A doctor has warned access to palliative care in the Lakes region will worsen if proposed Health NZ cuts are confirmed. Photo / Andrew Warner
A doctor has warned access to palliative care in the Lakes region will worsen if proposed Health NZ cuts are confirmed. Photo / Andrew Warner
A Rotorua doctor says proposed Health New Zealand Te Whatu Ora cuts are “deeply disappointing” and has warned that access to palliative care in the Lakes region will worsen if confirmed.
Consultation closed on February 10 for the proposed disestablishment of the only two nationalroles advising on palliative care policy development in New Zealand, an Australia New Zealand Society for Palliative Medicine press release said.
Dr Denise Aitken – a semi-retired Te Whatu Ora Lakes specialist physician working in palliative care – claimed the region already had the country’s least-resourced palliative care service and feared the cuts would impact patient care.
The “likelihood” of the region having a “comparable” service to others in New Zealand would be “greatly diminished” if the cuts went ahead, she said.
Health NZ said the changes were proposals at this stage and it recognised the “critical importance of palliative care”.
Dr Catherine D’Souza, Australia New Zealand Society for Palliative Medicine Aotearoa chairwoman and palliative medicine specialist, said specialists were trained in providing expert pain and symptom management that allowed people to live as well as possible with a terminal illness.
The roles facing disestablishment helped keep terminally ill Kiwis out of hospital by supporting them to receive care at home or hospice, D’Souza said.
If the proposal goes ahead, “huge amounts of public money” would be spent on hospital admissions for people who “have nowhere else to go”, D’Souza said.
Aitken told the Rotorua Daily Post a “significant” number of people died in hospital or received diagnoses which were “likely to be life-ending”.
A large part of her job was helping manage patients’ symptoms and “make plans”. She also worked closely with oncologists.
In 2017, she did additional training in palliative care “because of my perception that there was a desperate need for more support of palliative care”.
Aitken had hoped the development of a national palliative care strategy would address “long-standing inequities”.
“The proposal leaves people furthest from the centre most vulnerable.
“It’s felt like we took several steps forward and we’ve just slid down a huge scree slope.”
Dr Denise Aitken is concerned about the proposed disestablishment of the only two national roles advising on palliative care policy development at Health New Zealand.
In her view, the proposed cuts had “pushed” the responsibility of palliative care to primary care, which she felt was unsuitable.
Aitken said it was important to recognise the disparity in access to specialist palliative care across the Bay of Plenty.
Tauranga had an in-patient hospice unit at Waipuna Hospice of six beds. Health NZ Te Whatu Ora Hauora o Toi Bay of Plenty had two part-time physicians that covered Tauranga and Whakatāne Hospitals, two nurse practitioners (one part-time and one based in Whakatane), one part-time specialist nurse, and one registrar (palliative medical specialist in training).
She said Te Whatu Ora Lakes had no specialist palliative care doctor and only one nurse specialist.
“It means some people go for periods of time without adequate pain relief, or there are delays in people accessing care,” Aitken said.
“People go home and put up with what might be described as suffering. There’s no one to ring for help when things are complicated.
“This leads to distress for the person experiencing the symptoms and distress for their whānau.”
‘Massive step backwards’
D’Souza said the cuts would be “a massive step backwards” for ensuring quality, cost-effective healthcare was delivered to terminally ill New Zealanders.
D’Souza said the number of Kiwis requiring palliative care was increasing rapidly as the population aged, while people also lived longer with serious illnesses.
Without future planning, “the Government is guaranteeing that inequities in palliative care access between regions will deepen, and Kiwis will not get the care they need to prevent suffering at the end of their lives”.
Health NZ community and mental health co-director Debbie Holdsworth said it was committed to moving toward “a more sustainable future for New Zealand healthcare”.
The consultation documents released at the end of last year were proposals at this stage, she said.
“While changes are proposed to the structure of the planning, funding and outcomes team we recognise the critical importance of palliative care and our focus and commitment in this area will continue.”
Holdsworth said it was asking for and encouraging feedback from staff and unions on its proposals.
“All feedback will be carefully considered before final decisions are made. Any decision will be communicated to our staff and unions in due course.”
Staffing at hospitals was not connected to any proposed policy staffing changes.
Health New Zealand Te Whatu Ora Lakes operations group director Alan Wilson said it was committed to having a palliative care service that met the needs of its patients in hospital and the community.
“This form of care can be one of the most difficult and stressful for patients and their loved ones. All our staff work at ensuring they get treated in the most respectful and appropriate way.”
Wilson said there had been “some positive expressions of interest” for a palliative care physician to fill the vacancy left by Dr Denise Aitkens’ retirement.
“We acknowledge that this means the service is not at capacity, and we are working to address this.”
Wilson said an experienced full-time palliative care clinical nurse specialist provided support to patients in the district.
A palliative care specialist from Wellington covered one day per week to provide advice and support regarding “complex” patients.
Health NZ Lakes was arranging for another specialist to provide further cover, he said.
Any patients requiring hospital admission for palliative care were looked after by the general medicine team in Rotorua or the rural hospital medical team at Taupō Hospital, with support from Waikato Hospital specialists if required, Wilson said.
Hospice figures for palliative care
Figures from Rotorua Hospice showed 353 referrals were made to Rotorua and Taupō Hospices in the 2023/2024 financial year.
In 2022/2023, 493 referrals were made, and in 2021/2022, 424 referrals were made.
In 2020/2021, 456 referrals were made.
This story has been updated with information from Health NZ.
