• Palliative care services face a funding crisis, risking their ability to meet increasing demand.
• Dr Anna Meuli warns of a “postcode lottery” in care access if national advisory roles are cut.
• Referrals have increased by over 50% in eight years, but funding hasn’t kept pace.

A Gisborne doctor is concerned palliative care services will be unable keep up with a “tsunami” of need without a proportional funding increase.

A national funding crisis is making palliative care services unsustainable across New Zealand, according to Hospice Tairāwhiti medical lead Dr Anna Meuli and Society of Palliative Medicine Aotearoa chairwoman Dr Catherine D’Souza.

Meuli says staff also fear for the future of an already struggling palliative care system if a Government proposal to disestablish two national advisory roles goes ahead.

Meuli said the roles were established in 2022 to develop a model of care that would address a long-standing “postcode lottery”.

This “postcode” nature of palliative care had resulted in regions where “some Kiwis have access to in-patient, 24/7 specialist healthcare in their final months, while in other regions, others die without specialist support that would ensure a pain-free, peaceful and dignified death”, she said

“The National Palliative Care Work Programme is the first of its kind to bring together healthcare delivery and consumer sectors to ensure equitable access to palliative care across New Zealand,” Meuli said.

“The work is not expected to continue following restructuring, which would fold palliative care into a general primary care portfolio.

She said the restructure would “ignore the 30% of New Zealanders who die in hospital and the 30% of the population who die with hospice care, while also removing essential subject matter expertise.”

The cuts would ensure the “postcode lottery” would remain for Tairāwhiti.

Palliative care was the only medical specialty not fully publicly funded, and it relied heavily on fundraising and donations.

Hospice Tairāwhiti appreciated its supporters, but Gisborne was a poor, high-needs region.

Referrals to the service had increased by more than 50% in eight years, but Government funding had not increased proportionally during this time.

It faced a “tsunami” of need from an ageing population, Meuli said.

“We worry that we can’t keep providing the same level of service to the patients we’ve got.

“On a daily basis, we’re trying to prioritise the most urgent needs instead of being able to offer a truly holistic, wraparound service.

“We’re at the point where we’re having to prioritise which referrals we accept, which is morally distressing for our staff.

“If someone’s been referred, they have a need. We would love to take on everyone, but we just don’t have the capacity.”

Patients can access a hospice nurse 24/7 in Tairāwhiti but doctor availability is more limited because of funding issues.

The predominantly nurse-led service consisted largely of part-time roles, which were becoming increasingly difficult to fill, she said

“Last year, the service had a job vacancy that lasted 10 months.”

The only option for medical care after-hours and weekends in Tairāwhiti is the hospital’s emergency department.

No after-hours GP service exists in Gisborne.

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“Our ED colleagues are doing a phenomenal job within their stretched service, but all would be in agreement that for palliative patients, this is not an ideal environment to be in.”

D’Souza said New Zealand once ranked among the top three countries for palliative care provision.

The country now lagged behind Costa Rica and Lithuania, and alongside Mexico and Slovenia, largely due to a lack of palliative care policy and poor access to palliative specialists, leading to crises at end-of-life, as well as unwarranted, expensive intervention in hospital settings.

Health Minister Simeon Brown said it was his expectation that “Health New Zealand delivers timely, quality healthcare for all New Zealanders.

“That includes palliative care, which plays an important role in New Zealand’s healthcare system.

“I am aware that changes have been proposed to the structure of the planning, funding and outcomes team at Health NZ.

“Health NZ has highlighted to me that consultation documents released at the end of last year are proposals at this stage.

“I have been assured any feedback will be carefully considered by Health NZ before final decisions are made,” he said.