1. Australian Government Department of Health Update
End-of-life care workshop
22 May 2017
Dr Annie Dullow – Director Palliative Care

2. National Policy Context
National Palliative Care Strategy (2010)
COAG Health Council – Focus on end-of-life care
Consensus Statement – Essential elements for safe, high quality EOLC
Advance Care Planning - My Health record
Health Care Homes / Bilaterals
Primary Health Networks – Budget measure
Workforce - data
Emerging policy/funding

3. Palliative Care in Australia
The Australian Government provides financial assistance to states and territories to support them to operate palliative care services as part of their health and community service provision responsibilities.
In addition, the Australian Government funds a range of national palliative care projects primarily focussing on education, training, quality improvement and advance care planning, aged care and provides funding for palliative care through the Pharmaceutical Benefits Scheme and the Medicare Benefits Schedule.

4. World Health Assembly – Strengthening Palliative Care (2014)
Resolution WHA Calls for Member states to:
develop, strengthen and implement, where appropriate, palliative care policies to support the comprehensive strengthening of health systems to integrate evidence-based, cost- effective and equitable palliative care services in the continuum of care, across all levels, with emphasis on primary care, community and home-based care, and universal coverage schemes;
Guides our strategic policy and program development

5. National Palliative Care Strategy
Four Goal Areas:
Awareness and Understanding
Appropriateness and Effectiveness
Leadership and Governance
Capacity and Capability.
Awareness and understanding - There is a need to significantly enhance the understanding of dying, death, grief, bereavement and loss in Australia, including in health professionals and carers, to support better access to appropriate, timely services across the end of life continuum. Building awareness and understanding must be undertaken in a culturally respectful way.
Appropriateness and Effectiveness - Appropriateness is about ensuring the right approach, in the most suitable setting in a timely manner. Appropriateness requires good systems and processes to support access to information and services. This is critical to the provision of high quality palliative care. Effective care is also about providing those interventions which are supported by an evidence base and providing them effectively and efficiently. Appropriate and effective care systems need to be supported by a strong research base and services that have good systems and cultures of quality improvement.
Leadership and Governance - Governance is key to implementation and overall improvements in care quality and people’s experience of end-of-life care
Capacity and Capability - High quality palliative care requires adequate capacity and capability. In essence that means sufficient numbers of appropriately skilled people in the right place with adequate systems to support safe, quality care.

6. National Palliative Care Strategy
Evaluation completed in 2016 (Report)
The Report recommended that the Strategy be updated to reflect the changing environment in palliative care since 2010, and to improve the Strategy’s position as a mechanism to drive national, jurisdictional and service delivery activity.
Urbis has been engaged to update the Strategy, which will be done in collaboration with PCA, state and territory governments and will be informed by a wide and comprehensive national consultation.
The draft revised Strategy for public consultation is scheduled to be released in June 2017.

7. COAG Health Council Excerpt from Communique October 2016
End of life strategic discussion Ministers agreed that it is important that all Australians should experience optimal end of life care and that their preferences and values are recognised and respected in their end of life care. Ministers requested that the Australian Health Ministers Advisory Council (AHMAC) provide advice on actions to improve culturally appropriate end of life care including through:
pre-service and continuing education
raising community and clinician awareness and engagement
support end of life care conversations happening in primary care and a wider range of community settings such as aged care
examining opportunities to have a common language and tools to support good practice.

8. ACSQHC – Consensus Statement
Pivotal role in improving quality of care
End of life Essentials – a project funded through – National Palliative Care Project funding.
This project provides e-learning opportunities and resources for doctors, nurses and allied health professionals to improve the quality and safety of end-of-life care in hospitals.
There are clear links with the Consensus statement and the CHC EOLC Project.

9. Advance Care Planning
AHMAC endorsed the National Framework for Advance Care Directives in 2011.
Advance Care Directives can be uploaded to My Health Record.
Data at 9 April
Further information
Advance Care Directive Custodian Report
12,942
Advance Care Planning Documents
922
State and Territory Governments are responsible for both legislation relating to advance care planning and substitute decision making and, as health system managers, for implementing advance care planning policies and practices within their jurisdictions. Legislation relating to advance care planning and substitute decision making varies between jurisdictions.
Stats at 9 April 17:
Advance Care Directive Custodian Report
12,942
Advance Care Planning Documents
922

10. COAG Commitment
Commitment to progress enhanced coordinated care for patients with chronic and complex conditions.
To be progressed through bilateral agreements.
Bilaterals developed in parallel Stage 1 of HCH model, and will complement relevant HCH activities.
Results of evaluations of bilaterals and HCHs will inform COAG advice in early 2019.
COAG committed to progressing enhanced coordinated care for patients with chronic and complex conditions in the April 2016 COAG Heads of Agreement on Public Hospital Funding.  
This commitment is being progressed through bialteral agreements….
States and Territories are working with the Commonwealth to develop and finalise bilateral agreements that set out jurisdiction-specific coordinated care reform activities, for implementation from 1 July 2017. 
The activities identified within the bilateral agreements will build on and support the existing investments in infrastructure, governance systems, and service programs and initiatives that already support patients with chronic and complex conditions. 
The bilateral agreements are being developed in parallel to the implementation by the Commonwealth of the first stage of the Health Care Home (HCH) model in primary health care which will commence in selected Primary Health Network regions from 1 July 2017, and will complement relevant activities associated with HCHs, taking a flexible approach to build on existing and planned investments and innovations.
Results of evaluations of bilateral agreement activity and HCH activity will be drawn together to inform advice to the Council of Australian Governments (COAG) in early 2019 through the COAG Health Council, for further consideration of a joint national approach to enhanced care coordination for patients with chronic and complex conditions.
22 November, 2018

11. Agreed priority areas for coordinated care reforms
Core common characteristics (all bilaterals):
Data collection and analysis;
Care coordination services; and
System integration.
Examples of priorities that could be a focus :
Aged care integration;
Multidisciplinary team based approach;
End of life care;
Mental health; and
Rural and remote service delivery.
Through the core common characteristics and priority areas, the bilateral agreements will support the development of a joint national approach to enhanced coordinated care, while also providing flexibility to address local needs and priorities.
The CCWG has agreed that three core common characteristics, representing the underlying infrastructure necessary for collective coordinated car, will be included in all agreements. These are:
Data collection and analysis;
Care coordination services; and
System integration.
The CCWG also agreed that the following are examples of priorities that could be a focus for activities implemented under bilateral agreements include:
Aged care integration;
Multidisciplinary team based approach;
End of life care;
Mental health; and
Rural and remote service delivery.
22 November, 2018

12. Primary Health Networks
National network of 31 organisations to
improve medical services for patients at risk of poor health outcomes; and
improve the coordination of care, particularly for those with chronic and complex conditions.
Work directly with general practitioners, other primary health care providers, secondary care providers and hospitals.
In February 2017, over 50% of PHNs proposed at least one activity for the financial year which related to the provision of palliative care.
May 2017 – Greater choice for at home palliative care – Budget measure announced.
NOTES / TALKING POINTS
On 1 July 2015, 31 Primary Health Networks (PHNs) were established to increase the efficiency and effectiveness of medical services for patients.
PHNs are a national network of independent primary health care organisations with the objective to improve the efficiency and effectiveness of medical services for patients at risk of poor health outcomes and to improve the coordination of care, particularly for those with chronic and complex conditions.
PHNs will achieve these objectives by working directly with general practitioners, other primary health care providers, secondary care providers and hospitals to facilitate improved outcomes for patients.
Each PHN develops an Activity Work Plan each year which specifies how it aims to achieve the programme objectives across its region and for each specific policy stream of work. The activity priorities for the activity work plan are determined by a PHN through its regional needs assessment, which draws on an analysis of population health data and stakeholder views on service gaps, major health concerns and system capacity issues.
For ,  17 of the 31 Activity Work Plans for PHN core funding included at least one activity that was relevant to palliative care.  As an example, these activities can range from service system re-design to support access to palliative care in metropolitan areas, to the provision of care coordination services to support the needs of rural palliative care patients, and the provision of educational resources to primary health practitioners to support sharing of advance care plans and end of life care preferences between hospitals and primary health care providers.

13. Workforce data
Nationally, there were 192 specialist palliative medicine physicians and 3,269 palliative care nurses in 2014 (0.8 and 12 full-time-equivalent (FTE) per 100,000 population respectively).
The highest rates for specialist palliative medicine physicians and palliative care nurses were evident for Major cities (1 and 13 FTE per 100,000 population respectively).
In 2014, over 3 in 5 (63%) employed specialists palliative medicine physicians were female which is more than twice the proportion of all employed medical specialists (29%).
About 4 in 5 (80%) employed specialist palliative medicine physicians worked in a hospital setting, compared to about half (49%) of employed palliative care nurses.
This information was last updated in May 2016.
While there are data for specialist palliative care workforce there are no data regarding PHC, Community care to understand gaps and to inform planning for non-specialist services.

14. Under development
Data - AIHW have undertaken an analysis of data gaps - early planning phase
EOLC project in Strategic policy area of the department.
Awareness and understanding – based on a national survey, in development phase for a range of communications activities from July.
Best practice in general practice – early planning phase to publish and take forward research findings.
Grants – in progress for funding from July 2017
A recent survey commissioned by the Department of Health found that 76% of the Australian population have never heard of ACP. Even among those who claim to be knowledgeable, there are still many misperceptions and misinformation. Preliminary findings from a research project into the awareness and understanding of palliative care, EOLC and ACP within general practice has shown that there is confusion amongst some GPs about whose role it is to raise the topic of ACP, with some GPs believing it is that of the patient

15. Gaps?? Concerns?? Questions?? Thank you Annie.dullow@health.gov.au
Further information