By Tom Hunt.

Many millennials are forecast to die badly with reports of a palliative care system already struggling on dwindling fundraising and experts saying we already have a “postcode lottery” determining who dies in pain.

It comes as the new End of Life Choice Act means people with a terminal illness, and who meet exacting criteria, can end their own lives in a fully-funded system. But, if they want palliative care, to end their lives naturally and in comparative comfort, much of that funding comes from the likes of selling strawberries and second-hand clothes.

“Looking to the future is a nerve-wracking experience, as we see costs increasing but no sign of a commitment from Government to help us with the additional costs,” Mary Potter Hospice chief executive Brent Alderton​ said.

“It is ironic that the new end-of-life-choice service is fully funded, and our hospice care funded less than 50 per cent.”

The Wellington hospice gets half its funding from the Government and has to make up the rest itself which come from second-hand shops, bequests, donations, events and reserves. It was developing apartments in Newtown to rent out for income. Its annual Strawberry Festival fundraiser, scheduled for this week, was cancelled due to Covid-19. The last financial year left it with a deficit of more than $100,000.

A new report out from Danielle van Dalen​ of the Maxim Institute shows the need for palliative care in New Zealand is expected to increase by 50 per cent in the next 20 years and double in the next 50 years.

That means that people who are currently in the early stages of adulthood will be reaching their life expectancy when the need for end-of-life has doubled.

Van Dalen said an ageing population and modern medicine, keeping people with chronic conditions alive longer, was behind the forecast increase in demand, which was already being felt.

Covid-19 disruption, that had impacted fundraising, particularly at op shops, meant some palliative care services were having to dip into savings for the first time, she said.

“If funding doesn’t go up, along with other things, more people will have bad deaths.”

There were already too many New Zealanders who were dying without proper palliative care because a “postcode lottery” meant there was not enough care in their area.

Sue Sutherland, general manager of marketing at Nurse Maude, said the Government provided about 70 per cent of the funding for their hospice service. Fundraising covered the rest.

“We are fortunate in having strong support from the community through our hospice shops, Maudes on Trade Me, sponsorship, donations and trust funding.”

If the forecasted increase for hospice palliative care became a reality, there would need to be a rise in Government funding, Sutherland said, “so everyone who needs palliative care can continue to receive it”.’

Health Minister Andrew Little said the Ministry of Health was already looking into improving the “equity and quality of palliative care, in light of growing numbers of people requiring palliative care, increasing complexity of need, greater expectations around quality of care, and an increasingly diverse older population”.

Talks with those working in palliative care showed there were already areas that needed improvement, he said.

Government funding for palliative was currently $490.7 million over four years. It had also given it $20m for four years in 2019 plus an extra $7.3m in 2020 due to Covid-19.

College of General Practitioners medical director Bryan Betty said the Government should have fully funded palliative care when it brought out the End of Life Choice Act. The current system created an “uneven playing field”, where euthanasia was fully funded but there were parts of New Zealand where there was no decent access to palliative care.

Funding was needed to provide good quality and consistent palliative care across New Zealand, he said.