Palliative care in the community: Setting the national scene

Since the early days of colonisation, specific systems to care for dying people have been evident in Australia's health care system. In line with many developed countries, in the last 30 years or so more active care systems for those facing the end of life have emerged, including developments in medical technology and home-based care.

There are many different models and approaches to palliative care across Australia, including community care. When a person is diagnosed with an illness that may prematurely end their life, most of their remaining life will be spent at home. It is possible to be cared for and to die at home, supported by clinical and other care services. The home setting more readily enables care that can be individually responsive to requirements such as family, ethnic and cultural needs.

Palliative Care Australia is the peak body that addresses the challenges of incorporating palliative care within health care services, by the development of policies and standards for service delivery. Over time the standards have shifted in emphasis, from being documents that promoted a developing discipline within health care, to establishing a framework for the best care for people facing the end of life and the promotion of ways to incorporate palliative care into existing care (PCA 2005) and most recently providing a framework for sector assessment (PCA 2009).

The Australian Government's National Palliative Care Strategy supported PCA in the development of policy documents to address models of service provision on the basis of need and the strengthening of linkages with primary health care providers. PCA's work in recent years has been premised on specialist palliative care not being able to be provided for every dying Australian, nor being required for every death. The framework of palliative care places the primary care provider at the core and suggests that every dying person needs to be cared for using a ''palliative approach", with input from specialist services only when required.

This paper addresses the national developments that have been occurring in community palliative care over recent years. Starting with the historical developments, the paper will discuss that the growth in community palliative care has been essential in the discipline of palliative care taking its place within the health care system and along an individual's trajectory of illness.