Salina Iupati, a PHD candidate researching community specialist palliative care services in Aotearoa, has recently completed a survey of all 32 hospices to understand the range of community hospice care and service they provide and the populations they serve.
You can read the results of the survey, published recently in the NZ Medical Journal.
We asked Salina to discuss her study with us at Te Kahu Pairuri o Aotearoa / Hospice New Zealand.
Why motivated you to do this survey?
We know the new health reforms are calling for more equitable and accessible healthcare delivery for everyone in New Zealand. To re-design a system that is more sustainable and equitable starts with a stocktake of what exists now. I wanted to identify areas of gaps and inequity in the hospice model to help inform the wider health reforms.
What were some of the highlights about community hospice care you found in this survey?
Holistic, at- home care and delivering education are highlights of our hospice model.
We can take heart from the fact that every hospice is providing holistic and at-home care for patients. This holistic care, a cornerstone of palliative care, is a wrap-around of symptom management, family and carer support and bereavement care. Hands-on, end of life care that is being delivered in people’s homes by multi-disciplinary teams is making the difference to patient outcomes and is keeping people out of hospital beds.
We also do well as education providers. Most hospices offer specific education sessions onsite and have liaison staff who provide education on palliative care to aged care staff, along with GPs, nurses and as early training for medicine. But only nine hospices in the country are actual specialist palliative medicine training sites. Given that we already have a workforce shortage and the demand for palliative care is projected to increase substantially in the next 20 years this number is potentially inadequate to meet future demand.
What other areas for improvement did you find?
Māori cultural liaison, after-hours care and community services for children
Fifteen hospices do not have a Māori cultural liaison staff member. Although the majority of hospices do offer Māori cultural competence training, the varying availability of Māori liaisons or their equivalent is a gap to address. Health equity is a priority of our new health reforms and to see only this small number of hospices engaging actively with local Māori providers, indicates that further work in this area is needed. Hospices have this beautiful resource, Mauri Mate, a Kaupapa Māori palliative care framework that gives guidance to ensure adult Māori receive access to good palliative care. It is a gift that needs to be widely shared and acted on.
Only 19% of hospices are currently able to provide any afterhours care (direct or via telephone). This is potentially concerning, given that round the clock access to palliative care, including specialist care is a key element when it comes to enabling end of life care at home.
Ensuring children who need specialist palliative care get access in their community is challenging and it would be better if more hospices were involved. Only one hospice in the country provides specialist children services. Otherwise, terminal ill children must go to Starship Hospital, Auckland which works as the national resource service to collaborate with the child’s primary paediatric team and local adult specialist palliative care services
Any other thoughts on how our palliative care model of the future might do better for people?
We need models that can be locally flexible and where there is more integration of the specialist hospice care into the primary GP service so people needing palliative care can access it more easily. As our population ages, we are facing more complex and chronic conditions including dementia. A mix of primary and specialist health care in the community is the going to be the most cost effective way to meet our future health challenges. Success of such model however would depend on having enough GPs with the time and training to deliver a palliative care approach. For example, the availability of a primary care team doing home visits or longer appointment time as required.
This survey was the second part in Selina’s study. The final part of her thesis involves interviewing hospice service and clinical leads for their views on what a future, sustainable model for specialised palliative care might look like and how prepared our system is for this future state.
