The Auditor-General for New South Wales Margaret Crawford has released her report, in which she finds that NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.

“NSW Health has a limited understanding of the quantity and quality of palliative care services across the state, which reduces its ability to plan for future demand and the workforce needed to deliver it,” said the Auditor-General. “At the district level, planning is sometimes ad hoc and accountability for performance is unclear.”

Local Health Districts’ ability to plan, deliver and improve their services is hindered by:

• Multiple disjointed information systems and manual data collection.
• Not universally using a program that collects data on patient outcomes for benchmarking and quality improvement.

NSW Health should create an integrated policy framework that clearly defines interfaces between palliative and end-of-life care, articulates priorities and objectives and is supported by a performance and reporting framework. NSW Health should improve the collection and use of outcomes data and improve information systems to support palliative care services and provide comprehensive data for service planning.

The  Auditor-General made four recommendations that called for the development of an integrated palliative and end-of-life care policy framework; proper data collection on patient outcomes; a state-wide review of systems and reporting for end of life management; and improved stakeholder engagement.

Some improvements evident

Over the last two years, NSW Health has taken steps to improve its planning and support for Local Health Districts. The NSW Agency for Clinical Innovation has produced an online resource that will assist districts to construct their own, localised models of care. And eHealth, which coordinates information communication technology for the state’s healthcare, aims to integrate and improve information systems. These initiatives should help to address many of the issues now inhibiting integrated service delivery, reporting on activity and outcomes, and planning for the future.

NSW Shadow Health Minister Walt Secord welcomed the report, saying it provided a roadmap for the State Government to improve end-of-life care in NSW.

“As a prosperous nation, Australia and NSW have the means to ensure that the final years, months and days of elderly people and those with terminal diseases are lived in dignity,” Mr Secord said. “In my view our prosperity brings an obligation to do no less.

“We have to recognise that palliative care is a field that will only grow as Australians now have the longest life expectancy in the English-speaking world.

“Accordingly, we need a government response that embraces helping people to remain independent in their homes by finding ways to expand home and community care,” Mr Secord said.

A full copy of the report is on the Audit Office website.