The Disgrace Of The Hospice Care Funding Scandal
Ian Powell discusses the tipping point of the funding crisis facing hospice care in New Zealand.
In the referendum on assisted dying in which it was voted in by a decisive majority (65%) in 2020, I voted against it.
This was primarily because much of the argument in support seemed to me to centre on difficulties in accessing palliative care, including in hospices.
My view was that the priority was to improve accessibility to palliative care. I would have felt better if palliative care access had been improved but sadly it has further deteriorated to the point of crisis and tipping point.
Understanding palliative care and hospices
Palliative care is a branch of medicine regulated by the Medical Council. It improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening, including terminal, illness. When a person receives a terminal diagnosis, they can choose to receive hospice care.
Annually hospice services in New Zealand provide palliative and holistic wrap around care to over 10,000 people who die, as well as another 9,000 living with terminal illness, and their whānau.
Although hospices are not statutory health authorities, everything they provide is free of charge. Roughly there is a 50:50 split between government funding and hospice fundraising. Hospice New Zealand is the national representative organisation of these 32 hospices.
Hospice health professionals include doctors, nurses, therapists (physical, occupational and speech) and social workers. Consequently, even more so than hospitals, they are labour intensive.
Hospices provide medical care designed for the end of a person's life. The purpose of this care is to improve the quality of the life that these patients have left. It includes pain and other symptom relief, along with emotional, psychosocial, and spiritual help for both patients and their families.
Hospice care operates at four levels depending on circumstances – routine home care, continuous home care, general inpatient care, and respite care.
Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication.
Hospice funding crisis reaches tipping point
Unfortunately, despite the invaluable work for the terminally ill that only they as institutions can provide, the funding crisis that hospices face has reached a tipping point.
This was brought to the fore by Kathryn Ryan's Radio New Zealand Nine to Noon programme (6 June): Hospice funding crisis.
The focus was on one of the largest hospices, Tōtara Hospice, which services the communities of South and South-East Auckland. It has had to formally advise Health Minister Simeon Brown that it is planning to reduce services next month.
This action comes after years of warnings from hospices that their funding was unsustainable. This was reinforced by a recent report by the MartinJenkins consultancy which concluded that for the first time the hospice sector won't be able to raise enough money to break even.
Expanding the tipping point
Radio New Zealand's coverage of the funding tipping point continued three days later on Morning Report in a thorough piece by health journalist Ruth Hill: Collapse of hospices could cost taxpayers millions.
Hill reported the hospices warning that funding shortfalls were putting their critical services at risk. Already they were only available to one out of three New Zealanders who were dying. She provided individual examples of this sorry state of affairs.
The Government's scuttling of the pay equity claim for hospice nurses also had a negative impact. Hospice New Zealand chief executive Wayne Naylor noted that hospice nurses were currently paid up to 35% less than Health New Zealand nurses. He said:
That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop.
Hospices were being forced to consider two unpalatable alternatives. Naylor described it this way:
That then falls back on community to provide more money to support their local hospice. The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services.
Minister Brown has said that Health New Zealand had enough funding for hospice care. However, Naylor reported that the organisation had told Hospice New Zealand something quite opposite to the Minister:
They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. So essentially it's a no to funding from Health NZ right now.
Ruth Hill also tellingly cites the MartinJenkins report which that the 28 partially publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer emergency departments and hospital admissions or rest home stays.
What is to be done
Simeon Brown maintains that he and his government value the services hospices provide. What they provide is as core to the public health system as the services provided in our general practices and public hospitals.
Further, many (probably most) of the terminally ill are people who have invested in the public health system for much longer than those who sit around the cabinet table.
They have done their bit to ensure their health system has been funded for the benefit not just for themselves and their families.
It has also for hugely many more others that are unknown to them. It is only reasonable that hospice care should be available for them in their final weeks or months.
It is not just a question of the hospice service being sufficiently funded. It should not have to be financially dependent on charity to survive, let alone function.
This is fundamentally wrong. Being dependent on charity only makes sense if governments are so cynical to factor into their calculations that the terminally ill don't amount to many votes and not for very long!
It also makes sense if governments are so short-sighted that they can't see the financial return of investing in hospice care!
If hospice care being dependent on charity does make sense, then the words 'disgrace' and 'scandal' have no meaning.
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Scoop
11-06-2025
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The Disgrace Of The Hospice Care Funding Scandal
Ian Powell discusses the tipping point of the funding crisis facing hospice care in New Zealand. In the referendum on assisted dying in which it was voted in by a decisive majority (65%) in 2020, I voted against it. This was primarily because much of the argument in support seemed to me to centre on difficulties in accessing palliative care, including in hospices. My view was that the priority was to improve accessibility to palliative care. I would have felt better if palliative care access had been improved but sadly it has further deteriorated to the point of crisis and tipping point. Understanding palliative care and hospices Palliative care is a branch of medicine regulated by the Medical Council. It improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening, including terminal, illness. When a person receives a terminal diagnosis, they can choose to receive hospice care. Annually hospice services in New Zealand provide palliative and holistic wrap around care to over 10,000 people who die, as well as another 9,000 living with terminal illness, and their whānau. Although hospices are not statutory health authorities, everything they provide is free of charge. Roughly there is a 50:50 split between government funding and hospice fundraising. Hospice New Zealand is the national representative organisation of these 32 hospices. Hospice health professionals include doctors, nurses, therapists (physical, occupational and speech) and social workers. Consequently, even more so than hospitals, they are labour intensive. Hospices provide medical care designed for the end of a person's life. The purpose of this care is to improve the quality of the life that these patients have left. It includes pain and other symptom relief, along with emotional, psychosocial, and spiritual help for both patients and their families. Hospice care operates at four levels depending on circumstances – routine home care, continuous home care, general inpatient care, and respite care. Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication. Hospice funding crisis reaches tipping point Unfortunately, despite the invaluable work for the terminally ill that only they as institutions can provide, the funding crisis that hospices face has reached a tipping point. This was brought to the fore by Kathryn Ryan's Radio New Zealand Nine to Noon programme (6 June): Hospice funding crisis. The focus was on one of the largest hospices, Tōtara Hospice, which services the communities of South and South-East Auckland. It has had to formally advise Health Minister Simeon Brown that it is planning to reduce services next month. This action comes after years of warnings from hospices that their funding was unsustainable. This was reinforced by a recent report by the MartinJenkins consultancy which concluded that for the first time the hospice sector won't be able to raise enough money to break even. Expanding the tipping point Radio New Zealand's coverage of the funding tipping point continued three days later on Morning Report in a thorough piece by health journalist Ruth Hill: Collapse of hospices could cost taxpayers millions. Hill reported the hospices warning that funding shortfalls were putting their critical services at risk. Already they were only available to one out of three New Zealanders who were dying. She provided individual examples of this sorry state of affairs. The Government's scuttling of the pay equity claim for hospice nurses also had a negative impact. Hospice New Zealand chief executive Wayne Naylor noted that hospice nurses were currently paid up to 35% less than Health New Zealand nurses. He said: That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop. Hospices were being forced to consider two unpalatable alternatives. Naylor described it this way: That then falls back on community to provide more money to support their local hospice. The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services. Minister Brown has said that Health New Zealand had enough funding for hospice care. However, Naylor reported that the organisation had told Hospice New Zealand something quite opposite to the Minister: They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. So essentially it's a no to funding from Health NZ right now. Ruth Hill also tellingly cites the MartinJenkins report which that the 28 partially publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer emergency departments and hospital admissions or rest home stays. What is to be done Simeon Brown maintains that he and his government value the services hospices provide. What they provide is as core to the public health system as the services provided in our general practices and public hospitals. Further, many (probably most) of the terminally ill are people who have invested in the public health system for much longer than those who sit around the cabinet table. They have done their bit to ensure their health system has been funded for the benefit not just for themselves and their families. It has also for hugely many more others that are unknown to them. It is only reasonable that hospice care should be available for them in their final weeks or months. It is not just a question of the hospice service being sufficiently funded. It should not have to be financially dependent on charity to survive, let alone function. This is fundamentally wrong. Being dependent on charity only makes sense if governments are so cynical to factor into their calculations that the terminally ill don't amount to many votes and not for very long! It also makes sense if governments are so short-sighted that they can't see the financial return of investing in hospice care! If hospice care being dependent on charity does make sense, then the words 'disgrace' and 'scandal' have no meaning.
Scoop
11-06-2025
- Scoop
The Disgrace Of The Hospice Care Funding Scandal
In the referendum on assisted dying in which it was voted in by a decisive majority (65%) in 2020, I voted against it. This was primarily because much of the argument in support seemed to me to centre on difficulties in accessing palliative care, including in hospices. My view was that the priority was to improve accessibility to palliative care. I would have felt better if palliative care access had been improved but sadly it has further deteriorated to the point of crisis and tipping point. Understanding palliative care and hospices Palliative care is a branch of medicine regulated by the Medical Council. It improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening, including terminal, illness. When a person receives a terminal diagnosis, they can choose to receive hospice care. Annually hospice services in New Zealand provide palliative and holistic wrap around care to over 10,000 people who die, as well as another 9,000 living with terminal illness, and their whānau. Although hospices are not statutory health authorities, everything they provide is free of charge. Roughly there is a 50:50 split between government funding and hospice fundraising. Hospice New Zealand is the national representative organisation of these 32 hospices. Hospice health professionals include doctors, nurses, therapists (physical, occupational and speech) and social workers. Consequently, even more so than hospitals, they are labour intensive. Hospices provide medical care designed for the end of a person's life. The purpose of this care is to improve the quality of the life that these patients have left. It includes pain and other symptom relief, along with emotional, psychosocial, and spiritual help for both patients and their families. Hospice care operates at four levels depending on circumstances – routine home care, continuous home care, general inpatient care, and respite care. Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication. Hospice funding crisis reaches tipping point Unfortunately, despite the invaluable work for the terminally ill that only they as institutions can provide, the funding crisis that hospices face has reached a tipping point. This was brought to the fore by Kathryn Ryan's Radio New Zealand Nine to Noon programme (6 June): Hospice funding crisis. The focus was on one of the largest hospices, Tōtara Hospice, which services the communities of South and South-East Auckland. It has had to formally advise Health Minister Simeon Brown that it is planning to reduce services next month. This action comes after years of warnings from hospices that their funding was unsustainable. This was reinforced by a recent report by the MartinJenkins consultancy which concluded that for the first time the hospice sector won't be able to raise enough money to break even. Expanding the tipping point Radio New Zealand's coverage of the funding tipping point continued three days later on Morning Report in a thorough piece by health journalist Ruth Hill: Collapse of hospices could cost taxpayers millions. Hill reported the hospices warning that funding shortfalls were putting their critical services at risk. Already they were only available to one out of three New Zealanders who were dying. She provided individual examples of this sorry state of affairs. The Government's scuttling of the pay equity claim for hospice nurses also had a negative impact. Hospice New Zealand chief executive Wayne Naylor noted that hospice nurses were currently paid up to 35% less than Health New Zealand nurses. He said: That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop. Hospices were being forced to consider two unpalatable alternatives. Naylor described it this way: That then falls back on community to provide more money to support their local hospice. The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services. Minister Brown has said that Health New Zealand had enough funding for hospice care. However, Naylor reported that the organisation had told Hospice New Zealand something quite opposite to the Minister: They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. So essentially it's a no to funding from Health NZ right now. Ruth Hill also tellingly cites the MartinJenkins report which that the 28 partially publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer emergency departments and hospital admissions or rest home stays. What is to be done Simeon Brown maintains that he and his government value the services hospices provide. What they provide is as core to the public health system as the services provided in our general practices and public hospitals. Further, many (probably most) of the terminally ill are people who have invested in the public health system for much longer than those who sit around the cabinet table. They have done their bit to ensure their health system has been funded for the benefit not just for themselves and their families. It has also for hugely many more others that are unknown to them. It is only reasonable that hospice care should be available for them in their final weeks or months. It is not just a question of the hospice service being sufficiently funded. It should not have to be financially dependent on charity to survive, let alone function. This is fundamentally wrong. Being dependent on charity only makes sense if governments are so cynical to factor into their calculations that the terminally ill don't amount to many votes and not for very long! It also makes sense if governments are so short-sighted that they can't see the financial return of investing in hospice care! If hospice care being dependent on charity does make sense, then the words 'disgrace' and 'scandal' have no meaning. Ian Powell Otaihanga Second Opinion is a regular health systems blog in New Zealand. Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.
Otago Daily Times
08-06-2025
- Otago Daily Times
Hospices warn critical services under threat amid funding crisis
By Ruth Hill of RNZ Hospices are warning that critical services for the dying are under threat, with nothing for palliative care providers in the Budget. Hospice NZ says government funding only covers about half of what it costs to run New Zealand's 28 publicly funded hospices, but if services collapse, it will end up costing taxpayers millions of dollars more. Jen Nolan, whose younger brother Matt died at Te Omanga Hospice in Lower Hutt in 2019, said she dreaded to think how those final days would have gone without that "incredible, wrap-around care". The weeks following Matt Nolan's diagnosis with stage four melanoma were brutal: brain surgery, radiation, immunotherapy - nothing worked. It was a devastating blow when doctors said there was nothing more they could do - but Matt Nolan's admission to Te Omanga offered a different kind of healing. "When we walked in, I turned to one of my sisters and said 'God, it's like we've left Hell and we're in Heaven's waiting room'." Her brother's seizures and complex pain needs made it impossible for him to be at home, but Te Omanga became their home. "We could come and we could bring our dogs, he had a lovely room that opened out to the garden. His friends could come. "I walked in one day, and there he was, fast asleep, with two of his buddies also asleep in chairs. They were having a little nap together." Matt Nolan died in July 2019, three months after diagnosis. He had just turned 49. Six years on, Jen Nolan said it was heartbreaking that hospice services were only available to one in three New Zealanders who were dying. "If you face the death of a loved one, and you haven't got the option to go into hospice care, I think that would be a bloody grim place to be. "It was the most supportive and gentle place for us all to be with him. The care he received was outstanding. And I feel what we were shown as we navigated this incredibly difficult time was the best humans can be for each other." It cost $226 million to run the country's hospice services last year, with just half of that provided by the government. Hospice New Zealand chief executive Wayne Naylor said it was disappointing to not even rate a mention in the Budget - especially coming on top of the scuttling of the pay equity claim for hospice nurses. They are currently paid up to 35% less than Health NZ nurses. "That was a real out-of-the-blue sideswipe for hospices and hospice nurses in particular, to have our pay equity claim, which was almost completed, just stop." Indications that the government would not be covering future pay equity settlements for the funded sector were "very problematic". "That then falls back on community to provide more money to support their local hospice. "The alternative is that hospices have to make some staff redundant so that they can increase the salaries of other staff, and that leads to a reduction in services." Health NZ has enough money - Health Minister Health Minister Simeon Brown said the government "values the work of hospices", but he said it was up to Health NZ to do its own negotiations with providers. "This Budget has provided $1.37b to Health NZ to not only deliver an increase in investment for those front-line hospital and specialist services, but also an uplift in investment to that funded sector, which includes primary care, which includes aged care, which includes palliative care." However, Naylor was not optimistic following meetings with Health NZ officials, the most recent one this week. "They told us they had no more funding, that they have no contingency that they can call upon, and the people with whom we met said they had no authority to allocate funding from anywhere else. "So essentially it's a no to funding from Health NZ right now." Assisted dying services receive about $11m a year from Health NZ, in order to ensure equitable access. "Which is fine for the fewer than 1% of people who seek it," Naylor said. "But for the 99% of people who die from an expected illness, only about a third can access hospice care. So there still remains that inequity that needs to be addressed." For dying children, access to specialist palliative care services were even worse. A recent MartinJenkins report found New Zealand's 28 publicly-funded hospices are returning at least $1.59 in health benefits for every dollar of taxpayer money received, including fewer ED and hospital admissions or rest home stays. Add to that the clinical services they directly fund themselves, the public benefit is even higher. Most patients under hospice care are able to stay in their own homes, with brief admissions to hospice for respite or to adjust pain medication. Government 'exploiting' good will - nurses Nelson-Tasman Hospice nurse Donna Burnett loves her work, which is why she has stayed in the job for 36 years. However, the Nurses Organisation delegate said that good-will was being taken for granted by the government, and the end result for many was "burnout". "We can't keep giving the way we are. "Often we're short-staffed. We keep that patient centred care going, but it's coming at a cost. "We can't keep giving like we are and working understaffed because that has an impact on your wellbeing." In a written response, Health NZ said it would shortly begin seeking feedback from the public and the sector on a model of care proposal for adult palliative care. It plans to finalise both the paediatric and adult models of care by the end of the year.
