted dying is fully funded by the Government, so why isn’t palliative care, asks Danielle van Dalen.
Earlier this year the Spinoff’s Bulletin warned that ‘‘Hospices may need to reduce services or shut down altogether’’. This would be a tragedy indeed. But as dire as it sounds, the reality is much worse.
I’m no medical professional. But over the past few years, I’ve spent a lot of time researching the state of end-of-life care in our nation. I’ve learnt that hospices are not, as many believe, simply a place to die.
Rather, they provide palliative care that prevents and relieves suffering . . . whether physical, psychosocial or spiritual, right through the end of life. The more I researched and spoke with carers, the more I fell in love with the palliative approach.
Palliative care services are not currently receiving the funding they need. Wayne Naylor, Hospice NZ’s acting chief executive, says its annual costs have grown by more than $41 million since 2017, while government funding has increased by only $18.8m. It receives only partial government funding and must rely on charity cake sales and op shops.
It needs to fundraise at least $77m a year to survive – increasingly difficult in times of lockdown and retail restrictions, as well as rising costs of living.
In stark contrast, the End of Life Choice Act, which allows people to be assisted to die, is fully funded by the Government.
Palliative care is also an essential service in hospitals, homes and residential aged-care facilities. Tragically, it’s also struggling in these places. Over the past few months, I’ve spoken with a number of hospital-based palliative physicians, and their stories echo those of Hospice NZ. In fact, although many New Zealanders die in hospitals, some hospitals still have no specialist palliative care presence at all.
All this means too many New Zealanders are unable to access the end-of-life care they need to die well. Currently, where we live (in a major city versus rural areas) and who we are (our socio-economic and cultural background) plays a big role in determining whether or not we have access to palliative care. This is neither right nor fair.
With a population that is rapidly ageing, this problem is only going to grow unless we make some significant changes – and fast. Projections from 2011 by Health Workforce NZ suggested that ‘‘the number of people requiring palliative care will increase by nearly 25% over the next 15 years and will be just over double that by 2061’’.
In spite of this growing need – and the big structural changes to our health system – the Government has shown it is completely uninterested in making improvements to funding or access to end-of-life care services.
In fact, palliative care advocates and physicians have told me of their frustrating attempts to engage with politicians and the Government’s seeming lack of interest in even listening to the issues.
Raising the profile of palliative care and closing the funding gap are simple and important first steps for politicians and policymakers. We need to see an attitude change that is followed by action. Our politicians need to affirm the excellent care our palliative care services provide for those who can access it, and make a concerted effort to ensure their long-term survival.
Last year I released a Maxim Institute discussion paper Ending well: The urgent case for accessible palliative care. One of my recommendations highlights the need for increased and targeted funding, to ensure all hospitals have provision for palliative care.
Moreover, with targeted funding increases in areas that struggle to reach sufficient fundraising goals, people who live in regions like the West Coast might finally have access to palliative care services.
Shutting down or winding up hospice services would be a tragedy. And yet it seems that our politicians would rather focus on a health system where ‘‘all New Zealanders live well, stay well, get well’’.
These are good priorities for any healthcare system. But they ignore that people must also have the opportunity, when the time comes, to die well.