Hospice funding crisis: Collapse of services could cost taxpayers millions

RNZ News

6 hours ago

Hospice services are only available to one in three New Zealanders who are dying. File photo.
Photo:
123RF
Hospices are warning that critical services for the dying are under threat, with nothing for palliative care providers in the Budget.
Hospice NZ says government funding only covers about half of what it costs to run New Zealand's 28 publicly funded hospices, but if services collapse, it will end up costing taxpayers millions of dollars more.
Jen Nolan, whose younger brother Matt died at Te Omanga Hospice in Lower Hutt in 2019, said she dreaded to think how those final days would have gone without that "incredible, wrap-around care".
The weeks following Matt Nolan's diagnosis with stage four melanoma were brutal: brain surgery, radiation, immunotherapy - nothing worked.
It was a devastating blow when doctors said there was nothing more they could do - but Matt Nolan's admission to Te Omanga offered a different kind of healing.
"When we walked in, I turned to one of my sisters and said 'God, it's like we've left Hell and we're in Heaven's waiting room'."
Her brother's seizures and complex pain needs made it impossible for him to be at home, but Te Omanga became their home.
"We could come and we could bring our dogs, he had a lovely room that opened out to the garden. His friends could come.
"I walked in one day, and there he was, fast asleep, with two of his buddies also asleep in chairs. They were having a little nap together."
Matt Nolan died in July 2019, three months after diagnosis. He had just turned 49.
Six years on, Jen Nolan said it was heartbreaking that hospice services were only available to one in three New Zealanders who were dying.
"If you face the death of a loved one, and you haven't got the option to go into hospice care, I think that would be a bloody grim place to be.
"It was the most supportive and gentle place for us all to be with him. The care he received was outstanding. And I feel what we were shown as we navigated this incredibly difficult time was the best humans can be for each other."
It cost $226 million to run the country's hospice services last year, with just half of that provided by the government.
Hospice New Zealand chief executive Wayne Naylor said it was disappointing to not even rate a mention in the Budget - especially coming on top of the scuttling of the pay equity claim for hospice nurses.
They are currently paid up to 35 percent less than Health NZ nurses.
"That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop."
Indications that the government would not be covering future pay equity settlements for the funded sector were "very problematic".
"That then falls back on community to provide more money to support their local hospice.
"The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services."
Health Minister Simeon Brown told RNZ the government "values the work of hospices", but he said it was up to Health NZ to do its own negotiations with providers.
"This Budget has provided $1.37b to Health NZ to not only deliver an increase in investment for those front-line hospital and specialist services, but also an uplift in investment to that funded sector, which includes primary care, which includes aged care, which includes palliative care."
However, Naylor was not optimistic following meetings with Health NZ officials, the most recent one this week.
"They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else.
"So essentially it's a no to funding from Health NZ right now."
Assisted dying services receive about $11m a year from Health NZ, in order to ensure equitable access.
"Which is fine for the fewer than 1 percent of people who seek it," Naylor said.
"But for the 99 percent of people who die from an expected illness, only about a third can access hospice care. So there still remains that inequity that needs to be addressed."
For dying children, access to specialist palliative care services
were even worse
.
A recent MartinJenkins report found New Zealand's 28 publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer ED and hospital admissions or rest home stays.
Add to that the clinical services they directly fund themselves, the public benefit is even higher.
Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication.
Nelson-Tasman Hospice nurse Donna Burnett loves her work, which is why she has stayed in the job for 36 years.
However, the Nurses Organisation delegate said that good-will was being taken for granted by the government, and the end result for many was "burnout".
"We can't keep giving the way we are.
"Often we're short-staffed. We keep that patient centred care going, but it's coming at a cost.
"We can't keep giving like we are and working understaffed because that has an impact on your wellbeing."
In a written response to RNZ, Health NZ said it would shortly begin seeking feedback from the public and the sector on a model of care proposal for adult palliative care.
It plans to finalise both the paediatric and adult models of care by the end of the year.
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