The Post: The ‘basic dignity’ of hospice care threatened by health crisis

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Just as people should be able to live well, so too should they be able to die well. But even that basic dignity is under threat from the slow-moving disaster unfolding in our health system.

Hospices, a vital institution of care for dying people and their loved ones, face a $16 million shortfall this financial year, according to a report commissioned from consultants Martin Jenkins. Yet health officials are adamant that they have no funds available to fix that shortfall.

“What they have said to us clearly is there’s no money,” Tina McCafferty tells me. The head of South Auckland’s Tōtara Hospice, she oversees an institution that provides highly specialised medical care – not to mention emotional, social and spiritual support – for 1400 individuals and their families each year.

A decade or so back, state funding met around 70% of the operating costs for Tōtara and the country’s 27 other publicly contracted hospices. Now, in the wake of inflation, increasingly complex care demands and other costs, state monies cover less than half their budgets.

Even successful efforts to fund-raise elsewhere just can’t keep up, McCafferty says: “Every way I find to make money, there’s another layer of [state] disinvestment.”

Seasoned observers are stunned by the state of play. Our health system has always lacked cash: medical unions estimate we spend billions of dollars a year less - as a proportion of GDP - than comparable developed countries. Nonetheless, governments have generally found funding to support basic initiatives and simply keep the lights on.

Now, though, there may not even be that, as the system creaks under the combined weight of growing medical need, Labour’s ill-advised restructure, a decades-long failure to recruit enough nurses and doctors, and a National-led Government determined to shrink the state’s presence in our lives.

Last year’s Budget trumpeted supposedly massive health spending, but once inflation, Holidays Act back-pay and capital investments were accounted for, it provided just $93m extra– a 0.4% increase in operational spending – during a system crisis.

While health will notionally be protected in next week’s Budget, the Government’s obsession with cutting expenses as a proportion of GDP, coupled with increased defence spending and a refusal to significantly raise taxes, will in reality leave very little to go around. (As hundreds of thousands of female workers have just found out.)

Hence the stonewalling of the hospices. Nor is this a case of capricious officials; decisions on health spending are being made at the very heart of government.

The terrible irony of this cost-cutting is that, as is so often the case, it doesn’t even save money. If hospices have to cut back on the care they provide to people at the end of life, those individuals will simply require more hospital beds, emergency-department visits and ambulance call-outs.

Martin Jenkins estimate that the $100m spent annually on hospice care saves $108m in costs elsewhere in the health system, while easing the suffering of patients and their families in countless uncosted ways.

Whānau even recover more quickly if their loved ones have died a gentle death, McCafferty says. But for all the Government’s fine talk about social investment, such savings go largely unrecognised.

At places like Tōtara, the potential consequences are severe. “I can’t, hand on heart, tell our communities we can maintain services,” McCafferty says. “Because we can’t... If we have no uplift [in this year’s funding], we are going to have to reduce services to [people with] a prognosis of three months or less.”

That alone would represent a sharp – and hurtful – curtailing of the hospice’s mission. Even more alarmingly, McCafferty foresees a “domino” effect of service reductions at other hospices and then, if nothing changes, “a series of closures”.

This, she notes, is the exact situation unfolding in Britain, where the hospice sector is battling chronic underfunding. And the pressures on hospices here – which support nearly one-third of all dying New Zealanders – will only rise as the population ages.

The Government’s mean-spirited, Grinch-like approach will, of course, find its defenders among those who argue that the state’s coffers are bare. That, though, is a self-imposed choice.

The Green Party’s alternative Budget, released earlier this week, proposes an annual levy of 2.5% of the wealth held by couples over a threshold of $4m. This would, the party estimates, raise $18 billion for the “common good” services we all need to flourish – of which health is a prime example.

While such a levy would be unlikely to survive coalition negotiations with Labour, even a more modest capital gains tax could raise billions of dollars a year for healthcare and other services.

We have, then, a range of choices, from Greens to Grinches. And surely the latter path is a flagrant breach of our core social beliefs. Is this really what we want to become – a country that denies people even the dignity of dying well?