Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services

The Productivity Commission is the Australian Government's independent research and advisory body. It just released a report titled "Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services."

The report includes a chapter on end-of-life making several recommendations:

1. The Australian, State and Territory Governments should work together so that Australians can access end-of-life care that better matches their preferences. This will require governments to put greater focus on providing end-of-life care in the place where a person lives.

2. A significant increase in the availability of community-based palliative care is required. To achieve this, State and Territory Governments should:
− assess the need for additional services, select providers (typically using competitive processes) and adequately fund those providers
− establish standards for community-based palliative care services and fund the delivery of those services for people who wish to and are able to die at home. The standards should include integrated and coordinated nursing, medical and personal care
− ensure that monitoring frameworks and consumer safeguards are in place so that quality care is provided, and oversight is maintained, as the volume of services provided increases.

3. Available evidence indicates that the savings from avoiding a single hospital admission for palliative care (costing about $11 000) would more than cover the cost of providing community-based care over a period of months (costing between $6000 to $10 000).

4. People living in residential aged care facilities should receive end-of-life care that aligns with the quality of that available to other Australians. Delivering this will require the Australian Government to:
− remove current restrictions on the duration and availability of palliative care funding in residential aged care, so that clinical care is available to all residents at the end of life
− fund this additional care
− ensure that clinically trained staff hold timely conversations with aged care residents about their future care needs and preferences, and support residents to prepare an advance care plan if they wish to do so.

5. General practitioners and practice nurses could play a much larger role in helping people to articulate their preferences for end-of-life care through advance care planning. Changes to Medicare item numbers are needed to enable this.

6. The effectiveness of the above reforms will depend on governments implementing broader improvements to their stewardship of end-of-life care. This should involve the Australian, State and Territory Governments, through the COAG Health Council:
− co-operating to plan, fund, and set standards for end-of-life care so that patients receive high-quality care in each setting and in each jurisdiction
− developing and implementing an end-of-life care data strategy that establishes a national minimum data set for end-of-life care, and improves the accessibility and use of data
− commissioning an independent review in 2025 of the effectiveness of end-of-life care across all settings in which it is, or should be, provided.