Frustration mounting over hospice funding: delivery of palliative care depends on nurses. And hospice nurses, their employers and NZNO are getting frustrated by the lack of a Government response to their pleas for more money to pay nurses fairly.
NZNO also wants to meet the Minister to present him with the thousands of signatures gathered during street action by hospice nurses in March. Frustration is mounting and NZNO hospice MECA advocate Mark Lennox said members were considering options, given the amount of time that had elapsed. "The $2.45 million is not a huge sum of money in the scheme of things. We are considering what other pressure we can apply and hope to have a plan of action by the middle of this month," he said.
The NZNO letter to the Minister said hospices expected to deliver palliative care services to more than 4000 people in the coming year. "The additional funding will be a critical part of the ability of hospices to deliver the essential palliative care services set out in the New Zealand Palliative Health Care Strategy," the letter said. The strategy's vision for palliative care is: "All people who are dying who could benefit from palliative care and their family/whanau should have timely access to quality palliative care services that are culturally appropriate and provided in a co-ordinated way': But that is a vain hope unless more money materialises.
Neilsen has real fears for the delivery of palliative care if the extra money to fund the MECA does not eventuate. "It will have different implications for different hospices across the country but it will mean a greater burden will be placed on the community, which already gives marvellous support to hospices. There will be real pressure in recruiting and retaining suitably qualified staff. With palliative care, nurses are the people in the front line and our reputation and ability to get community support depends on them, so we have to get good people. Those who work in palliative care are not motivated by the money. They have a passion and want to work in palliative care but we can't expect them to go on sacrificing 20 percent of their wages" [how much more they could earn at DHBs], he said.
Last year the former Minister of Health Annette King announced that DHBs must move towards funding 70 percent of hospices' operational costs but Neilsen said very few of the 15 hospices involved in the MECA were at that level, with some receiving just 50 percent funding. Schumacher said this funding threshold was a response to the fact many hospices were in serious financial trouble and that hospices had not received any increase in government funding for three to five years. "Seventy percent funding is the goal but we haven't achieved that yet. Some hospices are funded to that level but there are wide disparities. There is no consistent funding model applied across the country. These disparities are largely a result of historical funding models."
Neilsen said the service level model of funding, developed in 1998/99, was "badly in need of review. The objective was to have that framework implemented across the country but that hasn't happened, so there are different models of funding."
Schumacher points out that not all hospices provided the same services--some have inpatient units, while others operate only in the community. While the hospice philosophy was consistent, palliative care is delivered in a variety of ways.
With funding directed through DHBs, it was essential hospices had good relationships with their local DHB. "The most successful models of palliative care delivery are where the DHB and the hospice work together and provide an integrated service. The Waitemata DHB and the North Shore Hospice provide an integrated service across their region and have a planned strategic approach to the delivery of palliative care in their region. Other DHBs and hospices are working together more and more," she said.
Schumacher believes the 70 percent funding level is acceptable to most hospices. "Hospices' relationship with their communities is really, really important. Hospices are hugely supported by their communities and if hospices were fully funded and mainstreamed, there is a risk that they would lose that wonderful relationship with their communities. Hospices grew out of a huge amount of community support and we never want to lose that. Communities have a real sense of ownership of their hospices and this improves access and demystifies dying."
Neilsen agrees. "The community is an essential part of what we do and adds value to what we do." But unless more government funding is forthcoming, hospices' ability to continue doing what they do will be severely compromised.