NSW Government makes social impact investment for palliative care

The NSW Government has made another social impact investment – a seven and a half year, $80 million commitment to support palliative care patients in Western Sydney.

In partnership with NSW Health, Silver Chain Group will deliver the Silver Chain Group Community Palliative Care Service in Western Sydney Local Health District. The service will be provided through an outcomes-based arrangement with NSW Health that will support Silver Chain Group to deliver positive outcomes for its patients.

The service will start in July 2017 and will provide approximately 8,300 patients who have an “advanced, life-limiting and progressing illness with enhanced community-based palliative care services,” according to a statement from the NSW government. Patients will benefit from an in-home service including support for daily living, together with respite care and bereavement support for their family, the government said.

“Nationally about 70% of people want to die at home, but about 14% do, according to a report from the Grattan Institute,” said Dr Christopher McGowan, Silver Chain Group chief executive officer. “To achieve that, you need to deliver a 24 hour/7 day a week service to the community, based in the community. We’ve had a model in Perth [for] that, and we have about 40 doctors who are mostly GPs, but some specialist palliative care doctors. There are also nurses, carers, and volunteers who support people who want to die surrounded by the people they love. Essentially, we’re taking that model and putting it in place in Western Sydney.”

The outcomes-based arrangement will see a pay-out based on the fact that in-home palliative care is less expensive than dying in hospital or in a hospice.

Twenty four hour palliative nursing consultancy services will also be offered in all Western Sydney Local Health District residential aged care facilities, and palliative nursing support will be offered for patients in their terminal phase of life, who are living in aged care facilities, where required, the government said.

Silver Chain provides in-home “medical, clinical and social care for people in the last years of life,” Dr McGowan said.

“We think primary care is good and reasonably distributed, we have really good hospital care, but there’s not much in between,” he said. “If you’re old and you have a health need more than a GP can provide, you wind up in hospital. Does it push people to nursing homes because they don’t want to go to the hospital? We think this part of the healthcare system can be delivered more efficiently and more value in people’s homes.”

In addition to providing overall financial benefit through providing at-home care, Silver Chain also measure a range of social outcomes measured under the Palliative Care Outcomes Collaboration (PCOC).

“We collect information on 10 variables every time we see patients, including insomnia, nausea, and pain and we weigh and rank all of those variables,” Dr McGowan said. “We’re typically in the top 10 percentile compared to in-patient care. We also provide services to support families, because you’re closer to the person who’s dying and caring for them in home, where you can be a bit more engaged. In hospice, you go you visit and you leave. We help to build capacity in families.”

These metrics are not part of the outcomes measured in the social impact investment, Dr McGowan said.

This is the fifth social impact investment developed by the NSW Government. It follows the Newpin and The Benevolent Society Social Benefit Bonds implemented in 2013, the On TRACC social impact investment developed in 2016 and the Resolve Social Benefit Bond developed in 2017.