ACT Health officials have revealed they are looking at setting up a palliative care ward in the Canberra Hospital, after damning evidence was given to a parliamentary committee of a system stretched beyond capacity.
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Territory politicians were told on Friday of doctors who did not know how to talk about dying, gaps in the aged care system and a shortage of palliative care beds and staff on the sixth day of hearings in the ACT's end-of-life choices inquiry.
While the inquiry was set up in the wake of Victoria's legalisation of voluntary assisted dying, its focus has most recently turned to the problems with the provision of palliative care in Canberra.
Chair of the ACT Palliative Care Clinical Network and the director of palliative care at the Canberra Hospital Dr Michael Chapman told the committee training more medical professionals to speak with patients and their families about dying was “an absolutely critical need of focus”.
He acknowledged recognising the need for palliative care could be difficult, and those conversations daunting.
Dr Chapman said while he was trying to build those skills within the hospital workforce, and there had been a "general recognition" it was important, "at the moment there’s not a lot of resourcing and support and attention".
He said there were only four palliative medicine specialists in the ACT, despite the 2013-2017 plan for the sector suggesting there should be eight.
"The current peak body recommendation from Palliative Care Australia for 2018 now suggests there should be two [full-time equivalent positions] per 100,000 of population for palliative medicine specialists to be able to provide best care, or perhaps more considering we treat many more people in the ACT," Dr Chapman said.
"A summary of that blurb would be to say we are on all accounts underresourced for palliative medicine specialists in the ACT."
However Health Minister Meegan Fitzharris disputed the figures.
"My advice is we are currently at 1.9 [specialist physicians] per 100,000 of the population and also have the second highest rate of palliative care nurses with 14.9 per 100,000," she told the committee.
Dr Chapman also said home-based and community-based palliative services were "stretched and aren't able to provide the best care" and beds often weren't available at Clare Holland House, the only in-patient palliative care service in Canberra, because of short-staffing.
"I understand the occupancy rate of that service is often around 80 per cent and so often there’s capacity in that facility in terms of physical beds, though staffing for those beds is perhaps more of an issue," Dr Chapman said.
A more pressing issue was the void of palliative care beds in an acute setting, he said.
"There’s consultation palliative care services which I run at the Canberra Hospital but there’s no availability for a person who has acute needs, who also needs specialist palliative care, for them to be in a palliative care bed in the acute hospital," Dr Chapman said.
There were also gaps in the provision of palliative care in aged care homes, although Dr Chapman said staff were "trying very hard, and very creatively" to do the best with what they had.
He said it was not a matter of throwing more money at the problem, but rather finding a new way to provide palliative care in conjunction with agencies outside the health sector.
ACT Health's executive director for cancer, community, and ambulatory health services Denise Lamb told the committee a new model of care for palliative patients would be implemented over the next 12 months that would have a greater emphasis on a network of care rather than solitary providers.
"With regards to the specialist ward, certainly we are exploring, looking at what that might look at from the perspective of a palliative card ward or end-of-life ward," Ms Lamb said.
