Palliative Care Nurses Conference –
Biannual conference
Wellington Convention Centre, Wellington

Hon Tariana Turia, Associate Minister of Health
Friday 13 November 2009; 9.30pm

I was delighted to accept the invitation of Helen Cleaver, Chairperson Palliative Care Nurses New Zealand, to take part in this very special conference.

Your role, in walking alongside families as they support their loved one to leave this world, brings with it responsibilities and obligations which touch at the very essence of our humanity.

You are charged with the awesome task of caring and supporting families in the process of dying; and during bereavement itself.

In being there at the sacred transition between life and death, you have enabled families to love and honour the person departing in the way in which they want to

And so I want in turn to honour you, Palliative Care Nurses, for the specialist nursing care you provide in this distinctive area of healthcare. Your role in the administering of end-of-life care is all about optimising the quality of life.

We’re not talking about administering of medicine; or treatments as the sole purpose for your role.

We’re talking about relationships. We’re talking about communication. We’re talking about strategies to address the physical, psychological, spiritual and cultural needs of the person and their whanau.
In essence, this is whanau ora at its strongest.

Whanau ora is a way of seeing the world which places whānau at the centre and builds on the strengths and capabilities already present in whānau.

It is about living by ngā kaupapa tuku Iho; the inherited values of our ancestors. Enabling Māori values, beliefs, obligations, and responsibilities to guide whānau in their day to day lives.

I am currently leading a policy programme which we are taking back to Cabinet at the start of 2010, to describe how whanau ora can work – and so I have to admit that I see every issue as another expression of whanau ora.

In the case of palliative care, whanau ora acknowledges that the dying process impacts on each member of a person's family as individuals and as part of a collective.

We say in Maori:

Ka hinga atu he tete-kura – ka hara-mai he tete-kura.
As one fern frond dies – one is born to take its place.

As palliative care nurses, you help families to focus on beginnings and endings; to find the hope of tomorrow in amongst the sadness of today.

An important part of this process is enabling family members to die in the comfort of their own home.

I was interested in the findings of Health and Disability Commissioner, Ron Paterson, that reported examples of poor nursing, of treating patients with a lack of dignity, of fragmented care. In his view only 15% of those who needed palliative care in Auckland actually received it.
And so, even if palliative care is intended to be available where the patient is – be that in the home, in hospital, in residential care, or in a hospice – if the complaints received are anything to go by, it would seem that much more work needs to go into education and support to promote the role of nursing within palliative care.

A critical issue that these findings bring up is the importance of an integrated approach to care that recognises the distinctive contributions that can be made by both generalists and specialists in meeting palliative care needs.

Specialist palliative care is the type of expertise I know is in abundance at this conference – where nurses will be an integral part of an inter-disciplinary team of palliative care health professionals

I mihi to you all for the special skills and values you bring to this role.

But I want to also recognise the significance of generalist palliative care providers – that provided by general practice teams, Maori health providers, allied health teams, and residential care staff as well as general ward staff or disease specific teams in areas such as oncology, respiratory, renal and cardiology.

Together, all of you can work to produce the total needs of a person and their family.

A couple of months ago I was really pleased to learn of the whanau ora palliative care service launched at Whakatu Marae in Nelson. As part of that service, three new kaitakawaenga hauora – palliative care workers – will work with Maori health services in Blenheim, Motueka and Nelson.
The service is based on the motivation to care for the sick and their whanau in a context of aroha.

Over in Palmerston North, there’s been debate around what is known as the Liverpool Care Pathway for dying patients. Based at Arohanui Hospice, the approach is a tool for ensuring dying people get the holistic care they are entitled to, determining the patient’s needs and how to meet them.

While up in Waikato, Hospice Waikato has appointed its own palliative care physician – to have a doctor specifically situated in the hospice rather than having to share with the DHB and Health Waikato.

Three different areas – and three different approaches.

I want to say to you, that our Government is absolutely supportive of the vital work undertaken in palliative care – and the distinctive ways in which this is being demonstrated.

We have funded an additional $13.4 million per annum to support hospice services which invests in greater certainty in funding and makes the services a lot more secure.

We have also funded an additional $1.3 million for ‘Access to care pressures’. This is a way of being able to support hospices to develop and deliver services which address equity in access issues, including the capacity to connect with Maori.

We’ve also supported the Ministry of Health to make progress on a palliative care work programme, including:
• Developing nationally standardised information for providers and for families, on advanced care planning;
• Establishing a Maori advisory group;
• Developing resources, such as an e-learning tool, for generalist nurses in palliative care; and
• Workforce development.

I know there are still many challenges ahead, not the least being those around pay parity and additional funding for hospital based specialist palliative care.

But I’m really pleased to be able to report to you the progress that has been achieved in collaborative prescribing. Collaboration between providers is absolutely essential in this area, as resources are always so limited, as is specific expertise in palliative care

I understand that the Ministry is serious about the opportunity to enable a registered nurse to initiate, monitor and modify treatments; and with any luck it will be on next year’s legislative work programme.

I know that as an Association, you have placed high priority on the development of a strategic plan; including analysis of the national professional development framework for palliative care.

This is a really important decision - to step up to the plate – to ensure that ultimately all people who are dying and their family, will be able to benefit from quality palliative care services that are culturally appropriate and can be provided in a coordinated way.

In this conference – united we stand – strengthening the links – you have made a call to support nurses working in any setting – and I would extend that to include support for families and whanau in any setting.

Finally, on a more personal note, I want to just acknowledge with enormous gratitude the significant difference you all make in our lives.

I remember when my brother was dying, the enduring respect, the consistent love and the compassionate and professional care he received from palliative care staff was tremendously important not just for his last months, but also in the months that followed his death.

Having the support of generalist and specialist palliative care workers around us, as we cared for him in his own home; was a fundamental part of our grieving process and the restoration of a sense of peace in our lives.

And so I want to thank you – on behalf of all family members - for making the difference we need in the crucial journeys of death and dying.

I wish you all the very best for a successful two days and I will be looking forward to the set of recommendations that you will produce as a result of your time together.

ENDS

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