Monday, March 26, 2018

Let Australians die as they want to, says PC

Tens of thousands of terminally ill Australians are dying in hospitals when they would rather be dying at home, a highly critical Productivity Commission report has found.

A wide ranging inquiry into ways to introduce competition and informed user choice into human services has found that most people want to die in surroundings that are familiar to them, surrounded by their family. Instead they are often rushed to hospital, even though it would be cheaper and more dignified to treat them where they lived.

“Aged care facilities are Commonwealth government funded and the Commonwealth considers palliative care a state funding issue, so aged care facilities receive very little funding for palliative care,” inquiry chairman Stephen King explained.

“It means that if you are in an aged care facility, and you are getting towards the end of life and need an intervention, you will most likely be popped in an ambulance and sent off to hospital.”

“Western Australia is the gold standard. It does state-funded well. Nurses visit homes and family members help with the care. It’s cheaper to set up in homes than in capital-intensive hospitals. After Western Australia it goes rapidly downhill. It wouldn’t be hard for all states to do as well as Western Australia and for the Commonwealth to fund palliative care in nursing homes.”

The report recommends that doctors encourage patients having their "70 plus" health check to create an advanced care plan that spells out ahead of time whether they would like to be revived after death or kept alive artificially. The plans should be updated within two months of entering an aged care facility.

The Commission also recommends that health insurance regulations be amended to make clear that patients can choose their own specialists rather than the ones their general practitioners refer them to. The right is already enshrined in law, but many GPs and specialists are unaware of it.

The MyHospitals website should be transformed into an information source on the performance of hospitals and specialists to make choice meaningful.

Dr King said that when Britain required the publication of of data on results, many poorly performing specialists left the profession or lifted their performance.

Many Australians were unaware of their right to public dental services and scared off by long waiting lists. The report recommends that states shorten waiting lists by contracting private dentists to perform services, which would result in earlier interventions and reduce the need for more expensive interventions later.

It recommends that Commonwealth rent assistance be extended to public housing tenants and that states contract out the provision of some public housing to private providers.

The inquiry was commissioned by Treasurer Scott Morrison. The government is considering its response.

In The Age and Sydney Morning Herald