ACT News


The solution to cutting the cost of aged care is as simple as offering a cup of tea, palliative care expert Dr Julian Abel said

There is a promising solution to solve the burden of an ageing population on the Australian health system, and it's as simple as offering someone a cup of tea.

The compassionate communities approach, which started in Australia, is being touted as a success by UK palliative care expert Dr Julian Abel who visited the national capital this week as part of a lecture tour.

The initiative aims to foster stronger, healthier communities. While there have been plenty of similar prototypes in the past, this new model is the most promising yet.

And the proof, Dr Abel said, is in the pudding.

In his hometown in south-west England, the model has reduced hospital emergency admissions by 30 per cent across the population as a whole. If implemented across the UK it could see a five to six per cent reduction in total health care cost, he said.

The burden of ageing on the healthcare system is evident in the number of days "nursing home-type patients" occupied beds in Canberra Hospital. This rose 25 per cent in the past financial year to more than 10,000 – a figure double that recorded just four years ago.


Dr Abel said one of the main benefits of the new model was that it could be implemented anywhere.

And it's not just for palliative patients, it can also be used to help sufferers of chronic illness and others needing extra support and care.

Dr Abel said there are two components. Firstly, identifying vulnerable populations and asking them where and how they'd like to live, and in some cases where they want to die.

Secondly, asking the question of whether professional care is the best way to go.

Dr Abel said while up to 90 per cent of people say they'd like to die at home, in reality in Australia only about 16 per cent do.

"We know there are significant numbers of people, particularly outside the cancer setting, who are not being asked about where they want to die, or where would they like to live well until they die, and that's a tremendous problem," he said.

The concern is if the person decides to die at home, professional care is often not an option primarily due to the burden and the cost.

The cost to the community is greater if a person who doesn't have the right support has to live or die in hospital. An analysis by Medibank Private, the nation's biggest health fund, showed Australians are being admitted to hospital more often and at greater expense than ever before as the population ages and gets sicker.

The age-group driving the bulk of the rise in admissions is 55 years-plus.

The compassionate communities approach aims to engage everyone, from friends and family, to neighbours and work colleagues, to help out in one way or another.

"There is a huge untapped resource of community support," Dr Abel said.

In 2015 when Dr Abel's mother was dying, he rallied the troops. After researching the compassionate communities charter for years, it was time to see it in action, and first hand.

Dr Abel describes the discussion with his mother, when she decided not to undergo chemotherapy, of where she wanted to die. Initially when leaving hospital, her wish was to spend time at home before moving to a hospice, so she wouldn't be a burden on the family. But she changed her mind.

"While she was still in hospital, we set up a supportive network. We rang around people and said, 'Look, mum is terminally ill and she's going to come home, let's see what we can do to help'."

With the help of an electronic app, which Palliative Care Australia are in the process of creating themselves, the close family, about five people, took control of the hands-on care.

"Downstairs, there was a tribe of people doing stuff like shopping, cooking and cleaning," Dr Abel said.

"I actually only cooked one meal in that time, in a period of a few weeks."

"She was so comfortable and so content [at home], she said 'I think I'd like to die here'."

"It worked so well that there were enough of us to have a shift system at night for the last few days of my mum's life, which meant that my step dad could sleep in another room. He was quite elderly, just having him do the caring you can see how quickly, if there were disturbed nights, that he would lose his own health."

Dr Abel described the experience, while in a very sad circumstance, as "life-enhancing" for everyone involved.

He said the key message for carers was to say yes.

"If someone says, 'I'm really sorry to hear about your illness, is there anything I can do to help', and people say no, they're managing fine, that is the opposite of network building. That is how you collapse networks," Dr Abel said.

"By the time somebody has asked three times if they can help they no longer know what to say and cross the street, rather than be caught in that situation again."Even if it's just asking for a litre of milk, when you've already got plenty, Dr Abel said.

When that person comes back with the milk, they might sit down and have a cup of tea.

"It helps on so many different levels. Maybe you just talk about how frustrated you are with Donald Trump, or maybe you talk about the hardships of being a carer."

Palliative Care Australia CEO Liz Callaghan said the Canberra community was better than other capital cities at rallying around people in need.

"We are a very caring community," she said.

But the compassionate communities model takes that a step further, by implementing a successful model to get the support networks initiated.

"The infrastructure around the primary health networks is a really good place to start, and in Julian's model in the UK, the GP practises there identified vulnerable populations that they could help network and identify those networks. That's the first step."

"I think there are pockets all over the country of small communities coming together and realising they want to do something different," Ms Callaghan said.

It all comes back to that cup of tea, Dr Abel said.

"The central thing is to sit down and have a cup of tea."

"Sitting around, talking over a cup of tea is a way people gather together and share what's happening and how you can support them."

He said that single action was akin to planting a seed and allowing it to grow.

"You're not going to suddenly have a great tree when you put the seed in, but you have to start somewhere and then nourish it and let it grow and the compassionate communities network is all about how you do that."