2 May 2024

Why our quality of death is slipping

From The Detail, 5:00 am on 2 May 2024

NZ Hospice relies heavily on donors, fundraising and its network of op shops to make up for a shortfall in government funding, but it's falling behind.

Bev Platt clinical services manager Harbour hospice

Bev Platt clinical services manager Harbour hospice Photo: Sharon Brettkelly

Why has New Zealand slipped from three on Quality of Death Indexes nine years ago to 12th? 

NZ Hospice chief executive Wayne Naylor has a list of reasons. 

"We don't have a current national strategy - the government hasn't renewed our 2001 strategy, so we don't have national direction. 

"We don't have stable, sustainable funding for community-based palliative care, particularly provided from hospices. It's widely variable. 

"There's no planned investment in it, so services are struggling.

"Our workforce training used to be fantastic. It's dropped away a bit, we're not training enough specialist doctors; we don't have funded post-graduate training for nurses any more. 

"And it's just not as well organised as it could be, compared to some other countries. 

"It's not great, because New Zealand has always done well when it comes to the care of people who are dying," he says. 

And here's an astonishing statistic. 

While the government funds about 45 to 50 percent of Hospice's work at $92 million a year, (it does keep patients out of hospitals, after all), the rest, $94 million, is collected from donors, bequests - and op shops. In fact the vast majority of it comes from those shops, run by volunteers. 

During Covid lockdowns when those shops were closed, and many fundraising events were cancelled, income plummeted. 

"Hospices were exposed because of their reliance on community fundraising and second-hand retail," says Naylor. 

"That money just wasn't coming in. And of course the government funding doesn't cover the cost of all of the clinical services that hospices provide. I think it's really made the hospice sector realise that although community funding is very important.... it's not something you can rely on all the time." 

There are 32 hospices across the country that cared for 10,800 dying people last year, about a third of everyone who died.

"I think that part of the issue we've got around funding end-of-life care, palliative care, really well is that it's been sidelined in our health system for so long," says Naylor. 

He says one of the problems is - we don't talk about dying enough. "It's not something we like to acknowledge happens in our medical system."

Today on The Detail we take a tour of a revamped hospice in Takapuna, a $20 million project financed entirely by donations, investments from bequests and fundraising. 

Bev Platt, the director of nursing and family support at Harbour Hospice, says the funding model is a challenge for the future, but "it's like everybody".

"Yes, the population's getting older and living longer so we're going to see a different illness trajectory - we know we're going to see an increase in dementia and frailty. We're also seeing an increase in complexity because treatments are better than they used to be." 

The demand for palliative care is estimated to increase 50 percent by 2040.

But complicating the funding issue is the stretched charity dollar in a recession, other health services crumbling, and the increased safety risks of reaching the dying in their homes. 

The Detail also speaks to Belinda Watkins, chief executive for mid Northland and Far North hospice looking after a population of 74,000 from Cape Reinga to just north of Whangarei.

There is no in-patient unit in the region which means that all the care is in people's homes. It has to raise two million dollars from the community. 

Hospice has a fundraising push coming up - its awareness week starts on 13 May. 

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