Continuous improvement (Voluntary Assisted Dying Board Annual Report 2023-24)
Continuous improvement of our voluntary assisted dying system in South Australia is underpinned by community and stakeholder engagement, education, training and support for health professionals and system and process improvements developed in response to day to day practice and feedback.
Community engagement
Community and stakeholder engagement activities are routinely undertaken by all clinical, operational and administrative staff supporting voluntary assisted dying in South Australia. Engagement activities have a focus on building community and clinician awareness and understanding to ensure a safe and accessible voluntary assisted dying program. This occurs through a wide range of activities including publication of information, provision of face to face information sessions and targeted engagement with key stakeholders.
Release of quarterly voluntary assisted dying reports
The release of four voluntary assisted dying quarterly reports during 2023-24 provided the Review Board with an opportunity to share feedback and learnings as well as keeping the community up to date regarding voluntary assisted dying activity in South Australia. Quarterly reporting will continue to be a key mechanism for building community awareness and understanding of voluntary assisted dying. To read past reports visit the Voluntary Assisted Dying Review Board website.
Community information sessions
During 2023-24 staff within SA Health provided a range of face to face information sessions to individuals, groups and organisations including:
- regular information sessions for clinicians and staff in Local Health Networks, private hospitals and Residential Aged Care facilities delivered by Care Navigators and Voluntary Assisted Dying Liaison Nurses
- information sessions for Justices of the Peace regarding being a witness
- information sessions for members of the public held on the south coast
- information sessions provided to Multicultural Communities Council of SA
- information sessions for private hospital providers
- information session for interpreters
- information session for Carers SA.
Voluntary Assisted Dying Day of Reflection
On 14 April 2024 the Review Board hosted the first annual Voluntary Assisted Dying Day of Reflection. This event brought together in reflection family, friends and loved ones of those who died on the voluntary assisted dying pathway in 2023, as well as clinicians and staff involved in voluntary assisted dying. Feedback on the event was that the beautiful atmosphere and thoughtful programme provided an opportunity for guests to connect, reflect, hear from each other and receive support. This event will be held annually in April for family, friends, loved ones of those who died on the voluntary assisted dying pathway in the previous year.
Engagement with key stakeholders
As the peak non-government representative body for voluntary assisted dying in South Australia, Voluntary Assisted Dying South Australia (VADSA) are an important and valued stakeholder. SA Health has continued to meet regularly with VADSA since the commencement of voluntary assisted dying on 31 January 2023 to share learnings and explore opportunities for collaboration and community education. The Review Board thanks VADSA for their advocacy and efforts and in particular for their work in establishing the successful VADSA volunteer witness register and looks forward to continuing the collaboration between SA Health and VADSA in the future.
Education, training, and support for health professionals
In addition to the mandatory medical practitioner training provided by SA Health there are a range of opportunities for medical practitioners and staff to continue to receive support for their involvement in voluntary assisted dying.
Voluntary Assisted Dying Community of Practice
The Commission on Excellence and Innovation in Health (CEIH) continues to convene a monthly Voluntary Assisted Dying Community of Practice in South Australia. The Voluntary Assisted Dying Community of Practice is a place where participating practitioners can:
- share and reflect upon their experiences participating in voluntary assisted dying
- provide practical and emotional support for each other
- learn from each other to advance best practice in voluntary assisted dying care
- collectively problem solve to manage complex aspects of voluntary assisted dying.
The Commission on Excellence and Innovation in Health (CEIH) also hosts a quarterly extended Community of Practice for all voluntary assisted dying service providers including the South Australian Voluntary Assisted Dying Care Navigator Service (SAVAD-CNS), Local Health Network Voluntary Assisted Dying Liaisons, South Australian Voluntary Assisted Dying Pharmacy Service (SAVAD-PS) and Voluntary Assisted Dying Operations team.
Feedback from clinicians is that the Community of Practice provides a safe space to connect with colleagues and discuss the complexities and ethical issues involved in supporting access to voluntary assisted dying and the opportunity to learn from each other’s expertise is highly valued.
Voluntary assisted dying Clinical Advisors
Voluntary assisted dying Clinical Advisors Dr Peter Allcroft and Dr Chloe Furst continue to play a central role in an advisory capacity to provide clinical guidance, policy advice and operational support to the operation of voluntary assisted dying at a statewide level. Both lead the Voluntary Assisted Dying Community of Practice and are available to provide advice and support to medical practitioners as required.
In addition to support provided by the voluntary assisted dying Clinical Advisors, clinical and operational advice and support for Care Navigators and voluntary assisted dying Liaison Nurses is also provided by the Director of Nursing, End of Life Care Kate Swetenham in the Department for Health and Wellbeing and the SAVAD Care Navigator Service Nursing Director, Emily Pumpa.
Peter and Chloe and Kate and Emily have been an integral part of the establishment of voluntary assisted dying and the Review Board are very grateful to have them in their respective roles.
Continuing Professional Development (CPD) points for completing the voluntary assisted dying mandatory training for medical practitioners
In recognition of the time required of medical practitioners to undertake the mandatory medical practitioner training, SA Health has provided information about the voluntary assisted dying medical practitioner training to specialist medical colleges for physicians, psychiatrists, surgeons, emergency medicine and intensive care, who each provide CPD points on a case-by-case basis.
From January 2024 medical practitioners who are members of the Australian College of Rural and Remote Medicine (ACRRM) can now claim Continuing Professional Development (CPD) points upon successful completion of the mandatory voluntary assisted dying training. This now allows members of ACRRM to claim 5.5 education activity hours and 0.5 performance review hours for CPD points for undertaking the training.
Many GPs use the Royal Australasian College of General Practitioners (RACGP) as their CPD Home. DHW has recently signed an agreement with RACGP to become an accredited provider of the voluntary assisted dying Mandatory Training for Medical Practitioners and members will be able to claim CPD points for completing the mandatory practitioner training in early 2025. Training will also be available through the RACGP website.
Systems and processes
Voluntary Assisted Dying Access Support Program
Medical practitioners play an essential role in voluntary assisted dying as the only healthcare professionals who are permitted to facilitate access for eligible patients in South Australia.
Medical practitioners have expressed concerns about the limitations of seeking remuneration under the Medicare Benefits Schedule. There are currently no Medicare rebates specifically related to voluntary assisted dying.
Doctors are generally unable to charge under Medicare for the care that they deliver in particular in relation to:
- time spent traveling to see a patient
- time spent providing services to patients in a public hospital
- practitioner administration of the voluntary assisted dying substance
- non-GP private specialists providing services at a patients home.
SA Health has established the voluntary assisted dying access support program which provides reimbursement for General Practitioners (GPs) and private specialists for voluntary assisted dying activity where there is no existing Medicare or private billing option
The Voluntary Assisted Dying Access Support Program is administered by the SAVAD-CNS.
Voluntary Assisted Dying Witnessing Program
SA Health has worked with VADSA and the Royal Association of Justices South Australia, to establish registers of volunteers willing to witness a Written Declaration. This is extremely helpful in circumstances when a suitable eligible witness cannot be identified by a voluntary assisted dying patient and reduces the need for staff in SA Health to undertake this role.
Volunteers have undertaken training to ensure competency in the process, provided a current National Police Check, and are required to sign a confidentiality agreement.
The VADSA witness register is accessed through the SAVAD-CNS and as witnesses complete training, confidentiality agreements and National Police Checks, they can be added to the register.
To provide guidance for people considering acting as a witness (PDF 142KB) to a written declaration a new fact sheet has been developed.