Palliative care workforce strained but resilient: report

Australia’s palliative care workforce is demonstrating remarkable resilience while operating under immense pressure, according to a new report by Palliative Care Australia (PCA).

Australia’s palliative care workforce: Challenges and opportunities presents findings from the 2024 National Palliative Care Workforce Survey, and was released this week at the Oceanic Palliative Care Conference in Brisbane.

The survey was commissioned by PCA and conducted by Winton Research and Insights between May and August 2024. It gathered the perspectives of 1400 health and aged care professionals, workers, and volunteers, which deliver a comprehensive view of the critical issues affecting the delivery of palliative and end-of-life care across the nation.

PCA chief Camilla Rowland described the report as a “wake-up call” for funders and policymakers.

“The survey revealed a clear workforce perception that the need for palliative care is increasing, but the additional investment needed to meet that demand has not,” she said.

Ms Rowland said that escalating demand, coupled with persistent funding constraints and workforce shortages, is placing an unsustainable burden on services, professionals, and volunteers alike.

This, she warned, will inevitably lead to increasing limitations on access to essential palliative and end-of-life care, alongside heightened stress for the dedicated palliative care workforce.

Ninety per cent of the respondents who work in specialist palliative care settings reported an increase in demand over the past year, while just 28 per cent believed the available funding was adequately meeting this escalating need.

The report also said the provision of crucial out-of-hours care is severely underfunded, with only 16 per cent of respondents agreeing funding was sufficient to provide this to all who need it.

As one specialist palliative care respondent articulated, there is an “exponential increase in demand for services expected with minimal foresight or planning.”

This disparity is not isolated; it is echoed across the entire health and aged care landscape.

Primary care workers are also feeling the pressure, with 72 per cent of respondents observing a rise in palliative care demand. Alarmingly, only 11 per cent of them felt their service was adequately funded to provide this essential care. This financial shortfall directly impacts capacity, despite 96 per cent of primary care workers agreeing that early discussion of palliative care is critical.

The aged care sector, a crucial frontier for palliative care, faces its own unique challenges. While 83 per cent of aged care services reported providing palliative care to all who needed it, only 39 per cent of aged care workers felt their service was adequately funded. This financial squeeze is particularly concerning given the Royal Commission into Aged Care Quality and Safety’s vision for palliative care to become ‘core business’ within aged care.

Despite significant reforms intended to embed palliative care more deeply, the PCA report reveals a notable stagnation in quality.

Almost half of the aged care workers surveyed reported either no change (37 per cent) or a decrease (12 per cent) in the quality of palliative care provided over the past one to two years, suggesting that while the intent is clear, the practical implementation and resourcing are falling short.

Workforce shortages are another pressing concern. In specialist palliative care, 69 per cent of services reported difficulty recruiting staff, and 48 per cent struggled with staff retention. Only a third (33 per cent) of specialist palliative care respondents felt their service had enough staff to ensure high-quality care for every patient.

The introduction of voluntary assisted dying (VAD) legislation across all Australian states – and the ACT from November 3 – has also added an unexpected layer of complexity.

The survey found that nearly half of respondents (49 per cent) believe it has actually increased demand for palliative care services, highlighting the interconnectedness of end-of-life care options and the ongoing need for robust palliative care support.

Despite these systemic pressures on people, the report underscores the remarkable resilience and dedication of the national palliative care workforce, with one in three specialist palliative care respondents having worked in the sector for more than two decades.

Confidence and capability is growing across the broader health and aged care systems in providing a palliative approach. For example, 72 per cent of primary care respondents reported sufficient expertise to respond to patients’ palliative care needs.

However, it is clear that workforce dedication cannot compensate for systemic underinvestment.

The report serves as a clear warning: without adequate funding and staffing, the delivery of high-quality, timely care for people with terminal illness is at serious risk.

The average time prior to death that a patient first sees a specialist palliative care service is just 15 days, despite evidence showing that early referral leads to better outcomes. With the number of Australians over 85 set to triple in the coming years, PCA chair Dr Peter Allcroft warned the demand for palliative and end-of-life care services will only intensify.

“It’s in many ways a good news story, with the generation born during the baby boom of the late 1940s benefitting from radical improvements in medicine and an associated increase in life expectancy. But it also brings serious challenges,” he said.

“This major demographic shift will have profound changes for our health and aged care systems. We will need to adjust not only to the sheer numbers of additional consumers with complex needs, but also to changing expectations of our care services, changing carer roles and a changing fiscal environment.”