4. Developing 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.