Table 2 Enablers and barriers to equity -focused palliative care

 Community advocacy

I think strong community advocacy is probably one of the drivers [of equity in palliative care]. I think the role of Palliative Care SA is another one and then their role is to lobby government and to make sure the community needs are seen, heard and addressed

 Workforce education

I think education of our workforce that would be not only in understanding what palliative care is, and what the model of care is, but for the general workforce to have better understanding of death literacy, also the needs of different populations.

 The importance of evaluation

Whatever happens should have an evaluation component and the evaluation to have a policy lens over it. You are not only talking about how you might improve a particular practice, but how might you improve policy to achieve a better outcome.

 The value of new technologies

I think at end of life can you build up a virtual community for a person who’s dying? There’s lots of apps out there, so that you can actually identify all the people that are in your social network and start to work through them.

 Gaps in professional and carer workforce

I think [barriers are] lack of funding, lack of the provision of palliative care beds, and a lack of workforce. I know that we’re in a particular period now with Covid. It’s just causing so many pressure points in the system and I know that palliative care services just can’t get staff and so as a consequence suffering, burnout of their existing staff.

 Priority setting and fragmented systems of care provision

We will never see 70% of people dying at home unless we can tackle community care in a really robust kind of way which says you can get the help assistance when you need it, which comes back to equity.

 Funding and resources

The federal government, by accepting the recommendations in the Royal Commission, haven’t accepted the funding formula recommendations and they haven’t changed the workforce.

 Competition for resources

It [palliative care] has to compete against other areas of health care, which are much louder. So you’ve got to compete against cardiology, and of course, people want cancer treatments … from a policy point of view, trying to keep palliative care on the agenda means you’ve got to beat that drum even louder because it’s got a lot of noise to breakthrough to be seen.

 Multiple complex barriers

No one person’s death is the same and their journey and their end of life journey is not the same. So then it really becomes almost every possible barrier that could come up: financial, computer literacy, whether you have family, whether you’re in an aged care facility. It comes to the point that every single possible barrier is another way in which we’re preventing equity of access to palliative care.