Palliative Care Reform Auslan Videos

Video transcript

A message from the Minister 

Life-limiting illness, dying, death, grief and bereavement are uniquely personal experiences. High-quality and accessible palliative and end-of-life care is a critical part of the health system. It improves quality of life for people with a life-limiting illness and can reduce unnecessary interventions and hospitalisations towards the end of life.

The Queensland Government has committed $171 million from 2021–22 to 2025–26 to strengthen palliative care across Queensland. This funding is in addition to the existing and ongoing investment Queensland Health provides for palliative care across the state.

By 2025–26, this will result in an additional annual investment of $66 million to fund more frontline nurses, doctors, and support staff, including bereavement counsellors. Over the next five years our frontline specialist palliative care workforce will increase by 87% across Queensland and more hospital, community and tele-support options will be available for all Queenslanders.

The Palliative and End-of-Life Care Strategy guides this investment to enable, strengthen and connect the system. The Strategy shows how we will collaborate to support access to existing, improved and new high-quality care and achieve Queenslanders' goals for care at the end of life.

Health equity is at the forefront of this Strategy. We are investing in more services and workforce in regional and remote Queensland to ensure we deliver accessible and culturally safe services for First Nations peoples, designed with community, to support a good death.

When developing the Strategy, Queensland Health consulted widely and reflected on the conversations and evidence that people presented to the Parliamentary Inquiry into aged care, end-of-life and palliative care about what they want and need for palliative and end-of-life care. I would like to thank our stakeholders, particularly consumers, their families and carers, for their input. The collective knowledge and lived experience we heard has directly informed this Strategy.

We know that improving Queensland’s palliative care system will require ongoing commitment from all levels of government, the sector, and consumers. The Strategy and its supporting actions are the first step in the journey to create meaningful change.

The Australian Government has an important role to play in the provision of palliative care for Queenslanders. State advocacy is a key part of this Strategy, and we are committed to working closely with the Australian Government to ensure palliative care in the community is prioritised. This Strategy also enables us to meet our commitments under the National Palliative Care Strategy 2018.

This Strategy provides a path for us to achieve our vision: that Queenslanders with a life-limiting illness and their families receive equitable, compassionate, and high-quality palliative care that meets their individual needs, preferences, and goals at the end of life.

Acknowledgement of Country

Queensland Health acknowledges the Traditional and Cultural Custodians of the lands, waters and seas across Queensland, pays respect to Elders past and present, and recognises the role of current and emerging leaders in shaping a better health system.

We recognise the First Nations peoples in Queensland are both Aboriginal peoples and Torres Strait Islander peoples, and support the cultural knowledge, determination and commitment of Aboriginal and Torres Strait Islander communities in caring for the health and wellbeing of our peoples for millennia.

Throughout the Strategy, the terms ‘First Nations peoples’ and ‘Aboriginal and Torres Strait Islander peoples’ are used interchangeably rather than ‘Indigenous’. Acknowledging First Nations peoples’ right to self-determination, Queensland Health respects the choice of Aboriginal and Torres Strait Islander peoples to describe their own cultural identities which may include these or other terms, including particular sovereign peoples, (for example, Yidinji or Turrbal), or traditional place names, (for example, Meanjin Brisbane).

Stakeholder acknowledgements

Throughout Queensland, complex palliative and end-of-life care services are coordinated and provided to health consumers, their families and carers across acute care and community settings.

The key role that dedicated volunteers, carers, families, non-government and peak body organisations play in the delivery of palliative and end-of-life care and support services is deeply acknowledged, as well as the support they provide to our Queensland Health staff delivering specialist palliative and end-of-life care services.

Executive summary

The Palliative and End-of-Life Care Strategy guides the Queensland Government’s additional investment in palliative and end-of-life care. We heard directly from many stakeholder groups who informed the Strategy’s vision, principles, goals, actions and outcomes.

Our vision

“Queenslanders with a life-limiting illness and their families receive equitable, compassionate, and high-quality palliative care that meets their individual needs, preferences, and goals at the end of life.”

The principles that guide palliative care reform are:

Care is high-quality, evidence-based and meets people’s needs.

Care is equitable, accessible, and culturally safe for all Queenslanders, when and where it is needed.

Care is holistic and integrated across the continuum of care.

Information about palliative and end-of-life care is available to support informed decision-making.

People with a life-limiting illness, their families and carers are supported from the time of diagnosis, with support continuing for families and carers after death.

Life-limiting illness, dying, death, grief, and bereavement are recognised as a normal part of life and are planned for.

Care is person-centred, compassionate, culturally safe, and respectful of the preferences and unique cultural and spiritual needs of people with a life-limiting illness, their families, and carers.

The principles are supported by goals for strategic change to palliative care across the health system. The Strategy’s seven goals are:

Access to quality services - people with a life-limiting illness can access high quality, efficient and integrated palliative care services, at the right time and in the right place.

Information about care – people with a life-limiting illness, their families and carers receive information that enables and supports them to make informed choices about palliative and end-of-life care.

Individual needs and preferences – people with a life-limiting illness receive compassionate and high-quality care that is aligned to their preferences and is respectful of their culture, age, identity, emotional, and spiritual needs.

Support for families and carers – families and carers receive timely and compassionate support while caring for people with a life-limiting illness and during bereavement.

Skilled workforce – care is delivered by a skilled, supported, and multidisciplinary workforce that is accessible for people with a life-limiting illness, their families and carers.

Data and research – research and performance data are used to continually improve palliative care policy settings and services.

Governance and advocacy – state governance of this strategy drives action, accountability, and sustainability of funded services.

Enhancing our palliative care system will take effort over time. This Strategy is an important step in the reform journey.

The Strategy includes 44 actions that will enable, strengthen and connect Queensland’s palliative care services. When delivered, the actions will achieve the Strategy goals.

The actions were directly informed by extensive consultation processes and align to the Queensland Government’s additional investment of approximately $171 million to strengthen palliative care through the following initiatives:

* Develop a new Palliative and End-of-Life Care Strategy

* Grow Queensland Health’s frontline specialist palliative care workforce, supported by a workforce plan

* Invest in community-based services to meet local needs

* Enhance palliative care digital services and telehealth support

* Deliver 24/7 secondary consultation for palliative care practitioners

* Provide education and advocacy about dying, death and advance care planning

High-level outcomes of the Strategy

More Queenslanders with life-limiting illness receive palliative care.

Queenslanders with life-limiting illness receive care in alignment with their preferences.

Data collection and research inform service development, delivery of care, monitoring and quality improvement.

Improved equity of access to palliative care across health system regions and resident populations.

Families and carers are supported while providing care for someone with a life-limiting illness and during bereavement.

Government supports the Strategy through funding, advocacy, coordinated leadership and accountability.

Information about palliative and end-of-life care is available and accessed by Queenslanders with life-limiting illness, their families and carers.

A multidisciplinary, skilled workforce provides quality care to people with life-limiting illness.

The Strategy will ensure palliative and end-of-life care is person-centred, compassionate, equitable and accessible to all Queenslanders. We know that a strong, collaborative effort is needed to deliver good care, and the Strategy responds to this need.

The Strategy is supported by the Queensland Health Specialist Palliative Care Workforce Plan. The plan outlines how we are growing our specialist palliative care workforce across the state to meet community needs.

Separate to palliative care investments, voluntary assisted dying will be available in Queensland from January 2023. This provides eligible people who are suffering and dying with an additional end-of-life option allowing them to choose the circumstances and timing of their death. Having access to both high-quality palliative care and the option of voluntary assisted dying provides dignity, choice, and care to those who are suffering.

Our commitment to palliative care reform has already started and the Strategy will drive better outcomes across the state.

Introduction

People with a life-limiting illness want choice in when, where and how their palliative care is provided. They also want support to make choices about their place of death and assurance that their families, carers and loved ones are supported.

A priority for Queensland Health is to ensure that all Queenslanders have access to high-quality palliative care and support at the end of life. The Strategy aims to strengthen the healthcare system to ensure this care is culturally safe person-centred, equitable and accessible to everyone, regardless of where they live.

When developing the Strategy, we heard directly from Queenslanders through extensive consultation processes about what is needed to improve palliative and end-of-life care across the state. The feedback we received has directly informed the vision, principles, goals and actions outlined in the Strategy.

The Strategy is focused on Queensland Health, but all services across the state are encouraged to use the principles within the Strategy to guide their services. All Queenslanders have a right to a good death that is free from suffering, with the support of high-quality palliative and end-of-life care services. We know that a collaborative effort is needed to deliver this care and improve the palliative care system over time, and the Strategy reflects this need.

Defining palliative and end-of-life care

Palliative care and end-of-life care can improve quality of life and promote wellness for people living with a life-limiting illness, their families, and carers. Often, people associate palliative or end-of-life care with cancer, however, this care is appropriate for anyone living with a life-limiting illness, other chronic conditions, dementia, and non-malignant degenerative diseases.

Palliative care and end-of-life care may be required at any age, and the needs of children and younger people, their families and carers need to be considered. Considering people’s cultural needs and ensuring culturally safe practices for everyone receiving care is also important. For First Nations peoples, the time before and after death, which may be referred to as Sad News and/or Sorry Business, are subject to customary practices and beliefs, which should be respected and accommodated during the palliative and end-of-life care journey. This Strategy responds to the diverse needs of Queenslanders and aims to ensure people receive compassionate palliative care and end-of-life care that is respectful of their cultural, spiritual, emotional, and physical needs and preferences.

This Strategy affirms that palliative care is a person-centred approach, which is consistent with the World Health Organization definition used in the National Palliative Care Strategy 2018. People with a life-limiting illness should be at the heart of their care, surrounded by their family, carers, community and supported by services, which may include one or more of a range of formal and informal supports.

When we refer to palliative care and end-of-life care in this Strategy, we mean:

Palliative care

Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are living with a life-limiting illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

End-of-life care

End-of-life care includes physical, spiritual and psychosocial assessment, and care and treatment delivered by health professionals and ancillary staff. It also includes support of families and carers, and care of the patient’s body after their death. Voluntary assisted dying is another end-of-life option for people who meet strict eligibility criteria. People are ‘approaching the end of life’ when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:

* advanced, progressive, incurable conditions

* general frailty and co-existing conditions that mean that they are expected to die within 12 months

* existing conditions, if they are at risk of dying from a sudden acute crisis in their condition

* life-threatening acute conditions caused by sudden catastrophic events.

We recognise that social and emotional wellbeing is the foundation for physical and mental health, including for First Nations peoples. This Strategy also adopts a holistic view for palliative and end-of-life care. This includes supporting relationships between individuals, family, kin and community while providing care, and recognising the importance of connection to land, culture, spirituality and ancestry, and how these affect an individual.

Policy context

International and national context

International and national palliative care strategies outline the importance of health systems providing high quality and accessible palliative care. This Strategy aligns with other strategies and describes Queensland’s approach to strengthening palliative and end-of-life care services.

In 2013, the World Health Assembly adopted a resolution to include palliative care in all health systems, at all levels of care, and for the whole population.

In January 2014, the Executive Board of the World Health Organization published policy directions recognising the need for palliative care and end-of-life care to be provided ‘in accordance with the principles of universal health coverage’ and for palliative care to be offered by all health systems. These policy directions were endorsed by the World Health Assembly in April 2014.

The Australian Government, in partnership with states and territories, leads policy development for palliative care in Australia. The national policy direction for palliative care is set through the National Palliative Care Strategy 2018 and supporting Implementation Plan. Queensland has committed to support the implementation of the National Strategy and ensure the highest possible level of palliative care is available to all people in Queensland. This commitment will be met by implementing the actions in our Strategy.

The Australian Government also has a key role in supporting palliative care in the community through primary care. We will continue to advocate to the Australian Government for increased investment, particularly across primary care and in community settings, to support the delivery of palliative care services in Queensland.

Palliative Care Australia is the Australian peak body for palliative care. The Palliative Care Australia Roadmap 2022–2027 sets the direction Australia needs to take from now until 2027 to ensure high-quality palliative care is available for all who need it, where and when they need it. It outlines key areas to be prioritised across investment, support for carers, workforce, awareness campaigns about death, dying and palliative care, data and research, and palliative care in aged care. This Strategy aligns to these key areas.

State context

While the focus of this strategy is palliative care and end-of-life care services, lessons from across the health system have been incorporated to improve access and equity of access to services. The report Unleashing the potential: an open and equitable health system - Healthcare for Queenslanders in a pandemic ready world explored lessons from the COVID-19 pandemic. It offers recommendations to progress reform across the continuum of care and create a health system:

* that is focused on consumers,

* that is integrated across health providers,

* that supports a flexible and empowered workforce,

* where clinicians, consumers and providers genuinely work in partnership, and

* where good ideas and practices are evaluated and shared across the system.

The new Strategy also builds on directions and actions from Queensland's previous Statewide strategy for end-of-life care 2015. Both strategies aim to strengthen the capacity of Queensland Health servicesto respond to the needs of peoplewith a life-limiting illnessand deliver high-qualitypalliative care services.

A key component of delivering quality services is making sure that the rights and interests of people with a life-limiting illness are protected and recognising the needs of people who may be vulnerable or at risk, including but not limited to, Aboriginal and Torres Strait Islander peoples, people with disability, people from culturally and linguistically diverse backgrounds, people with cognitive impairment, people experiencing homelessness and older people. All people have the right to exercise choice to access palliative care services based on their preferences, and in the environment of their choosing. Appropriate advanced care planning supports people to make and/or communicate decisions about their own life and the type of care and outcomes they would consider acceptable, and helps to ensure that their preferences are documented and respected.

Guidance and resource materials should be available to health professionals and others who care for people with life-limiting illnesses. Through information and education, professionals should have enhanced capacity to support decision-making practices, identify potential forms of abuse such as elder abuse, and to address issues.

This Strategy reflects these needs. It includes actions that strengthen person-centred palliative care services through greater collaboration, integration and use of technology. The Strategy also contains actions that will help to develop a skilled workforce, through the provision of targeted information and professional development opportunities, to ensure staff are able to respond to the diverse needs of people with a life-limiting illness.

Health equity for First Nations peoples

End of life is a significant and sensitive time for First Nations peoples. It is a time that is subject to important customary and cultural practices and has meanings that are sacred to First Nations peoples.

This Strategy supports Queensland Health’s First Nations health equity reform agenda. Recent amendments to the Hospital and Health Boards Act 2011 and Hospital and Health Boards Regulation 2012 have created the strongest legislative foundation for Queensland's public health system to achieve health equity for First Nations peoples and eliminate institutional racism across Hospital and Health Services. These legislative amendments and the release of the Making Tracks Together – Queensland’s Aboriginal and Torres Strait Islander Health Equity Framework are placing First Nations peoples at the centre of healthcare design and delivery, including palliative care and end-of-life care services.

The Strategy prioritises investment in First Nations led culturally appropriate and family-centred models. It recognises the kinship ties among First Nations peoples and communities to deliver holistic palliative care. This is supported by the Queensland Health Specialist Palliative Care Workforce Plan which builds the capability of palliative care services by growing the First Nations palliative care workforce across the system.

Queensland’s journey so far

In recent years, we have introduced new palliative care services and end-of-life care initiatives and committed more investment to improve these services across the state. We have also committed to working with the Australian Government and other states and territories to continually improve palliative care services through the National Strategy.

The Queensland Health Palliative Care Services Review 2018 and the Parliamentary Inquiry into aged care, end-of-life and palliative care sought feedback from thousands of stakeholders across Queensland. The findings and recommendations from these processes have informed the development of this Strategy, as well as extensive consultation and engagement undertaken in 2021.

2012 - 2013

Parliamentary Inquiry — Palliative and Community Care in Queensland

2015

Statewide strategy for end-of-life care 2015

2017

Productivity Commission Inquiry – Human Services (End of Life Care)

2018 - 2019

Queensland Health Palliative Care Services Review

National Palliative Care Strategy 2018

2018 - 2020

Queensland Parliamentary Inquiry into aged care, end-of-life and palliative care, and voluntary assisted dying

2020

Queensland Government commitment $171 million Palliative Care Reform Program

2021

Consultation and engagement: Palliative and End-of-Life Care Strategy and Queensland Health Specialist Palliative Care Workforce Plan

2022

Palliative and End-of-Life Care Strategy and Queensland Health Specialist Palliative Care Workforce Plan released

Investments in palliative care

We have a track record of investing in palliative care to improve accessibility and equity across the state.

Existing investment and innovation in palliative care includes all the following:

Funding over four years from 2021–22 for Ambulance Wish Queensland,

Jointly funding the Specialist Palliative Care in Aged Care Project for equitable access to specialist palliative care in residential aged care facilities,

Funding the Office of Advance Care Planning to deliver education, advocacy and raise awareness about Advance Care Planning,

Establishing PallConsult, a service that supports and builds capacity across Queensland for community-based clinicians,

Funding for the Specialist Palliative Rural Telehealth Service to support the delivery of palliative care services in regional, rural and remote areas of Queensland,

Funding for the Paediatric Palliative Care Outreach Collaborative to support the delivery of services for children in regional and remote areas,

Funding for the Medical Aids Subsidy Scheme - Palliative Care Equipment Program to support

the delivery of palliative care services at home,

Funding Palliative Care Queensland to build community capacity through community development, engagement and awareness,

We have service agreements with the following non-government organisations to deliver community-based and hospice services:

* Cittamani Hospice Service

* Ipswich Hospice Care Ltd

* Hopewell Hospice Services (Wesley Mission Queensland)

* Karuna Hospice Services Ltd

* Little Haven Cooloola Sunshine Coast Palliative Care Association Inc

* St Vincent’s Private Hospital

* Toowoomba Hospice Association Inc

* Hummingbird House (Wesley Mission Queensland)

* Katie Rose Cottage Hospice

Further includes $13.3 million in 2021-22 to non-government organisations to deliver community-based care, training, and information and awareness services

$17 million provided to Hospital and Health services to deliver new palliative care services in regional and rural areas of Queensland across 2019–20 and 2020–21

$157 million approximate investment by Hospital and Health Services to provide palliative care services in 2021–22

New investment in palliative care

We will invest approximately $171 million in additional funds across 2021–22 to 2025–26 to strengthen palliative care services. By 2025–26, this will result in an additional annual investment of $66 million per year. This funding increase is in addition to existing funding we provide for Hospital and Health Services, which will continue to increase over time. In 2025–26, Queensland’s total spend on palliative care is estimated to be close to $250 million per annum.

The additional funding will be allocated to the following initiatives:

Develop a new Palliative and End-of-Life Care Strategy

Total funding to 2025–26 is $0.5 million.

Grow Queensland Health’s frontline specialist palliative care workforce, supported by a workforce plan

Total funding to 2025–26 is $102.5 million.

Invest in community-based services to meet local needs

$54.8 million.

Enhance palliative care digital services and telehealth support

$7.2 million.

Deliver 24/7 secondary consultation for palliative care practitioners

$4.3 million.

And provide education and advocacy about dying, death and advance care planning

Total funding to 2025–26: $1.6 million.

The investment will gradually increase over five years to ensure that services grow in a sustainable way and that workforce is available to fill new specialist palliative care workforce positions that we are creating.

Developing the Strategy

Who we consulted

People with a life-limiting illness, their families and carers, clinicians, peak bodies, advocates, and the palliative care sector told us what they want for palliative and end-of-life care services, now and into the future.

Building on feedback received through the Review and Inquiry, we developed principles and goals, which align to the National Strategy and the previous Statewide strategy for end-of-life care 2015.

We invited stakeholders to participate in consultation opportunities, including workshops, targeted consultation sessions, Kitchen Table Discussions and Yarning Circles, or to provide feedback through email or a survey. We sought feedback on the proposed principles and goals, initiatives that were working well, and ideas about potential actions that could be included in the Strategy.

We heard from a wide range of stakeholders from across Queensland, including clinical and non-clinical representatives from the Queensland Hospital and Health Services, private clinicians, Primary Health Networks, Palliative Care Queensland and other peak bodies, training organisations, industrial unions, and consumers and carers.

We consulted:

* 142 consumers and carers across 14 towns and cities, including rural and remote areas, through Kitchen Table Discussions and Yarning Circles, facilitated by Health Consumers Queensland

* Queensland Health staff, including specialist palliative care clinicians, and nurses, physicians, and allied health practitioners, through multiple meetings with the 16 Hospital and Health Services and an internal survey

* Clinicians, nurses, allied health staff and consumer representatives through four workshops

* 49 representatives from 39 different non-government organisations, including palliative care service providers, peak bodies, Primary Health Networks, national peak bodies and aged and disease specific peak bodies related to palliative care facilitated by Palliative Care Queensland.

We also held:

* Meetings with Queensland Health staff about the current workforce for palliative care, local workforce priorities and the development of the Workforce Plan.

* A workshop focused on principles of good practice and models of care for designing and delivering First Nations led culturally safe community-based palliative and end-of-life care for First Nations peoples.

What we heard

The contributions from consumers and carers, the community, sector, and clinicians throughout the consultation process was invaluable. The information we received through the consultation process directly informed the actions and strategic directions contained in the Strategy and will also be used as a basis to enhance the palliative care system beyond the life of the Strategy. People told us what good palliative care should look like and how we must deliver essential change across the palliative care system in Queensland.

We collected and analysed a vast amount of feedback during our consultation activities and identified eight key themes that emerged during the process. These themes were:

* Bereavement support is a key aspect of care and should be provided from the time a person receives a diagnosis and during the provision of quality palliative and end-of-life care.

* Information needs to be timely and provided to patients, their families and carers at the right time.

* Compassion is a key aspect of palliative care and needs to be reflected across the principles and goals.

* Governance and accountability for the Strategy needs to be clearly articulated to ensure oversight of its implementation and monitoring.

* The importance of carers, families and other loved ones needs to be clearly outlined in the Strategy.

* There is a need for new investment and better ways to allocate funding and investment to fill gaps and strengthen service delivery.

* Growth, training and support for a multidisciplinary workforce that can cater to people’s needs, including cultural and spiritual needs, is necessary.

* Awareness and education about the benefits of Advance Care Planning is required to safeguard individuals’ preferences at the end of life.

"Increasing specialist palliative care workforce ensures skilled clinicians can support the generalist population but also deliver high-quality palliative care that meets people's needs." Queensland Health survey response.

"Support for carers is also very high on the list, as in my experience, the carers’ needs are two-fold, during the end-of-life process, then the bereavement stage after. There are still fairly significant gaps for this support, especially for those who don’t even know where to start looking. And the information isn’t readily available." Consumer, Kitchen Table Discussion, Cairns.

"There is a need for recurrent funding for current models that are working well, such as PallConsult, Specialist Palliative Rural Telehealth Service, Paediatric Palliative Care Collaborative for sustainability." Participant, Queensland Palliative Care Clinical Network Steering Committee engagement session.

"There is an opportunity to review programs funded by the state to identify duplications, roles and responsibilities and what can be improved at a statewide basis and how investment can be allocated more efficiently." Participant, Queensland Specialist Palliative Care Services Directors’ Group.

"It is important to recognise that bereavement support is a fundamental part of end-of-life care and supporting families and carers following the passing of a loved one." Participant, Care at End of Life Collaborative engagement session.

"There is a need for staff training and education … all health and support staff [need to] understand palliative and end-of-life care, compassionate care, and culturally appropriate care." Participant, Queensland Palliative Care Clinical Network Steering Committee engagement session.

"There needs to be staff who have connections with our mob while in hospital, so we need to make sure that Aboriginal and Torres Strait Islander Liaison Officers are present. Need adequate staff numbers." Consumer, Yarning Circle, Hervey Bay.

"The Medical Aids Subsidy Scheme Palliative Care Equipment Program is amazing and now assists patients to be loaned the appropriate equipment … It is much easier for the families." Queensland Health survey response.

Better palliative and end-of-life care for Queenslanders

Our vision 

Queenslanders with a life-limiting illness and their families receive equitable, compassionate and high-quality palliative care that meets their individual needs, preferences and goals at the end of life.

The Strategy will help us to achieve this vision by including initiatives for improved models of care at the system level and the local level that improve palliative care experiences and outcomes for Queenslanders.

Growing and supporting our specialist palliative care workforce will be critical to achieving our vision. The Workforce Plan guides how a sustainable specialist workforce for Queensland will be established, developed and maintained over time to better meet the current and future needs of consumers and families.

Through the Workforce Plan and new investment, the frontline specialist palliative care workforce will be increased across Hospital and Health Services. An expanded specialist palliative care workforce will also support the primary care sector to build capability and their skills to support people to receive care in the community.

Expanding services outside of southeast Queensland and facilitating more care at home are key focus areas under the Strategy. Investing in these services will support people to achieve their goals at end of life and reduce pressure on our hospital system. Partnerships across sectors, including with the primary health sector, will help us to integrate services and provide better care for people, allowing them to die with dignity.

People with a life-limiting illness, their families and carers are the foundation of the palliative care system. Many palliative care services are provided by families and carers with support from health professionals. Through this Strategy, there will be more support for people with a life-limiting illness, their families and carers to ensure they have better outcomes and are supported after a loved one’s death.

Principles

The Strategy has seven principles that guide the goals, actions and intended outcomes of the Strategy.

* Care is high-quality, evidence-based and meets people’s needs.

* Care is holistic and integrated across the continuum of care.

* People with a life-limiting illness, their families and carers are supported from the time of diagnosis, with support continuing for families and carers after death.

* Care is person-centred, compassionate, culturally safe, and respectful of the preferences and unique cultural and spiritual needs of people with a life-limiting illness, their families, and carers.

* Care is equitable, accessible, and culturally safe for all Queenslanders, when and where it is needed.

* Information about palliative and end-of-life care is available to support informed decision-making.

* Life-limiting illness, dying, death, grief, and bereavement are recognised as a normal part of life and are planned for.

Enhancing our palliative care system will take effort over time. This Strategy identifies the wide range of actions we must take to improve palliative care in Queensland, and is an important step in the reform journey.

What the Strategy will deliver

The Strategy has seven goals. These are what we expect to achieve by implementing the actions outlined in the Strategy.

Goals

Information about care

People with a life-limiting illness, their families and carers receive information that enables and supports them to make informed choices about palliative and end-of-life care.

Support for families and carers

Families and carers receive timely and compassionate support while caring for people with a life-limiting illness and during bereavement.

Data and research

Research and performance data are used to continually improve palliative care policy settings and services.

Access to quality services

People with a life-limiting illness can access high quality, efficient and integrated palliative care services, at the right time and in the right place.

Individual needs and preferences

People with a life-limiting illness receive compassionate and high-quality care that is aligned to their preferences and is respectful of their culture, age, identity, emotional, and spiritual needs.

Skilled workforce

Care is delivered by a skilled, supported, and multidisciplinary workforce that is accessible for people with a life-limiting illness, their families and carers.

Governance and advocacy

State governance of this strategy drives action, accountability, and sustainability of funded services.

Making it happen

The Strategy aims to reform palliative care service delivery in Queensland through investment and policy to design, enable, strengthen and connect the palliative and end-of-life care service delivery system.

This approach is outlined as follows:

2022-23 Design

New initiatives are co-designed, backed by evidence and enable place-based models of care.

2023-24 Enable

New frontline workforce improves models of care.

Community-based care services increase and support care at home for Queenslanders in regional and remote areas.

2024-25 Strengthen

Workforce is expanded and specialist support is increased to strengthen service delivery and local level responses.

Support for workforce consumers and carers is strengthened across sectors and with key partners.

2025-26 onwards Connected

Innovative models of care are expanded and integrated across the system. Action is evaluated and proven approaches are embedded in service delivery and local models of care.

Actions

When delivered, the 44 actions outlined in this Strategy will achieve the Strategy goals for palliative care reform. Implementation of the actions will be staggered across the Strategy’s implementation period in alignment with the reform approach.

The actions focus on expanding existing initiatives and exploring new areas. The actions emerged from the consultation process and aim to improve outcomes for people with a life-limiting illness and to better support families, carers and loved ones.

Some actions from the Workforce Plan are also reflected in this Strategy as a skilled, multidisciplinary, and supported workforce is one of the most important enablers to delivering high-quality palliative care.

Access to quality services

These are listed as actions followed by their time frame.

Work with Hospital and Health Services to support implementing of new initiatives and palliative care services, including continuous improvement to support the delivery of high-quality palliative care.

Ongoing

Explore program enhancement opportunities for the recurrently-funded Medical Aids Subsidy Scheme – Palliative Care Equipment Program to support palliative care at home.

Ongoing

Support patient care choices by providing funding to non-government service providers, including hospices, to deliver palliative care services within the community, and support people to receive care, and die, at home.

Ongoing

Continue to provide funding for the Paediatric Palliative Care Outreach Collaborative to support the delivery of palliative care services for children living in rural areas.

Ongoing

Establish and promote statewide grief and bereavement resources for people of all ages, including vulnerable groups, and seek opportunities to standardise approaches to service provision in services provided or funded by Queensland Health.

Ongoing

Expand the Specialist Palliative Rural Telehealth Service to provide additional support and education to staff and support the delivery of palliative care in rural and remote areas of Queensland.

2023-24

Co-design improved models of care that support consumers’, carers’ and clinicians’, including ambulance officers’, needs for information, referral, clinical advice and after-hours support.

2022–23

Investigate digital healthcare access barriers and identify opportunities to pilot, scale and spread digital healthcare service delivery to enhance the quality of palliative care across the state.

2023–24 — investigate

2024–25 — implement/pilot initiatives

Showcase proven digital healthcare initiatives operating in Queensland that increase access and choice and reduce inappropriate or unwanted admissions to hospital.

2023–24 then ongoing

Deliver new community-based care services for consumers living in regional, rural, and remote areas outside South East Queensland to support people’s preferences to receive care closer to home.

Commencing 2022–23

Co-design and commission demonstration models of First Nations led community-based palliative care services for First Nations peoples, to support best practice care and social and emotional wellbeing, that can be evaluated and potentially scaled up and expanded in the future.

Commencing 2022–23

Continue contracts with non-government organisations providing valued hospice services and support them to identify own source revenue for ongoing sustainable service provision.

2022–23 then ongoing

Support palliative care service integration, including through engagement with Primary Health Networks, particularly for residents of residential aged care facilities.

2022–23 then ongoing

Information about care

Actions

Develop and refine advance care planning forms, supporting documents and processes through co-design approaches with multi-disciplinary groups to ensure they provide appropriate and easy to understand information and guidance to clinicians and consumers.

2022–23 then ongoing

Trial the Decision Aid – Care Companion for people living with a life-limiting illness and their families to support decision-making for end-of-life care.

2022–23 and 2023–24

Deliver a contemporary social media marketing and engagement campaign to increase public awareness and reduce stigmas about death, dying and palliative care, and share information on advance care planning, Advance Health Directives, Wills and Enduring Powers of Attorney.

2022–23 then ongoing

Deliver education and advocacy for health professionals about their role in advance care planning, palliative care access and choices, and bereavement care, to ensure people living with a life-limiting illness, their families and carers are involved in decision-making and have an opportunity to communicate their preferences for care.

2022–23 then ongoing

Engage with specific populations, including LGBTIQA+ people, people with disability, people in prisons, carers of older people, and older people who live in residential aged care facilities to identify their education and awareness needs for palliative and end-of-life care and the specific issues that these people in our community face when living with a life limiting illness.

2023–24 then ongoing

Individual needs and preferences

Actions

Review guidelines and policies supporting care for deceased persons and integrate appropriate prompts to enable tailored services that respond to cultural needs.

2023–24

Promote the need for, and use of, experienced interpreters for First Nations language speaking communities and culturally and linguistically diverse patients and loved ones for all health services, including palliative and end-of-life care.

2022–23 then ongoing

Co-design translated, easy English and culturally safe palliative and end-of-life care resources for First Nations and culturally and linguistically diverse people, with peak bodies and community to increase awareness of palliative and end-of-life care and knowledge to support informed decision-making.

2022–23 scoping and co-design work

2023–24 implementation

Explore options to support First Nations people with a life-limiting illness to pass away on country or be returned to country after passing.

2023–24

Embed First Nations led culturally safe approaches into palliative care service models, to promote health equity and social and emotional wellbeing of First Nations consumers, their families, and carers.

2023–24 then ongoing

Support for families and carers

Actions

Work with Palliative Care Queensland, other peak bodies and Primary Health Networks to support compassionate communities’ initiatives, and community development, engagement and awareness initiatives about palliative and end-of-life care.

Ongoing

Investigate technology that can be used to support people to undertake advance care planning, and cope with dying, death, grief, and bereavement in Queensland.

2023–24 — investigate

2024–25 — implement initiatives

Provide palliative care information and advice to support consumers, carers, and families to access palliative care services and support, before and after the death of a loved one.

2022–23 development of model

2023–24 then ongoing

Skilled workforce

Actions

Continue to provide funding for PallConsult, a 24/7 secondary consultation phone service for palliative care practitioners and supportive educational service.

2023–24 then ongoing

Deliver investment and frontline workforce increases across Hospital and Health Services, informed by population need and service demand.

2023–24 then ongoing — variable across HHSs

Establish dedicated Aboriginal and Torres Strait Islander health workforce position/s for each specialist palliative care service to maximise culturally safe care.

2023–24 then ongoing — variable across HHSs

Build the workforce required to link in and support community-based specialist palliative care services for consumers choosing care in the community.

2023–24 then ongoing — variable across HHSs

Establish dedicated bereavement care coordination and counselling positions and build the capability of the specialist palliative care workforce in bereavement care to increase access for carers and family.

2023–24 — variable across HHSs

Promote targeted information and professional development opportunities for Queensland Health staff about palliative care, including providing compassionate care, to ensure staff are equipped to respond to the spiritual, cultural, age related, and other diverse needs of people with a life-limiting illness.

2022–23 then ongoing

Promote existing resources and informal education and training opportunities to improve understanding of grief and bereavement among health and aged care workers, General Practitioners, nurses, and a variety of other community services, including relevant skills for identifying risk of prolonged grief disorder.

2022–23 then ongoing

Data and research

Actions

Co-design standardised approaches for measuring patient outcomes and experiences.

Ongoing

Monitor and evaluate the implementation of the Strategy and consider lessons learned to improve service delivery and patient outcomes.

Ongoing

Support research and the translation of research into practice to inform models of care, workforce education, and palliative and end-of-life care resources for patients and carers through the Centre for Palliative Care Research and Education.

2022–23 then ongoing

Governance and advocacy

Actions

Support the Queensland Palliative Care Clinical Network and other clinical networks to drive development of quality models of care, innovations and improvement across specialist, generalist (including primary) palliative care service delivery and support system integration.

Ongoing

Advocate for continued Australian Government funding for the Specialist Palliative Care in Aged Care project, delivered under the Comprehensive Palliative Care in Aged Care Measure, ahead of the current agreement’s cessation on 30 June 2024.

Timeframe 2022–23 and 2023–24

Advocate to the Australian Government to provide additional investment in primary palliative care services through Medicare Benefits Schedule items to support palliative care and advance care planning consults.

Ongoing

Support Hospital and Health Service planning for palliative care services through regular consultation with Queensland Health executive forums and clinical networks and use of endorsed Queensland Health planning guidelines for palliative care services.

Ongoing

Undertake reporting against the National Palliative Care Strategy 2018 – Implementation Plan as required by the Australian Government.

Ongoing

Establish ongoing governance arrangements within Queensland Health, including but not limited to, consumer and First Nations representation, to provide oversight of implementation, monitoring and reporting for the Strategy.

Ongoing

Continue to support Palliative Care Queensland by providing funding for peak body services and advocacy activities.

Ongoing

Include palliative and end-of-life care needs as part of pandemic and other emergency preparedness, response and recovery planning.

Ongoing

Future areas for reform

During the consultation process, we heard about innovations, initiatives and models of care that could improve the experience of people accessing palliative care, and improvements to support clinicians and the sector to deliver improved services. While not included in the action list, we have identified these further opportunities to explore:

Volunteers and volunteer coordinator roles in Hospital and Health Services to provide additional support to people with a life-limiting illness, their families and carers.

Opportunities of a First Nations Centre of Excellence with the Queensland Palliative Care Clinical Network.

Improved clinical digital systems to support information-sharing across health and care services and service systems, such as between specialist and GP, for streamlined service experiences and better multidisciplinary care. Mobile formats for information need to be explored for improved consumer experiences. Innovation in this area is likely to improve interactions with GPs, care staff, and palliative care specialists when they are involved in a person’s care.

Opportunities to increase pathways across different areas responsible for end-of-life care including palliative care, voluntary assisted dying, and other services, to promote equal access to quality bereavement support regardless of how a person dies.

Outcomes and evaluation

Queensland Health is responsible for leading the implementation of the Strategy and driving the reform of palliative care service delivery in Queensland. We will work closely with our partners and stakeholders to deliver the Strategy’s actions.

The Strategy will be evaluated to make sure outcomes have been delivered. Undertaking an evaluation will help us to understand the impact of the Strategy and identify areas for future improvement.

The high-level outcomes for the strategy are:

Outcomes

* More Queenslanders with life-limiting illness receive palliative care.

* Improved equity of access to palliative care across health system regions and resident populations.

* Information about palliative and end-of-life care is available and accessed by Queenslanders with life-limiting illness, their families and carers.

* Queenslanders with life-limiting illness receive care in alignment with their preferences.

* Families and carers are supported while providing care for someone with a life-limiting illness and during bereavement.

* A multidisciplinary, skilled workforce provides quality care to people with life-limiting illness.

* Data collection and research inform service development, delivery of care, monitoring and quality improvement.

* Government supports the Strategy through funding, advocacy, coordinated leadership and accountability.

Video transcript

Acknowledgement of Country

Queensland Health acknowledges the Traditional and Cultural custodians of the lands, waters, and seas across Queensland, pay our respects to Elders past and present, and recognise the role of current and emerging leaders in shaping a better health system.

We recognise the First Nations peoples in Queensland are both Aboriginal peoples and Torres Strait Islander peoples and support the cultural knowledge, determination, and commitment of First Nations communities in caring for health and wellbeing for millennia.

Stakeholder acknowledgements 

Throughout Queensland, complex palliative and end-of-life care services are coordinated and provided to health consumers, their families and carers across acute care and community settings.

The key role that dedicated volunteers, carers, families, non-government and peak body organisations play in the delivery of palliative and end-of-life-care and support services is deeply acknowledged, as well as the support they provide to our Queensland Health staff delivering specialist palliative and end-of-life care services.

Introduction

Background and context

The Queensland Government has committed $171 million in additional funding for palliative care services, including dedicated funding of $102.5 million to develop a workforce plan and increase our specialist palliative care workforce by 2025-26.

Informed by the findings and recommendations from the Queensland Parliamentary Inquiry into aged care, end-of-life in palliative care and voluntary assisted dying, a new Queensland Palliative and End-of-Life Care Strategy will set the strategic directions and guide investment decisions over the next five year implementation period. The strategy builds on previous reforms in Queensland and is the next step in the journey to strengthening the palliative care system. Under the Strategy, investment will be targeted at key activities to support a person's palliative and end-of-life care journey and better meet the needs, preferences and goals of the individual and their family at the end of life. The Strategy aligns to the National Palliative Care Strategy 2018 and its associated implementation plan.

The Voluntary Assisted Dying Act 2021 was passed in September 2021 and will be available to eligible Queenslanders from the 1st of January 2023. Voluntary assisted dying is an additional end-of-life choice that gives eligible people who are suffering and dying the option of asking for medical assistance to end their lives. The Queensland Government's implementation and provision of voluntary assisted dying services is separate to the investment for additional Queensland Health specialist palliative care workforce.

The Queensland Health Specialist Palliative Care Workforce Plan is a key component of the Queensland Government's investment to build and develop the Queensland Health specialist palliative care workforce as a key enabler in the delivery of specialist palliative care services. The Workforce Plan is a complementary document to the Strategy.

Currently, health consumers and their families in Queensland may experience differing and inequitable access to specialist palliative care services as a result of where they live. Addressing this inequity is one of the key priorities of the Strategy and Workforce Plan.

This Workforce Plan aims to position the specialist palliative care workforce within Queensland Health to provide equitable, responsive, culturally safe and appropriate and holistic treatment and care to people with life-limiting illnesses of all ages and provide support for their families and carers in Queensland. The Workforce Plan focuses on strategies and actions to build, attract, recruit, develop and retain a specialist palliative care workforce.

What is specialist palliative care and who delivers this service?

The National Palliative Care Strategy 2018 defines specialist palliative care as: “Services provided by clinicians who have advanced training in palliative care. The role of specialist palliative care services includes providing direct care to patients with complex palliative care needs, and providing consultation services to support, advise and educate non-specialist clinicians who are providing palliative care.”

In Queensland, generalist palliative care is provided across a range of settings by a wide network of general practitioners (GPs), Aboriginal and Torres Strait Islander Community Controlled Health Services, other medical specialists such as paediatricians, oncologists and geriatricians, nurse practitioners, nurses, allied health professionals, counsellors, pastoral carers, family members and others.

Queensland Health also delivers specialist palliative care services. The current Queensland Health specialist palliative care workforce primarily comprises but is not limited to specialist palliative medicine physicians, nurse practitioners, clinical nurse consultants and clinical nurses a range of allied health professionals (including social workers, occupational therapists, bereavement counsellors, psychologists and pharmacists), and supporting administrative and other staff. The workforce within any one specialist palliative care service depends on the model of care, health service setting and geographical location. This workforce is currently primarily located in the south-east corner of the State and in larger cities in regional Queensland.

Very few First Nations healthcare workers currently work in either generalist or specialist palliative care.

The Queensland Health specialist palliative care workforce

In September 2021, based on validated workforce profiles developed from payroll data and consultation with individual Hospital and Health Services, it was reported that 265.61 permanent full-time equivalent (FTE) health professionals and supporting staff were dedicated to delivering specialist palliative care in Queensland Health. An FTE refers to full-time equivalent employees currently working in a position, and several part-time employees may add up to one FTE.

The total workforce included 66.30 FTE dedicated specialist palliative care medical practitioners and 140.03 FTE specialist palliative care nurses.

In addition, there were 33.14 FTE dedicated specialist palliative care allied health practitioners including social workers, psychologists, occupational therapists, pharmacists and bereavement counsellors. It is noted that allied health services for Queensland Health specialist palliative care services are often accessed through the generalist allied health service or related services such as oncology, offered within the relevant facility.

The dedicated specialist palliative care Aboriginal and Torres Strait Islander workforce was 1.00 FTE and the dedicated specialist palliative care administration workforce supporting the clinical workforce above was 25.14 FTE.

Please refer to this information as depicted on this pie chart. Queensland Health Specialist Palliative Care Workforce - Full-time equivalent (FTE) per profession as at September 2021. This profile does not include staff employed on a temporary basis at that time, such as in the Specialist Palliative Care in Aged Care (SPACE) Program.

It is noted that, in November 2021, the Department of Health approved recurrent funding to continue the statewide Specialist Palliative Rural Telehealth Service (SPaRTa), delivered by Gold Coast, Sunshine Coast, Townsville and Cairns and Hinterland Hospital and Health Services. Recurrent funding was also approved to continue the Paediatric Palliative Care Outreach Collaborative (PPCOC), delivered by Children's Health Queensland. Both services were previously funded non-recurrently through the Care in the Right Setting (CaRS) Program. This funding further expanded the permanent Queensland Health specialist palliative care workforce by 6.9 medical practitioner FTE, 4.5 nursing FTE, 9.0 allied health FTE, and 5.6 administration FTE in advance of additional investment under the Workforce Plan.

Developing the Workforce Plan

Scope

The scope of this Workforce Plan is focused on designing, enabling, and strengthening the specialist palliative care workforce within Queensland Health by 2025-26, supported by strong connections both within and across palliative care service sectors.

Palliative care providers outside of Queensland Health, particularly in primary health care, are not considered within scope of this Workforce Plan. However, it is recognised that these providers have a critical and complementary role and offer invaluable expertise in the delivery of palliative care within their own profession or field.

Strategic alignment

The Workforce Plan is founded on the vision and principles set out in the Strategy and aims to contribute to the delivery of all goals, but in particular: Care is delivered by a skilled, supported, and multidisciplinary workforce that is accessible for people with a life-limiting illness, their families and carers.

Workforce planning within Queensland Health is conducted in line with the Health Workforce Strategy for Queensland, Advancing health services through workforce: A strategy for Queensland 2017-2026, ensuring our workforce is designed, strengthened, enabled, and supported to deliver sustainable, consumer-centred health care.

The Workforce Plan also aligns to the guiding principles outlined in the Making Tracks Together: Queensland's Aboriginal and Torres Strait Islander Health Equity Framework, and the commitment to improve First Nations peoples’ health outcomes, experiences, and access to care across the system.

The Workforce Plan contributes to Queensland's broader economic recovery and growth through safeguarding our health; growing our regions; investing in skills; and backing our frontline services.

Stakeholders and engagement

Stakeholder feedback and submissions to the parliamentary inquiry provided a valuable and extensive resource in the identification of palliative care workforce issues, challenges and potential solutions. These responses were collated and analysed to identify key workforce themes.

Feedback relating to palliative care workforce opportunities and challenges was also sought through consultation sessions and surveys led by the Department of Health, Palliative Care Queensland, and Health Consumers Queensland, to inform the development of the Strategy. Stakeholders included health consumers, families and carers, private palliative care service providers and peak bodies, and Queensland Health clinicians and executive leadership.

The specialist palliative care workforce themes identified as part of this consultation and engagement process were further explored and investigated during targeted consultation with each of the 16 Hospital and Health Services, identified private service providers contracted to deliver public services (such as Mater Misericordiae Brisbane and St Vincent's Private Hospital), as well as key stakeholders within the Department of Health including Clinical Chiefs.

This targeted engagement significantly contributed to the development of workforce strategies and actions included in the Workforce Plan that will enable a sustainable, responsive, and culturally safe and capable specialist palliative care workforce to meet the needs of Queenslanders, regardless of age, location or culture.

What strengths can we build on?

Stakeholder engagement highlighted the many strengths of our current specialist palliative care workforce, including but not limited to:

* A committed, motivated and experienced workforce

* Strong working partnerships between palliative care providers across the public, private and non-government sectors

* Passionate community spirit within the generalist and specialist palliative care workforce to improve the delivery of compassionate and holistic care

* A consumer-focused approach to service delivery, including a particular focus on supporting families and carers.

What can we improve?

Despite previous efforts and commitments at national and State levels, palliative and end-of-life care requires ongoing system reform to ensure it meets the needs of the population now and into the future.

Research and stakeholder engagement clearly identifies the need to increase specialist palliative care workforce capacity across Queensland, with a particular focus on regional, rural and remote locations to enable equity of service access regardless of where people live, how old they are, or what cultural and/or spiritual needs they have.

Further effort is also needed to value, invest in, and grow a First Nations specialist palliative care workforce to ensure culturally safe care is provided to First Nations peoples.

Workforce capability can also be improved through:

* Boosting access to quality clinical placements and supervision

* Increasing the number of training positions and clinical exposure to the field of specialist palliative care

* Ongoing education and professional development opportunities, and

* Articulating career pathways.

These initiatives will contribute to strong attraction and retention strategies and the reform agenda.

Uplifting digital connectivity, reducing workforce travelling times, reviewing equipment administration processes, and supporting access to appropriate staff accommodation in regional, rural and remote locations are identified as complementary and practical enablers for building and supporting this workforce.

Consumers and carers may have limited understanding of what holistic specialist palliative care is available and/or are not sure of care pathways and options. Enhancing consumer access to information, equipment, and technology, along with an integrated workforce approach, will support consumers to access treatment and care that meets the needs of individuals and their families and carers, and enables them to make informed choices about care preferences.

Priority areas

Key priority areas were identified for consideration in the development of the Workforce Plan. These areas relate to the specific needs of groups of Queenslanders, whether it be due to location, age or culture. In addition, the areas of bereavement and spiritual care were consistently raised as essential elements of specialist palliative care.

Diverse characteristics of populations require the workforce to be tailored towards different models of care across a range of health settings. Providing holistic palliative and bereavement care, according to individual preferences, requires a workforce with specialised skill sets.

Improving equity for rural and remote Queenslanders

Rural and remote communities globally have inequitable access to health professionals, exacerbated by transient workforces, ageing populations, disadvantaged populations, large distances and inconsistent economic conditions. Although more than one-third of the Queensland population live in rural and remote areas, there is a maldistribution of the specialist palliative care workforce which is concentrated in the south-east corner.

Rural and remote regions are supported by a generalist workforce, partnered with specialist palliative care telehealth services. The Specialist Palliative Rural Telehealth Service (SPaRTa) is a telehealth model that delivers virtual specialist palliative care services where there are no dedicated specialist palliative teams or services available. PallConsult provides telephone specialist advice and support for local clinicians caring for people with life-limiting conditions.

Increasing capacity and capability of a dedicated local workforce in rural and remote areas in partnership with remote specialist palliative care services is a priority for locally accessible, culturally and clinically safe quality care.

Achieving equity for First Nations peoples

First Nations peoples experience twice the rate of burden of disease, and have more palliative-related hospital admissions than other Australians. Despite this, palliative care services are under-utilised.

A range of factors influence access to services, including limited information provided to First Nations peoples about the availability of specialist palliative care compounded by language and communication barriers. Limited understanding by service providers of First Nations peoples’ cultural needs and/or the culturally safe practices and protocols when talking about death and dying (Sad News and/or Sorry Business) is also a barrier. First Nations peoples’ experiences of economic and geographic disadvantage further impact access to palliative care services.

First Nations health consumers in Queensland want palliative care to embrace the cultural, physical and emotional wellbeing of a person and their family, and enable comfort, dignity, cultural respect, and honoured wishes.

Building cultural safety requires a multifaceted strategy. While establishing identified Aboriginal and Torres Strait Islander health workforce positions in the specialist palliative care team is critical, increasing the number of First Nations people working across all clinical, non-clinical and cultural roles in urban, regional, and rural and remote areas is essential to foster trust, connection, and improve holistic care. Empowering the Aboriginal and Torres Strait Islander workforce to lead a holistic approach to palliative care, including navigating all aspects of palliative care and Sad News and/or Sorry Business, and yarning about advance care planning, will contribute to improved outcomes and health care equity.

The Queensland Health Aboriginal and Torres Strait Islander Health Division and the Queensland Aboriginal and Islander Health Council are partnering to design demonstration models of culturally and clinically safe community based palliative care services for First Nations peoples, to be delivered through the Aboriginal and Torres Strait Islander Community Health Sector. This is being supported through the community-based palliative care funding allocation under the Palliative and End-of-Life Care Strategy.

Delivering unique care for children and youth

The prevalence of life-limiting conditions is increasing. The most significant increase in life-limiting conditions in Queensland is for children less than one year of age and those who identify as Aboriginal and Torres Strait Islander. Treating and providing care for a child with a life-limiting condition demands a service response that delivers complex medical care, equipment, and holistic care that supports the social, emotional, educational, cultural, and spiritual needs of children and their families. This includes difficult conversations around end of life, and death and dying.

Specialist paediatric palliative care service delivery has unique characteristics that differentiate services from specialist adult palliative care and warrant specific consideration and planning. Care is family-centred and requires varying levels of care throughout the illness trajectory, often over many years to early adulthood and coordinated across all sectors of health and other relevant organisations and services. Particular consideration needs to be given to First Nations children and families as well as people from culturally and linguistically diverse backgrounds.

The inter-disciplinary team based at the Queensland Children's Hospital provides statewide care through the Paediatric Palliative Care Service (PPCS). Effective transitioning from paediatric to adult palliative care may be complex and usually involves multiple other treating teams and support services. Significant planning is required to enable coordinated care to reduce fragmentation, mitigate barriers and optimise wrap-around support and a seamless and positive experience for young people and their families.

Providing bereavement support

How a person experiences bereavement is unique to the individual. Specialist palliative care services align to individual needs and offer a psychological, social and emotional wellbeing support system to help the family, kinship groups, and carers cope at diagnosis, during the person's illness and during bereavement or Sad News and/or Sorry Business.

Bereavement support, including the coordination of support, may be delivered by a range of clinicians and others, including bereavement counsellors, social workers, nurses, psychologists, medical practitioners, and pastoral or spiritual carers. Bereavement support services need to be sensitive to the social, cultural, and spiritual beliefs, values and practices of the individuals being supported.

Expanding our workforce capacity and capability to support diverse populations during bereavement and Sad News and/or Sorry Business is a priority.

Supporting spiritual needs

Spiritual needs may be broader than faith-based or religious needs and may encompass diverse cultures, language, beliefs, preferences, and traditions. Caring for the spiritual needs of consumers and carers is integral to the delivery of high quality, holistic, person-centred palliative care.

Queensland Health’s Framework for Integration of Spiritual Care in Queensland Health Facilities acknowledges that spiritual care services are provided differently across Hospital and Health Services. These services are primarily provided by non-employees through the Queensland Multifaith Health Care Council and work collaboratively with care teams.

While integral to holistic care, the workforce to deliver spiritual care is not within scope of the Workforce Plan. However, it is important that all specialist palliative care staff acknowledge the spiritual needs of diverse population groups across all dimensions of care, include spiritual needs in consumer and family assessments, and foster professional communications with spiritual carers.

The future specialist palliative care workforce

Specialist palliative care workforce planning

Collaboration and partnership are required to enable Queensland's specialist palliative care workforce to be skilled and responsive to consumer needs and preferences, sensitive to the role of emerging technologies and changing models of care, and delivered efficiently with the best use of resources.

Planning for our specialist palliative care workforce includes the following:

Understand the Business

* What is the current state of services?

* What is the future population need?

* What are the palliative care principles and goals?

Analyse the Workforce

* What does our workforce look like?

* What do the national and state planning guidelines recommend?

* What does the future workforce model recommend based on set parameters?

* Can we sustainably implement this in Queensland Health and within the funding envelope?

* What are the identified workforce gaps?

Plan for the Future

* What are the workforce priorities?

* What strategies can we implement to deliver on the agreed palliative care principles and goals?

* What are the measures of success?

Developing a system perspective

For the purposes of developing a Queensland Health system perspective of the future requirements of the specialist palliative care workforce, a workforce modelling framework was developed including a tailored specialist palliative care workforce planning methodology and guiding parameters. This framework was informed by consultation with Hospital and Health Service specialist palliative care clinicians and by national and state planning guidelines and benchmarks, including:

* Palliative Care Australia: Palliative Care Service Development Guidelines 2018

* Queensland Health Clinical Services Capability Framework for public and licensed private health facilities v3.2 - Palliative Care Services module

* Queensland Health Palliative Care Services Planning Guideline 2021

Additional guiding parameters were developed to also inform the desirable workforce profile and modelling of the future specialist palliative care workforce. The guiding parameters include:

* A three-step planning approach should identify the workforce profiles required to achieve a baseline core workforce, a sustainable workforce for service stabilisation, and the future workforce for service growth for each Hospital and Health Service.

* A minimum Hospital and Health Service population of 100,000 is required to support a palliative medicine physician-led specialist palliative care service. If there are fewer than 100,000 in the population, services should be nurse-led supported by larger Hospital and Health Services, and specific services, including SPaRTa, the Paediatric Palliative Care Service and PallConsult.

* For Hospital and Health Services under a 100,000 population, a baseline core workforce profile should comprise nursing, allied health, Aboriginal and Torres Strait Islander health workforce and administrative support.

* Each Hospital and Health Service over 100,000 population should have workforce to deliver consultation and community palliative care services.

* The delivery of inpatient services is determined by each Hospital and Health Service. Planning for additional palliative care inpatient services is not included within the Workforce Plan.

* Individual Hospital and Health Service workforce requirements will be influenced by a range of additional factors including variations in geography and population distribution, access to services delivered by non-government organisations, First Nations population representation and staff recruitment and retention issues. These factors need to be considered in finalising any negotiations relating to workforce growth.

Stage 1: Baseline Core Workforce establish and/or enhance

Stage 2: Sustainable Workforce optimise capacity and capability

Stage 3: Future Growth Workforce to meet future needs

Based on local workforce and current and future population characteristics, Hospital and Health Services were grouped into three clusters during the planning process:

* Rural and remote Hospital and Health Services - fewer than 100,000 population and including South West, Central West, North West and Torres and Cape Hospital and Health Services.

* Regional Hospital and Health Services – more than 100,000 but less than 300,000 population and including Cairns and Hinterland, Mackay, Central Queensland, Wide Bay, Darling Downs, and West Moreton Hospital and Health Services.

* Major Hospital and Health Services - more than 300,000 population and including Metro South, Metro North, Gold Coast, Sunshine Coast and Townsville Hospital and Health Services as well as Children's Health Queensland (CHQ) as a statewide service.

Strategies and actions for implementation

How will the Workforce Plan establish, sustain, and grow the workforce?

The following four workforce focus areas align to the Advancing health service delivery through workforce: A strategy for Queensland 2017-2026 and actions of the Workforce Plan.

Keeping Connected

Strengthening

Designing

Enabling

Workforce Plan Strategies and Actions.

Across each of these focus areas, strategies and actions were identified that are key to the short and long-term success of our specialist palliative care workforce and the clinical services that will be delivered to health consumers, their families and carers.

The strategies were developed with the understanding that a capable, well-organised and engaged specialist palliative care workforce underpins the delivery of safe, high-quality palliative and end-of-life care services.

Queensland Health Specialist Palliative Care Workforce Plan: Strategies and actions

The following four columns are titled as follows:

Designing the workforce

Enabling the workforce

Strengthening the workforce

Keeping connected

Designing the workforce

* Research and implement sustainable workforce models using a staged approach to respond to Queenslanders’ needs.

* Shape workforce models for improved equity of access to care for rural, regional and First Nations peoples.

* Design integrated workforce models to support consumers choosing care closer to home.

1.1 Expand positions across medical, nursing, allied health, Aboriginal and Torres Strait Islander health, and administration workforces to strengthen a multidisciplinary team approach.

1.2 Establish a baseline core specialist palliative care workforce in priority areas of need.

1.3 Build a sustainable local specialist palliative care workforce to meet community needs and preferences.

1.4 Grow and foster the specialist palliative care workforce in line with projected future population needs.

1.5 Establish Aboriginal and Torres Strait Islander workforce positions to deliver and support culturally safe and appropriate care.

1.6 Establish positions to support bereavement care for consumers, families and carers.

1.7. Build Hospital and Health Service community-based palliative care workforce models for local communities.

1.8. Implement workforce models that integrate virtual health care solutions where appropriate.

1.9 Design and mobilise workforce models to enable out-of-hours specialist palliative care delivery.

1.10 Enhance workforce capacity and capability to support transition from paediatric to adult palliative care services.

Enabling the workforce

* Enable the workforce to deliver care effectively through access to appropriate technology, equipment and resources.

* Support the specialist palliative care workforce to provide quality care to consumers, families and carers.

* Enhance workforce wellbeing and inclusive and culturally safe workplaces.

2.1 Continue funding the Queensland Palliative Medicine Advanced Training Pathway.

2.2 Continue to partner with relevant entities to enhance access to technology, telehealth, broadband and WiFi for improved connectivity and virtual healthcare across regional, rural and remote locations.

2.3 Work with local health services and palliative care equipment providers to enable prompt access to the equipment needs of consumers regardless of location.

2.4 Increase the administration workforce to appropriately support specialist palliative care services.

2.5 Inform quality improvement of care models, processes, practices and pathways to ensure cultural safety and the elimination of racism.

2.6 Consider assistant roles to support specialist clinicians to maximise scope of practice.

2.7 Enable access to programs that support staff safety and wellbeing including debriefing support and reflective practice.

2.8 Ensure appropriate clinical governance arrangements are in place to support the workforce to provide safe and quality specialist palliative care across the State.

2.9 Support clinicians to undertake practice-based research and translate to practice.

Strengthening the workforce

* Strengthen workforce capacity and capability to deliver quality care through education, training and development.

* Develop initiatives to support attraction and retention, particularly in regional, rural, and remote Queensland.

3.1 Increase the number of funded training positions for advanced trainees in palliative medicine.

3.2 Promote the inclusion of palliative care in pre-entry and entry level health education programs.

3.3 Optimise access to student clinical placements across professions and disciplines.

3.4 Implement local approaches to grow staff into design positions through upskilling and ‘Grow-Your-Own’ career pathways.

3.5 Support access to incentivised immersive experiences in specialist palliative care for new and emerging workforces.

3.6 Incentivise post graduate qualifications for specialist palliative care workforces.

3.7 Enhance access to programs for the Aboriginal and Torres Strait Islander health workforce to build palliative care skills and capability.

3.8 Develop succession plans with particular focus on ‘critical roles’ to support service continuity.

3.9 Provide mentoring opportunities for emerging and future specialist palliative care leaders.

3.10 Establish and connect educator roles in hub locations (SPaRTa and CHQ) to support education, training and development for specialist palliative care workforces in regional, rural, remote services.

Keeping connected

* Strengthen partnerships across sectors and services to maximise:

- opportunities for a connected and agile workforce

- the reach of specialist palliative care services

- consumer experience for consumers, families and carers.

4.1 Work with consumers, families and carers, the local community and other providers for an integrated community-based workforce approach.

4.2 Enhance partnerships between SPaRTa, PallConsult, and CHQ with local regional and rural teams.

4.3 Strengthen links between acute, primary, and aged care sectors to enable streamlined and connected quality care.

4.4 Continue to encourage workforce participation in specialist palliative care communities of practice, the Queensland Palliative Care Clinical Network, and/or other relevant professional networks.

4.5 Continue to share information on best practice to enable quality improvement.

4.6 Grow innovative partnership workforce models that improve the coordination of palliative care, and the navigation of options and pathways for consumers, carers and families.

4.7 Work with service provider partners to expand specialist palliative care knowledge across the lifespan for local workforces and community.

Investing in the future specialist palliative care workforce

With a system perspective established, detailed consultation and collaboration with individual Hospital and Health Services occurred to focus on how local requirements could best be met, while driving system-level improvements in accordance with the Strategy's principles and goals and the Workforce Plan strategies and actions.

Specialist palliative care workforce expansion

Under the Workforce Plan, our frontline specialist palliative care workforce will increase by 87.0%, and uplift from 265.61 FTE in September 2021 to a total of 496.80 FTE in June 2026.

More specifically:

* Medical practitioners will increase by 88.99% (59.00 FTE)

* Nurses, including registered nurses, clinical nurses, clinical nurse consultants and nurse practitioners, will increase by 54.42% (76.21 FTE)

* Allied health professionals will increase by 173.75% (57.58 FTE)

* Aboriginal and Torres Strait Islander health workforces will increase by 1605% (16.05 FTE)

*  Administration officers will increase by 88.90% (22.35 FTE)

These increases are reflected in the following graph. FTE per profession as at September 2021 and June 2026 (projected).

The allocation of investment will support a staged build of the specialist palliative care workforce to enable growth in the greatest areas of need first.

Investment will be prioritised to establish a core baseline specialist palliative care workforce profile where this is not currently available, then build a sustainable workforce profile to enable service stabilisation, and subsequently grow the workforce to respond to future population growth within each Hospital and Health Service.

Please refer to the following graphs. Queensland Health specialist palliative care FTE per 100,000 population 2021 and 2026 (projected)

Please note these graphs all show two different columns, each representing 2021 and 2026 respectively across the various areas.

These planned workforce enhancements will support greater equity of access to specialist palliative care services by achieving a more comparable number of FTE per 100,000 population across each of the major and regional specialist palliative care Hospital and Health Services by 2026. Establishment of a core baseline workforce for rural and remote Hospital and Health Services results in comparatively higher workforce to population ratios, regardless of the projected future resident population for these Hospital and Health Services.

Specialist palliative care FTE supporting statewide programs such as Children's Health Queensland, PallConsult and MASS-PCEP are not included in Hospital and Health services population graphs, as they deliver services to all Queensland Hospital and Health Services.

Similarly, SPaRTa FTE operating from hubs based at Gold Coast, Sunshine Coast, Townsville and Cairns and Hinterland Hospital and Health Services are not included in Hospital and Health Services population graphs, as they deliver services primarily to rural, remote and regional communities.

Please refer to the following map, which represents the projected Queensland Health specialist palliative care workforce growth by 2026. Total Hospital and Health Services FTE by 2026 and percentage growth between 2021 and 2026

You will see that each area is represented by its FTE and percentage growth. The standalone box represents the area in South East Queensland on the greater area map.

Investment in capability development

The achievement of the future specialist palliative care workforce required to meet the needs of Queenslanders is contingent on the availability of appropriately qualified and skilled workforces across professions.

Building and strengthening the capability of our specialist palliative care workforce and supporting the development of students and clinicians seeking a career in specialist palliative care is essential to achieving the workforce of the future.

Separate to investment in additional frontline positions for Hospital and Health Services, investment will be made in specific capability development initiatives from within the committed $102 million from 2022-23.

Informed by consultation with clinicians and service providers, these investments include:

* The creation of additional opportunities for immersive experiences in specialist palliative care service delivery through the development of a multidisciplinary immersion program, and funding access to the Program of Experience in the Palliative Approach (PEPA) and Indigenous PEPA (iPEPA). (Actions 3.5 and 3.7)

* A review of existing nursing Transition to Practice Programs to build on palliative care knowledge and practice to ensure foundation capability within the Queensland Health nursing workforce. (Action 3.2)

* Incentives to support the completion of post graduate qualifications relevant to specialist palliative care, such as Graduate Certificates in Palliative Care and related areas such as lymphoedema management, and Master of Nursing programs leading to Nurse Practitioner qualifications. (Action 3.6)

* Incentives to support completion of post graduate qualifications in bereavement care, such as Graduate Certificates in Bereavement Counselling and Intervention, or Counselling, or Trauma Responsive Practice, and in Master of Counselling leading to certification as a bereavement counsellor. (Action 3.6)

* Funding for short-term leadership mentoring for nursing and allied health practitioners moving into leadership roles within specialist palliative care services. (Action 3.9)

* Continued funding for the Queensland Palliative Medicine Advanced Training Pathway to coordinate a statewide training program to develop a skilled palliative medicine physician workforce. (Action 2.1)

* Establishment of an additional 4.0 FTE temporary medical registrar positions in regional locations from early 2022 for a period of two years prior to the implementation of new permanent training positions from 2023-24. (Action 3.1)

* Establishment of an additional 2.0 FTE educator positions in each of the four SPaRTa service hubs to deliver education, training, and supervision support for nursing, allied health practitioners and Aboriginal and Torres Strait Islander health workforces. (Action 3.10)

Implementation and reporting

Measuring progress in the implementation of the Workforce Plan is to be undertaken as part of the Strategy's evaluation. The evaluation will make sure outcomes have been delivered, and also identify the impact of the Strategy and Workforce Plan and areas for future improvement.