A National Strategy for Palliative Care
The provision of palliative care is supported by five guiding principles:
- The focus of palliative care is the person who is dying and their family/whanau.
- All people who are dying should have access to quality health care. Their rights to appropriate and accessible care are the same as those who are being treated for non-terminal conditions.
- Each person's uniqueness, culture and autonomy must be respected.
- Palliative care affirms and encourages the quality of life of each individual.
- Palliative care requires a multi-disciplinary approach to achieve total care of a person who is dying.
Currently, about 90% of people known to be accessing palliative care services in New Zealand have cancer. It is estimated though, that the needs of people dying from non-malignant disease could be as great as for those dying of cancer. There are currently 37 hospice and palliative care services in New Zealand, the first three hospices being established in 1979. Each service in New Zealand has a different configuration but generally services comprise a range of elements eg. in-patient care, home-based care, bereavement care, volunteer co-ordination, advice, education and research.
The discipline of palliative care is developing in New Zealand as in many other countries. However, the growth of palliative care services has predominantly been driven by public interest. This has resulted in a diversity of organisational and funding arrangements, with hospices ranging from local community based services run entirely by volunteers to specialist palliative care units offering a broad range of clinical expertise as well as education, research and quality improvement programmes. Despite the rapid growth and great public support, there are still many New Zealanders without reasonable access to a comprehensive hospice service, therefore denying some people who are dying an opportunity to make an informed choice about their care.
In 1992, the Government recognised that there had been limited central planning of palliative care services, and charged the Core Health and Disability Support Services Committee with collecting information and providing advice. The report recommended that hospice services be given priority by regional health authorities over the next two years. The following year the Ministry of Health published the report of a Consensus Forum on Hospice/Palliative Care Services. Other reports were produced over the following years and finally in 1998, the New Zealand National Advisory Committee on Health and Disability (National Health Committee) established a Working Party on the 'Care of People who are Dying'.
During 1999/2000 an advisory group, comprising members with differing areas of expertise in palliative care, drew on that previous work, and with the Ministry of Health, Health Funding Authority and National Health Committee produced a report "The New Zealand Palliative Care Strategy". This discussion document set in place a systematic approach to the future provision and funding of palliative care services.
In summary, the strategy acknowledges that there is a fundamental need to raise the profile of palliative care amongst communities and health and disability providers. The report proposes a set of publicly funded essential services that will include multi-disciplinary assessment (initial and ongoing), care co-ordination, advisory and education services, clinical care and support care. It acknowledges the key role of primary health care, and proposes a flexible configuration that builds on existing services incorporating two inter-linked levels of palliative care provided throughout the country; specialist palliative care services providing specialist advice, maintaining links with the tertiary hospitals, and local palliative care centres provided by each District Health Board. Each District Health Board will have access to specialist palliative care services, and these services will be linked nationally.
Strategies have been developed which will be implemented over a 5-10 year period in order of priority and will link with the overall New Zealand Health Strategy. Early priority will be given to the provision of essential core services, the development of local palliative care services and the provision of specialist palliative care services co-located with tertiary hospitals.
Despite the evidence that palliative care is effective in improving the quality of life for people who are dying, it is still poorly understood by many health professionals. Despite huge support from the public many people still see the focus of hospice care as dying rather than living. The development of a strategic approach to the provision of care for people at the end of life will surely help New Zealanders to better understand the needs and wants of people at the end of life. The provision of effective care at the end of life is a social obligation as well as a personal offering for those involved. The New Zealand Palliative Care Strategy gives us all an opportunity to see that we meet that social obligation and provide care for people, whoever or wherever they are, in an effective and compassionate way.
 Ministry of Health. The New Zealand Palliative Care Strategy; discussion document. Wellington: Ministry of Health, 2000.
(also available on the Ministry of Health website: http//www.moh.govt.nz)
Dr Rod MacLeod is Director of Palliative Care, Mary Potter Hospice, Wellington