The issue of what care people receive towards the end of life is deeply sensitive.
Readers of this column would know I am a passionate supporter of palliative care and the work of local doctors and community champions in a part of the NSW health system too frequently overlooked.
There could be no family in NSW untouched by the scourge of cancer, motor neurone disease, kidney failure, dementia or Alzheimer’s. As our population ages, these are the epidemics of the 21st century. When suffering the effects of an advanced condition with minimal chances of survival, the focus of doctors, nurses and allied health practitioners inevitably shifts to providing compassionate and spiritual support, identifying symptoms and managing pain.
Where there is life, there should be the hope and expectation of dignified care to the final breath.
The recent announcement that St Joseph’s Hospital in Auburn – a crucial part of our region’s patchwork of palliative care services – will close in mid-September flies in the face of this principle. The news has come as a great shock to the Western Sydney medical community.
Founded by the Sisters of Charity in 1886 and rebuilt several times, St Joseph’s is today managed by St Vincent’s Health while sitting within the Western Sydney Local Health District. The hospital does not have an emergency department or accept after-hours admissions. Rather, it is a subacute facility providing palliative care, rehabilitation and geriatric psychiatry services, and catering for both inpatients and visitors during the day.
It is well known the hospital’s ageing buildings required an upgrade. However, no support has been forthcoming, including from government.
In a statement, St Vincent’s Health acknowledged the decision by its board of operators to close down had been extremely difficult. “The viability and sustainability of the campus has been under threat for many years… regardless of our best efforts, we have not been able to secure the necessary investment to address the deteriorating infrastructure”.
The decision comes amidst plans to expand palliative care capacity at Auburn and Westmead Hospitals. St Vincent’s is also offering to transfer patients to Darlinghurst. Regardless, it is disappointing the board has decided to focus its resources on inner-city Sydney, resulting in a net diminution of services to the west.
Leading palliative care advocate Dr Philip Lee, who has spearheaded the successful push for a dedicated ward at Westmead, began his career as a visiting medical officer at St Joseph’s. From 1995 to 2002, he worked with one of the fathers of palliative care in Australia, Dr Michael Barbato OAM. “It was an amazing unit with 23 dedicated beds,” Dr Lee recalls.
Now the ward is combined between rehabilitation and palliative care and they have significantly fewer beds – but they do provide a very important service”.
St Joseph’s, he adds, offers specialist support for elderly sufferers of motor neurone disease. These are people whose needs are too complex to manage at home, or else they receive transfers from nearby general hospital wards. There is now a question of how these neurological patients will be managed.
He questions the failure of St Joseph’s to consult with the community or coordinate with palliative care doctors and nurses on the ground. For example, it is understood staff at St Joseph’s were unaware Auburn Hospital’s palliative care services would be expanded. Dr Lee suggested this appeared to be a breach of NSW Health planning requirements for meaningful engagement.
“Where is the evidence?” he says. “The first I heard of it was on the news. There hadn’t been any rumours and all of a sudden this announcement comes out.”
The new dedicated palliative care ward at Westmead is due to open in early 2026 with 15 beds. When added to 10 beds at Auburn and 16 at Mount Druitt, this will only take Western Sydney Local Health District to 41 beds. As Lee notes, still below every comparable metropolitan area in Sydney.
Lee, who is on the project user group at Westmead, acknowledged the “thorough work” underway to identify all infrastructure requirements and establish a suitable site. He suggests that with the closure of St Joseph’s, every effort should be made to bring the ward’s opening date forward.
Anyone who believes that palliative care is essential care in a modern, well-resourced health system could only agree.
Alan is a journalist and communications specialist. He writes a weekly column for Parra News.