Chair: Dr Libby Sallnow
a. Why ask if we can’t delivery? Articulating public health palliative care national policy with local practice wisdom to improve genuine choice at the end of life
Genuine choice for care preferences at the end of life is constrained by many factors. Why therefore, do we ask about end-of-life wishes, when our systems lack capability, and our community capacity is insufficient, to deliver them? To provide genuine choice for people, we need to address systemic inadequacies in both these domains. The systems and sectors that result in poor end of life outcomes can be challenged and reoriented through evidence-based measures, and cultural and societal norms that highlight the value and capability of citizens to engage in caring at the end of life can be re-invigorated.
A public health palliative care approach based on systems and policy reform and asset-based capacity building strategies can promote societal transformation. Working within systems and policy for sustainable and systemic change is most effective when informed by local practice wisdom gathered from the settings, communities and citizens impacted by such systems. Working across jurisdictions harnesses the strengths, resourcefulness and networks of these assets to build end-of-life capability, capacity and sustainable leadership to complement the contributions of the health sector to end of life care. The task of connecting health and community networks, and of linking systems (vertically) across jurisdictions (horizontally) is of current interest in our attempts to strengthen public health as the central framework for the end of life.
This presentation will consider frameworks that use a strengths-based capacity building partnership approach to integrate national systems and levels of decision-making bodies with local community infrastructure to develop sound social policies and practice on end-of-life choice.
b. Community participation in palliative care: what have we learned?
Dr Suresh Kumar
The theory, practice and evolution of Neighbourhood Network in Palliative Care in Kerala and community based projects in palliative care at multiple sites in and outside India. The challenges/ successes / failures and lessons. Suresh will detail his experiences from the politically polarised West Bengal, caste divided Pondicherry, Politically distrurbed Manipur, Slums in Bangladesh, challenges in Thailand and a two year experiment in Switzerland in addition to what is happening in Kerala. Suresh will also look at how different platforms for community participation in Palliative Care influence responses from the community and outcomes
c. PHPC: are we pulling the right policy levers?
The public health approach to palliative care aims to identify negative social determinants of health and use surveillance (evidence) to inform a multifaceted approach to improving the quality of dying. Applying the public health approach to palliative care involves:
• Public education
• Programs that support community efforts
• Policy reform
Compassionate communities recognise that people at end of life and their families have better experiences and outcomes when health professionals, communities and civic institutions at the local level work together. In Australia, individual communities have made gains towards compassionate communities, however the complexities of health reform requires an understanding of how these collectively fit within the broader health and social services context, and which policy levers are required within a more informed public health approach to palliative care in order to achieve sustainable and significant outcomes.
This presentation will provide a snapshot of the work Palliative Care Australia (PCA) has done to-date, and an overview of policy reform in the Australian context, where
PCA believes quality palliative care occurs when strong networks exist between specialist palliative care providers, primary generalist, primary specialist and support care providers and the community to those living with a life-limiting illness.