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End-of-life care among six human service areas flagged for reform


People would have a greater say over where and when they receive end-of-life care through increased competition in the delivery of services under proposals being considered by the Productivity Commission.

Access to high quality end-of-life care varies within and between jurisdictions while indigenous Australians, those from culturally and linguistically diverse backgrounds and people with illnesses other than cancer are particularly underserviced, according to a new report from the commission.

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The Productivity Commission’s report

The Commonwealth tasked the commission with investigating whether the efficiency and effectiveness of the government’s human services could be improved by introducing greater competition and user choice.

Introducing these conditions could improve outcomes for some but not all human services, the commission found in the report, the first part of its inquiry, which was published on Sunday.

The commission identified six priority areas – social housing, public hospitals, public dental, services in remote Indigenous communities, end-of-life care and government-commissioned family and community services – that it said were best suited to deliver improved outcomes in a more competitive environment.

Well-designed reform could improve quality, increase access and give people a greater say over the services they use and who provides them, the commission said.

However, it said reform must be underpinned by strong government stewardship, citing Australia’s recent disastrous experience with the vocational education and training FEE-HELP scheme as an example of failed policy in the area.

With 26 services in scope of the inquiry, residential and home aged care services did not make the priority list but were among those which the commission said could benefit from this type of reform.

For those nearing end of life, the commission said preferences could be better satisfied and outcomes improved if people were provided with more choice about the timing and setting of end-of-life care.

This could include extending access to high-quality care in different settings and introducing greater  competition as part of a broad suite of reforms.

Achieving improved outcomes would require deeper integration of end-of-life care within existing models, including aged care facilities, it said.

Advocates agree action needed

Palliative Care Australia CEO Liz Callaghan agreed more could be done to ensure Australians received the right end-of-life care, in the right place at the right time.

“Access to high quality end-of-life care, including access to specialist palliative care for those with complex symptoms is critical in supporting these people to maximise their quality of life, right up until the end of their life.” Ms Callaghan said.

She said PCA was calling for greater investment in specialist palliative care, so that all who would benefit could access it.

“People missing out include some people living in rural areas and in aged care facilities, it includes some Aboriginal and Torres Strait Islanders and people from culturally diverse backgrounds, as well as people with dementia and other non-cancer life-limiting conditions,” Ms Callaghan said.

Alzheimer’s Australia acting CEO Maree McCabe said the commission’s finding that greater competition and user choice would not lead to improved outcomes in all human services was significant in the context of people living with dementia.

“There are inherent risks in focusing too heavily on increasing competition and contestability in service provision to people living with dementia,” Ms McCabe said.

“Any moves towards greater competition and contestability must ensure access and equity for vulnerable members of our community.”

The commission’s final report outlining recommendations will be handed to government in October 2017.

Access the report here.

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