This review is a five-year revisit of the Health Performance Council’s 2013 report, Improving end of life care for South Australians. The 2013 work was a midpoint examination of the implementation of SA Health's palliative care services plan 2009-16, which outlined the South Australian government’s commitment to expand and reshape end-of-life services in the state.
The Health Performance Council finds that achievement of South Australia’s palliative care services plan 2009-16 has been uneven across the state.
Despite the early impetus to establish a sustainable, consumer-centred and centrally coordinated model of end-of-life care, progress in achieving the 2009-16 plan and its goals has stalled. The four objectives identified in the plan – improved health and wellbeing outcomes, person-centred care, more care in the community, and consistent service delivery – have been achieved only in part. Excellence in end-of-life care can be found in South Australia’s public health system, within local health networks and work units, and among individual staff. Consumers regard highly the expertise and compassion of palliative care specialists. New advance-practice roles and regional and integrated service units, operating from the metropolitan local health networks, have centralised expertise and resources. There has also been some expansion of community care, including through the use of extended care paramedics. But almost two years after the plan’s conclusion, there is much undone.
The lack of implementation progress is due to factors such as contested resources, service variability between local health networks, and the absence of central coordination and governance. Confusion about the plan’s strategic intent, desired outcomes and explicit priorities also contribute.
For consumers, families and carers, the lack of action can have real and significant impacts: less community-based care than was promised, continued high levels of hospitalisation and acute care treatments, more pressure on carers, more disruption for consumers as they move between systems, delays in receiving care, and inconsistent quality of care.
Evaluation of the plan’s achievements has in some cases been difficult, and in others impossible. Of critical concern is the paucity of, and lack of access to, SA Health data on end-of-life care in South Australia. The Health Performance Council can only conclude that, in many cases, the state-level data that would justify additional funding and other resources, and establish benchmarks for future assessment, does not exist. The degree to which data and evidence do inform current end-of-life policy and planning in the state should also be questioned. For example, the Health Performance Council sought data on whether proposed increases to resources and staffing had occurred, but there was insufficient data available for it to reach a conclusion. In many areas, in fact, the Health Performance Council has been unable to draw reliable, evidence-based conclusions on health and wellbeing outcomes for consumers, families and carers.
In late 2018, SA Health made available on their website a new End of Life Care Strategy that includes many activities to improve services and care for South Australians, and the late 2018 South Australian State Budget allocated addition money to palliative care support. The Health Performance Council hopes this review will support the new strategy’s implementation and shape spending of the new funding allocation to offer best value to South Australian consumers.