Palliative care services in Australia

National Hospital Morbidity Database

Data on admitted patient palliative care are sourced from the National Hospital Morbidity Database (NHMD). This annual collection is compiled and maintained by the AIHW, using data supplied by state and territory health authorities. Information from almost all hospitals in Australia is included in the database: from public acute and public psychiatric hospitals, private acute and psychiatric hospitals, and from private free-standing day hospital facilities (AIHW 2022). Some of these hospitals have hospices affiliated with them. The latest available data at the date of publication of this report was 2021–22. A complete Data Quality Statement – NHMD 2021–22 [PDF 650kB] is available online.

Episode-based data

The NHMD is episode-based, with the term ‘hospitalisation’ used to refer to an episode of admitted patient care; individual patients may have multiple hospitalisations ending in discharge, transfer, or statistical discharge with a change in care type and ultimately death. Each record in the NHMD, is based on a single episode of treatment for an admitted patient, with such episodes classified in the ‘Care type’ data item as Acute care, Palliative care, Rehabilitation care, Newborn and other types of care. When a patient receives only one type of care during a hospital stay (such as only Acute care or only Palliative care), the length of stay for that hospitalisation is equal to the total length of time the patient spent in hospital during that stay. 

However, where patients receive different types of care during one hospital stay (for example, a person may be admitted for active cancer treatment but then later reclassified as a palliative care patient), the patient may be statistically discharged from the hospital after the first type of care and then statistically readmitted into a second phase of care. Thus, a single patient may have two or more hospitalisations during any one hospital stay. Since each record within the NHMD is based on an episode of care, the hospitalisation count is a count of episodes, not persons. In cases of more than one care type, length of stay refers to the length of the episode of care, not the total duration of the patient’s hospital stays.

Coverage

For each of the years considered in this report, the coverage of the NHMD has been very good. For example, in 2021–22, coverage for the NHMD was high – data from all public hospitals were included (AIHW 2022). Most private hospitals also provided data, the exceptions being the private free-standing day hospital facilities and two overnight private hospitals in the Australian Capital Territory. Note that the data for private hospitals and all hospitals (public and private combined) in Tasmania, the Australian Capital Territory and the Northern Territory were not published for confidentiality reasons. 

Hospitals may be re-categorised as public or private between or within years (see Local Hospital Networks/Public hospital establishments National Minimum Data Set (NMDS) 2021–22 for further information). This should be considered when comparing data by sector over time.

Data on state/territory of hospitalisation should be interpreted with caution because of cross-border flows of patients. This is particularly the case for the Australian Capital Territory. In 2021–22,19% of hospitalisations in the Australian Capital Territory public hospitals were for patients who lived in New South Wales. 

The AIHW Indigenous identification in hospital separations data: quality report assessed the quality of Indigenous status identification in Australian public hospitalisations. The results of this study indicated that data for all jurisdictions should be used in any analyses of Indigenous hospitalisation rates and that the ‘true’ number of Aboriginal and Torres Strait Islander (First Nations) people was close to 9% higher than the number indicated in hospital records (AIHW 2013). This should be considered when interpreting the hospital data by Indigenous status. Note, no adjustment has been applied to the counts in the hospital data by Indigenous status in this report. 

Standard admitted patient care data exclusions

As per the standard AIHW practice when analysing admitted patient data in the NHMD, the data presented in this report exclude those records for which the ‘Care type’ data item was reported as newborn (unqualified days only), hospital boarder or organ procurement (posthumous).

Further information

Comprehensive hospital statistics from the NHMD are released by the AIHW on an annual basis in Admitted patients (AIHW 2023a) and further information about the NHMD can be obtained from those publications. Metadata information for the Admitted Patient Care and Local Hospital Networks/Public Hospital Establishments NMDS, that are the basis for the AIHW National Hospital Databases (AIHW 2022), are published in the AIHW’s online metadata registry – METeOR and the National Health Data Dictionary.

From 1 July 2013, care types have been reported using revised definitions, with the aim to improve consistency in reporting for the subacute and non-acute care types. Therefore, changes in the care type definitions should be considered when interpreting changes over time.

National Public Hospital Establishments Database

The National Public Hospital Establishments Database (NPHED) holds establishment-level data for each public hospital in Australia, including public acute hospitals, psychiatric hospitals, drug and alcohol hospitals, and dental hospitals in all states and territories. The collection covers hospitals within the jurisdiction of the state and territory health authorities only. Hence, public hospitals not administered by the state and territory health authorities (hospitals operated by the Australian Government Department of Health and Aged Care, Department of Defence, or correctional authorities, for example, and hospitals located in offshore territories) are not included. The collection does not include data for private hospitals.

For 2021–22, the collection was based on the Local Hospital Networks/Public Hospital Establishments national minimum data set (LHN/PHE NMDS). Information is included on a hospital’s resources, expenditure, average available bed numbers, peer group, and the statistical local area and remoteness area of its location. For more information on the data collection method and other relevant data issues, refer to NPHED Data Quality statement 2021–22 [PDF] (AIHW 2023b).

Palliative Care Outcomes Collaboration

The Palliative Care Outcomes Collaboration (PCOC) is a national program using standardised validated clinical assessment tools to measure and benchmark patient outcomes in palliative care. 

Participation in the PCOC is voluntary and open to all palliative care service providers across Australia. Representation is sought from public and private health sectors, rural and metropolitan areas, and inpatient and community settings. PCOC aims to assist services to improve the quality of the palliative care they provide through the analysis and benchmarking of patient outcomes. The PCOC model is embedded into routine clinical practice. As such, the standardised clinical assessment tools are used as part of routine practice with each consecutively admitted patient.

The PCOC palliative care outcomes collection dataset (PCOC 2012) includes data on patient demographics, clinical setting information, and patient outcomes from the following PCOC assessment tools (Daveson et al. 2021; PCOC 2012): 

• Palliative Care Phase
• PCOC Symptom Assessment Scale (PCOC SAS)
• Palliative Care Problem Severity Score (PCPSS)
• Australia-modified Karnofsky Performance Status (AKPS) Scale
• Resource Utilisation Groups – Activities of Daily Living (RUG-ADL). 

Data using Version 1 of the PCOC dataset were collected between January 2006 and January 2007. Version 2 of the dataset was enacted from July 2007, and Version 3 was implemented in July 2012 (PCOC 2012). More information about this dataset can be found in the PCOC Version 3.0 Dataset Data Dictionary and Technical Guidelines.

The national information presented in this report reflect all palliative care services that submitted data for the 1 January 2018 to 31 December 2022 period. A full list of the services that contributed data to this report can be found on the Palliative Care Outcomes Collaboration website.

National Health Workforce Data Set

The Workforce Surveys are administered to all health practitioners registered by the Australian Health Practitioner Regulation Agency (AHPRA) and are included as part of the registration renewal process. The workforce surveys are voluntary. The respective surveys are used to provide nationally consistent workforce estimates. They provide data not readily available from other sources, such as on the type of work done by, and job setting of, health practitioners; the number of hours worked in a clinical or non-clinical role, and in total; and the number of years worked in, and intended to remain in, the health workforce. The survey also provides information on those registered health practitioners who are not undertaking clinical work or who are not employed. The information from the workforce surveys, combined with some National Registration and Accreditation Scheme (NRAS) registration data items, comprises the National Health Workforce Dataset (NHWDS). 

Past and present surveys have different collection and estimation methodologies, questionnaire designs and response rates. As a result, caution should be taken in comparing historical data from the AIHW Medical Labour Force Surveys prior to 2010 with data from the NHWDS.

Details of medical practitioners, nurses, and allied health practitioners registered with the Australian Health Practitioner Regulation Agency (AHPRA) are available for public access through the Department of Health and Aged Care’s Health Workforce Data Tool (HWDT). This report examines medical practitioners and nurses, as these professionals can be identified using the HWDT as specialist palliative care providers. 

The palliative care workforce is made up of a broad range of professional groups, each playing a unique role in supporting people with a life limiting illness to receive comprehensive, patient-centred care. It is recognised that general practitioners, other medical specialists, social workers, occupational therapists, physiotherapists, and other allied health professionals form an integral part of the palliative care workforce. However, existing national data sources are not able to accurately capture the extent of palliative care services provided by these health professionals.

The numbers in this report reflect those extracted using the HWDT as of 1 July 2023. Workforce for each profession is defined as those employed in Australia in the profession, who specialise in or work in palliative care. Additionally, an employed health professional is defined in this report as one who: 

• reported (the week before the survey) practising in Australia (including practitioners on leave for less than 3 months), or
• was involved with work that is principally concerned with their health discipline (including non-clinical roles – for example education, research, and administration).

Employed palliative medicine physicians only include practitioners whose main speciality is palliative care. Employed palliative care nurses include only nurses whose principal job area is palliative care. This excludes those practitioners who:

• practice palliative care as a second or third speciality
• are registered in the profession but are retired from regular work
• work outside the profession
• work in the profession but are on extended leave of 3 months or more
• are only engaged in unpaid/volunteer work or 
• work outside Australia.

The full-time equivalent (FTE) is defined in this report as the number of standard-hour workloads worked by employed health professionals. The FTE is calculated by multiplying the number of employed professionals in a specific category by the average total hours worked by employed people in that category and dividing by the number of hours in a standard working week. The standard working week, equivalent to 1 FTE, is based on working 38 hours per week for all practitioners with the exception of medical practitioners, where it is defined as 40 hours. In this report, the FTE for palliative care nurses is therefore based on working 38 hours per week and for palliative medicine physicians 40 hours per week. 

There may be differences between the data presented here and that published elsewhere due to different calculation or estimation methodologies or extraction dates. Additionally, the HWDT uses a randomisation technique to confidentialise small numbers. This can result in differences between the column sum and total and small variations in numbers from one data extract to another.

Further information regarding the Medical practitioner workforce and Nursing and midwifery workforce surveys is available from the Department of Health and Aged Care’s Health Workforce data website. 

References

AIHW (Australian Institute of Health and Welfare) (2013) Indigenous identification in hospital separations data: quality report, AIHW, Australian Government, accessed 28 January 2023.

AIHW (2022) Admitted patient care NMDS 2021–22, AIHW, Australian Government, accessed 26 June 2023.

AIHW (2023a) Admitted patients, AIHW, Australian Government, accessed 4 July 2023.

AIHW (2023b) Hospital resources 2021–22 Appendix information, AIHW, Australian Government, accessed 20 March 2024.

Daveson BA, Allingham SF, Clapham S, Johnson CE, Currow DC, Yates P, et al (2021) The PCOC Symptom Assessment Scale (SAS): A valid measure for daily use at point of care and in palliative care programs, PLoS ONE 16(3): e0247250. 

PCOC (Palliative Care Outcomes Collaboration) (2012) PCOC Version 3.0 Dataset: data dictionary and technical guidelines, University of Wollongong Australia website, accessed 20 March 2024.