Palliative Care Crisis: Expert Concerns over Proposed Cuts in New Zealand

New Zealand faces a significant challenge in its palliative care sector, as proposals to disestablish key national roles could severely impact the quality of end-of-life care for terminally ill patients.

Specialists’ Perspective

Dr. Catherine D’Souza, the chairwoman of the Australia New Zealand Society for Palliative Medicine Aotearoa and a palliative medicine specialist, emphasizes the critical role of trained specialists in managing pain and symptoms effectively.

These specialists play a vital role in keeping terminally ill Kiwis out of hospitals and instead supporting them to receive care at home or in hospices.

D’Souza warns that if the proposed cuts go ahead, “huge amounts of public money” would be spent on hospital admissions for people with “nowhere else to go,” highlighting a potential waste of resources and compromised care quality.

Advocate’s Concerns

Dr. Denise Aitken, a key figure in Rotorua’s palliative care services and the Bay of Plenty DHB Oncology department, shares her deep concerns over the proposed changes.

In an interview with the Rotorua Daily Post, Aitken reported a “significant” number of deaths in hospitals and diagnoses likely to result in terminal conditions.

Aitken’s role extends beyond managing patients’ symptoms to planning their future care, particularly in collaboration with oncologists.

In 2017, Aitken pursued additional training in palliative care because of her convictions about the “desperate need for more support in this field.”

She hoped that the development of a national palliative care strategy would address existing “long-standing inequities.”

Aitken expresses reservations about shifting the primary responsibility of palliative care to general practitioners, arguing that this could exacerbate existing disparities in access to specialist care across different regions.

For instance, Tauranga’s health services are more robust, featuring an in-patient hospice unit and a palliative care consultation service with multiple specialists.

Conversely, Te Whatu Ora Lakes has limited access to specialist palliative care, with only a single nurse specialist.

This disparity can lead to inadequate pain management and delayed access to critical care, causing suffering for both patients and their families.

Impact on Equity and Quality

D’Souza predicts that the proposed cuts will constitute “a massive step backwards” in maintaining equitable and high-quality healthcare for New Zealanders with terminal illnesses.

The increasing number of Kiwis requiring palliative care, attributed to aging populations and extended survival times with serious illnesses, underscores the urgency of addressing these disparities.

Without strategic forward planning, the government risks deepening inequalities in palliative care access and ensuring that patients do not receive the necessary support to alleviate suffering in their final days.

Health NZ’s Response

Health NZ Te Whatu Ora’s community and mental health co-director, Debbie Holdsworth, avers the organization’s commitment to fostering a sustainable future for New Zealand’s healthcare system.

Holdsworth acknowledges the consultation proposals released last year as preliminary suggestions and emphasizes the ongoing recognition of palliative care’s importance.

She encourages staff and unions to provide feedback, which will be carefully considered before final decisions are made.

Holdsworth asserts that any ultimate decision will be communicated transparently to stakeholders.

Referral Trends

Figures from Rotorua Hospice reveal a consistent trend of rising referrals for palliative care services over the past few financial years:

• 353 referrals in 2023/2024
• 493 referrals in 2022/2023
• 424 referrals in 2021/2022
• 456 referrals in 2020/2021

Health NZ, however, did not provide specific figures on palliative care access in the Lakes region annually prior to publication.

Conclusion

The proposed cuts in New Zealand’s palliative care sector threaten essential services critical to terminal patients’ well-being and could reverse years of progress in improving end-of-life care.

Expert opinion uniformly criticizes the plan, emphasizing the importance of specialist palliative care roles and the potential for increased suffering among vulnerable populations.

Health NZ continues to seek stakeholder feedback, offering a pathway to address these concerns and refine their proposals.

We invite our readers to share their thoughts on this matter, contribute to potential solutions, and help advocate for higher standards of palliative care in New Zealand.

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