1. Department of Human Services General Practice Victoria Palliative Care Workshop Jo Hall, Regional Palliative Care Consortium Support Cancer and Palliative Care Department of Human Services 6 August 2009

2. Overview How is palliative care provided and key data Service delivery framework Nurse Practitioner project Medical training program Policy review Clinical service improvement

3. Consortia regions Southern Region Consortium Eastern Region Consortium North & West Region Consortium Barwon South Western Region Consortium Gippsland Region Consortium Hume Region Consortium Grampians Region Consortium Loddon Mallee Region Consortium

5. How is palliative care provided in Victoria? Total palliative care funding is approximately $80 million per annum –$42 million to inpatient services – bed based, consultancy teams, day hospices –$35 million to community services – home based care, unassigned bed fund –$2.5 million to statewide services – direct care, advocacy, packages of care, bereavement –$1.0 million for academic appointments & centres –$0.84 million to Regional Palliative Care Consortia –Palliative Care Resource Allocation Model (PCRAM)

6. Key data Approximately 13,000 people receive specialist palliative care each year Of all Victorian deaths per annum (32,000) nearly 50% have a diagnosis that would benefit from a palliative care intervention Demand for palliative care is increasing at a rate of 4.6% per annum Cancer represents about 85% of pall care referrals Non-malignant conditions represent about 15 – 19% of referrals

7. Key data (cont.) Cancer incidence is increasing by up to 40% over the next 10 years due to ageing population Palliative care related diagnoses are growing at a faster rate than the total population 56% of people with a terminal illness would prefer to die at home In Victoria in 2007/08, 55% of palliative care patients died in hospital, while 28% died at home

8. Inpatient services 252 beds (57 rural, 199 metro) = 76,000 palliative care bed days Beds in hospitals and stand-alone facilities Bed day rate - $517 rural & $514 metro in 08/09 5,180 inpatient separations in 07/08 palliative care: The average length of stay is 14.7 days Palliative care consultancy teams

9. Inpatient bed days 07/08 & 08/09 YTD

10. Palliative care consultancy teams DHS funded palliative care consultancy teams in every metropolitan hospital Secondary consultation – supporting treating team Education and training Linking with community palliative care

11. Community services 39 community services In 2007/08: Over 8000 patients seen = 400,783 contacts. Face to face, assessment, nursing, case coordination, clinical care, consultancy, education, spiritual support, bereavement The average length of stay is 133 days Unassigned Bed Fund Day hospices Diversional activities, respite and assessments

12. Community – no. of patients & deaths 07/08

13. Place of death 07/08 & 08/09 YTD

14. Statewide services Victorian Paediatric Palliative Care Program (VPPCP) http://www.rch.org.au/rch_palliative http://www.rch.org.au/rch_palliative Motor Neurone Disease Association of Victoria (MNDAV) http://www.mnd.asn.au/ http://www.mnd.asn.au/ Australian Centre for Grief & Bereavement (ACGB) http://www.grief.org.au/ http://www.grief.org.au/ HIV/AIDS Consultancy Service Peter MacCallum Cancer Centre – Pain and Palliative Care Service Palliative Care Victoria (PCV) http://www.pallcarevic.asn.au/http://www.pallcarevic.asn.au/ Academic appointments and centres

15. Service Delivery Framework and Funding Model Review (SDFFMR) Objectives –Access –Acceptability –Appropriateness –Continuity –Effectiveness –Education and research

16. Service delivery model

17. Palliative Care Nurse Practitioner program Eleven auspicing health services Approx. 22 NP Candidates by 2011 Collaborative service models Endorsed by Palliative Care Consortia Rural - Ballarat Health, Barwon Health, Bendigo Health, Central Gippsland Health Service, and Northeast Health Wangaratta Metropolitan - Calvary Health Care Bethlehem, Northern Health, Peninsula Health, Peter MacCallum Cancer Centre, Southern Health, and St Vincent's Hospital

18. Rural Palliative Care Medical Purchasing Fund Implementation completed - key evaluation findings –Access to specialist palliative medicine consultations increased –Partnerships between metropolitan and rural services established –General practitioners’ capacity in palliative care has increased - 14 rural medical practitioners accessing medical scholarship fund for tertiary qualifications in palliative care Evaluation report available on DHS website

19. Statewide Palliative Medicine Training Program VCAP funding to support –Ongoing coordinating role through CPCER –Purchasing fund to secure mandated training rotations in oncology and community palliative care –Fellowship year and mentoring program –Governance group will be established Clear guidelines for accessing fund

20. Clinical Service Improvement Framework Increase capacity of palliative care services to develop a program of clinical improvement Aims to reduce variations in care Consortia lead Align with other projects and initiatives – SDF, NSAP, PCOC, VCAP Implement over 3 year period

21. Project approach Four key stages of project –Ascertain existing initiatives and identify key statewide priorities –Develop agreed measurement requirements –Statewide implementation workshops –Establish priority areas for improving care, ensure systematic framework is embedded in practice

22. Literature review Summary of common themes –Service delivery and patient outcomes –Symptom burden –Quality of life and quality of care Strong evidence - symptom burden negatively correlated with quality of life and patient satisfaction Improved outcomes facilitated by routine assessment and engagement in discussions to prepare for the end of life Outcome measurement requires systematic standards and criteria Consideration of tools for utilisation in diverse practice settings

24. Strengthening Palliative Care - aims Shifting the focus of care from cure to symptom control and quality of life Seeks to promote access to quality palliative care Ensure individual services part of integrated whole Strengthening specialist palliative care Articulates principles and planning goals

25. Strengthening Palliative Care - principles 1.Information about options and involvement in decisions 2.Carers supported by health and community providers 3.All have access to the palliative approach 4.Access to specialist palliative care 5.Coordinated and integrated care 6.Quality services and skilled staff 7.Supported by communities

26. Evaluation and refresh – Strengthening Palliative Care Policy What has/is working & where the gaps are “Initiatives take a long time to achieve /give things time to work” – Consortium Manager “Communication and good communication mechanisms are important” – Consortium Manager Development of consistent clinical tools “More focus on clinical areas” – Consortium Manager

27. Implementation of SDF and quality clinical improvement framework Continue regional and state planning “Stronger links with statewide services” – Consortium Manager “Capacity building within consortium” – Consortium Manager Links b/w specialist palliative care and generalist services/community “Relationship building very important” – Consortium Manager “Good relationships with Division of General Practitioners” – Consortium Manager Evaluation and refresh – Strengthening Palliative Care Policy (cont.)

28. Examples of supporting projects and initiatives Hospital training & development grants Rural medical & palliative care scholarships Palliative medicine coordination training program Palliative care academic, research and training centres Rural palliative medicine purchasing fund Hospital based palliative care consultancy teams Development of HBPCC Minimum Data Set Community palliative care performance measure and target setting Costing study in palliative care Decision making groups role statements Palliative Care Supplement (referral tool in SCTT 2009 revision)

29. Improving access to palliative care for people who have had a stroke ‘Developing the role of a pharmacist in community palliative care multidisciplinary teams to improve outcomes for people at home, and their carers’ After hours CPC policy and funding Victorian Palliative Care Satisfaction Instrument Indigenous palliative care project Paediatric palliative care policy & statewide service Motor Neurone Disease Packages of Care Health promoting palliative care Program of Experience Palliative Approach (PEPA) Examples of supporting projects and initiatives (cont)

30. Key documents and links Strengthening palliative care policy Service delivery framework Decision making groups role statements National Standards Assessment Program Palliative Care Resource Allocation Model Palliative Care Victoria Program of Experience in the Palliative Approach Rural Medical Purchasing Fund Service Coordination Tool Templates Unassigned Bed Fund Victoria’s Cancer Action Plan

31. For more information … Jackie Kearney, Manager, Palliative Care 9096 2143 or Jackie.Kearney@dhs.vic.gov.auJackie.Kearney@dhs.vic.gov.au Jo Hall, Palliative Care Consortia Support 9096 2138 or Jo.Hall@dhs.vic.gov.auJo.Hall@dhs.vic.gov.au Amanda Bolleter, Senior Project Officer 9096 2115 Amanda.Bolleter@dhs.vic.gov.auAmanda.Bolleter@dhs.vic.gov.au Ellen Sheridan, Senior Project Officer 9096 5296 Ellen.Sheridan@dhs.vic.gov.auEllen.Sheridan@dhs.vic.gov.au Greg Dalton, Senior Project Officer (currently on secondment) 9096 1459 Gregory.Dalton@dhs.vic.gov.auGregory.Dalton@dhs.vic.gov.au www.health.vic.gov.au/palliativecare

32. Abbreviations CPC – Community Palliative Care GPV – General Practice Victoria HBPCCT – Hospital Based Palliative Care Consultancy Teams HPPC – Health Promoting Palliative Care ICS/RICS – Integrated Cancer Services/Regional ICS MDS – Minimum Data Set NSAP – National Standards Assessment Program PCRAM – Palliative Care Resource Allocation Model PCV – Palliative Care Victoria PEPA – Program of Experience in the Palliative Approach RMPF – Rural Medical Purchasing Fund SCTT – Service Coordination Tool Templates SDF – Service Delivery Framework UBF – Unassigned Bed Fund VAED – Victorian Admitted Episodes Dataset VCAP – Victoria’s Cancer Action Plan VINAH – Victorian Integrated Non-Admitted Health