{"id":239860,"date":"2026-01-18T17:02:20","date_gmt":"2026-01-18T17:02:20","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/239860\/"},"modified":"2026-01-18T17:02:20","modified_gmt":"2026-01-18T17:02:20","slug":"how-we-die-inside-new-zealands-looming-crisis-in-palliative-care","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/239860\/","title":{"rendered":"How we die: Inside New Zealand\u2019s looming crisis in palliative care"},"content":{"rendered":"

As New Zealand\u2019s population ages, the number of people dying each year will rise rapidly. With hospices already experiencing funding shortages, who will care for us at the end of our lives?\u00a0<\/p>\n

One day, Bev Evans will notice a pain burrowing into the side of her back. Here, she leans forward slightly from her couch, bends her arm at the elbow and lays her palm on the approximate site of that expected pain. It will signify that the aneurysm in her aorta, formed in the place from which years ago she had another surgically removed, has burst. She\u2019ll be overwhelmed by tiredness. She will fall asleep. In that sleep she will die. \u201cI\u2019ve gotten used to that fact,\u201d Evans, 83, says in her small, inhibited and slightly croaky voice, her still-sharp eyes shining brightly. Next to her is an open book of crosswords, and her walking frame is within easy reach. On the walls of her immaculately tidy Mount Wellington apartment hangs a selection of her own artwork, which commemorates important moments of her life: family holidays in Whitianga, the births of grandchildren. \u201cThere\u2019s nothing I can do about that.\u201d<\/p>\n

About three years ago, Evans\u2019 GP noticed she was beginning to struggle on her own \u2013 she also suffers from chronic obstructive pulmonary disease, described as \u201choles in my lungs\u201d \u2013 and recommended a palliative approach to Evans\u2019 remaining time. It was difficult for Evans to hear there was nothing more doctors could do to cure her, that she should try to accept that her life had reached its terminal phase \u2013 that she should, in effect, prepare herself for death. <\/p>\n

She was referred to Mercy Hospice, and a friend who was already engaged with the team there strongly encouraged her to take advantage of the services it offers. She is very glad she listened. \u201cIf I hadn\u2019t had that palliative care, I probably would have been dead by now,\u201d she says.\u00a0<\/p>\n

\"\"\/Photo: Adrian Malloch<\/p>\n

I first met Evans at Mercy Hospice on the fringe of the Auckland CBD on a sunny, breezy morning in early spring. Years ago, when I had first moved to Auckland, I used to walk past the hospice on my way to and from work; I hardly ever did so without my imagination travelling down the long driveway, past the pretty gardens glimpsed from the street, and inside the cheery, peach-coloured walls. Then, I\u2019d thought of the building as the site of dreary and depressing final days, a place to be avoided until the very end. But when I met Evans, with a breeze blowing the scent of that garden through the building\u2019s open windows, spring sunlight spilling across the floor, and a succession of 70s and then 80s pop hits energising the wellness session she frequently attends, it had a much different air, something like the seniors\u2019 exercise classes you\u2019d expect to find at any retirement village. <\/p>\n

Half a dozen or so people followed an instructor, lifting half-kilogram dumbbells at an intensity low enough to allow for plenty of group-wide chatter about what constituted the ideal breakfast and which country served the best coffee: far from being merely a place one comes to die, hospice had become a hub of Evans\u2019 life. On the floor above, in the eight-bed in-patient unit, someone at that instant may have been expelling their very last breath; but here, death seemed a much-distant concept as, with a tinkling of its porcelain, the morning-tea trolley was wheeled in.\u00a0<\/p>\n

If there is a minor irony in Evans\u2019 belief that a branch of medicine primarily concerned with easing one\u2019s final days and years had prolonged her own, it is one confirmed by the literature, which consistently finds that patients engaged with hospice services benefit from more effective pain management, that they are happier, more fulfilled, and more at peace with the end to which every life travels. Likewise, society benefits: a 2024 report compiled by advisory firm Martin Jenkins found that in New Zealand hospice services take the pressure off many other aspects of a national healthcare system often stretched beyond its capacity, that those engaged with hospice are less likely to require hospital admission, visits to emergency departments or ambulance callouts. Hospice reduces the burden on stressed and exhausted family caregivers, and offers bereavement support for those left behind. That report conservatively estimated that every dollar the government invests in hospices generates $1.59 in health benefits for the country\u2019s taxpayers.\u00a0<\/p>\n

\"\"\/Photo: James Borrowdale<\/p>\n

Yet, as that same report also makes clear, it is a sector that is \u201cfragmented, complex, and at risk of collapse\u201d. In 2024, according to official numbers 37,722 New Zealanders died, but with the population of the nation rapidly ageing, that number is forecast to increase to nearly 54,000 by 2043. And if the proportion of dying New Zealanders engaging with hospice was to remain the same, that timeframe would see demand for the service rise by 53 percent \u2013 a looming catastrophe for a sector of the country\u2019s healthcare system already struggling to make ends meet. <\/p>\n

For years, as Hospice New Zealand CEO Wayne Naylor told me, funding shortages have meant cost-cutting measures at the 28 publicly contracted hospices across the nation, with administrative and executive staff often having to be let go in an attempt to keep overheads low and the shortfall from impacting on those, like Evans, under their care.\u00a0That, however, is no longer possible \u2013 and will become increasingly less so unless the financial pressure is eased. \u201cSome hospices are making cuts, which is impacting on patient care\u2026 That\u2019s happening around the country, and unless something changes, more hospices will be moving to the point where they have to start cutting clinical staff,\u201d Naylor says. <\/p>\n

Once ranked by the World Map of Palliative Care Development report as the third best country in which to die, New Zealand had slipped to 15th by the 2025 report. Minister of Health Simeon Brown told The Spinoff that hospices play \u201ca critically important role in the healthcare system in New Zealand\u201d, but that importance has never been adequately acknowledged in funding \u2013 by his or any previous government.\u00a0In 2024, for instance, it cost $226 million to run the country\u2019s hospice services, with the government providing roughly half of that amount. The balance was made up by charity and the proceeds from the network of second-hand stores that Hospice NZ operates around the country, not to mention the many, many hours of labour given by volunteers. <\/p>\n

It is an \u201calways fragile\u201d model, Naylor says \u2013 and one whose fragility was demonstrated by Covid-19 and the lockdowns that eliminated for a time the income from its more than 120 op shops. He argues that hospices, if they are indeed the critically important pieces of infrastructure politicians assure us they are, should be funded with the same inevitability as the more established pillars of health care in New Zealand. \u201cWe see hospice and palliative care as a key part of the healthcare system,\u201d Naylor says. \u201cThe same way you fund general surgery or maternity services, hospice should be funded as a core part of the healthcare system.\u201d Increasingly, the current way of doing things will become untenable: the Martin Jenkins report estimated that, by 2043, the cost of running the country\u2019s hospice services would climb to over $530 million \u2013 far beyond the capacity of the current funding model, and a stark indication, experts warn, that it needs to change.\u00a0<\/p>\n

\"\"\/<\/p>\n

That it hasn\u2019t already could be, according to Dr Carol McAllum, who leads both Mercy Hospice\u2019s community action and its medical team, partly a result of societal uneasiness around the subject at the core of palliative medicine: dying and death. We spoke in a disused downstairs function room, the furniture pushed to the wall. The escaped strands of her tied-up grey hair\u00a0 were highlighted against a bouquet of white flowers resting on the sideboard behind her, the remnant of a Scottish accent \u2013 her family moved to the Antipodes when she was 12 \u2013 detectable in her speech.\u00a0<\/p>\n

When McAllum was a student \u2014 she qualified as a doctor in 1979, the year New Zealand\u2019s first hospice opened in Wellington \u2014 she remembers a culture of discomfort around dying so persistent that even patients imminently close to death were shielded from that knowledge. A leukaemia patient, who had been just a few years older than her when she was a student in the late 70s,\u00a0came to mind: \u201cHe asked me, \u2018Am I dying?\u2019\u201d McAllum, of course, knew that he was. \u201cSo how could I say no? So I didn\u2019t say no, we had a conversation.\u201d <\/p>\n

That wasn\u2019t appreciated by the senior consultants who, McAllum says, stuck closely to the prevailing theory that even with patients that close to the end, death was a subject to be avoided. That was an idea that chafed against McAllum\u2019s growing belief that the least she owed her patients was honesty \u2013 even, or perhaps particularly, when the news wasn\u2019t good.\u00a0<\/p>\n

\"\"\/Photo: James Borrowdale<\/p>\n

Another formative experience occurred early in her career. It involved a nine-year-old boy suffering from a fatal hematological condition \u2013\u00a0to guard against infection, McAllum remembers, he was kept insulated and spent much of his time \u201cbeing looked at through a window\u201d. He was exhausted, McAllum says, aware that he was dying and ready to do so. \u201cHe was just done,\u201d she says her conversations with the child had taught her. <\/p>\n

So she was furious when she later learned he had been encouraged to undergo what was then, in the early 1980s, the experimental treatment of a bone-marrow transplant \u2013 an experiment that ultimately proved futile. \u201cYou wouldn\u2019t just let that young man die a natural death,\u201d she remembers thinking. \u201cYou had to keep subjecting him to tests, to reverse-barrier nursing.\u201d\u00a0<\/p>\n

Those early lessons guided her into a career in small-town general practice, during which she often found herself caring for dying patients in the community, and later into the hospice system. Over the course of her career, she says, as hospices have become more established in New Zealand\u2019s healthcare system, she has seen a more enlightened, a more honest,\u00a0approach to dying develop, even if she believes there is still far to go. Western medicine, she says, has long been predicated on a \u201ctreat treat treat treat\u201d philosophy, driven relentlessly by the development of new drugs and a \u201cdrive for longevity\u201d. Palliative care, in her view, was born out of \u201cprotest\u201d against a view of medicine that seemed to reduce the measure of its success almost to a single metric: how long one could prolong a life.\u00a0<\/p>\n

\u201cIt\u2019s so much easier to write a prescription, do an intervention, drain a lung; but knowing when not to do it, that\u2019s an art.\u201d<\/p>\n

Palliative care, of the kind offered by hospices, takes a broader view, she says, always guided by what a patient desires from their remaining time, whether that be fighting for every extra hour of life or mere pain management as death is left to run its unrestricted course. McAllum calls it \u201can art and a science\u201d. \u201cIt\u2019s so much easier to write a prescription, do an intervention, drain a lung; but knowing when not to do it, that\u2019s an art.\u201d And one, she says, that can put it at philosophical odds with a prevailing medical culture that places finding a cure at the apex of its ambition. \u201cIt\u2019s seen as a bit soft, you know, as just looking after someone\u2026 [but] it is a damned hard speciality.\u201d <\/p>\n

A 2025 survey of this country\u2019s medical workforce by the Medical Council of New Zealand found that of the country\u2019s roughly 20,000 doctors, only 135 worked in palliative medicine, about the same number who specialised in urological surgery. Within Health New Zealand\u2019s Planning, Funding and Outcomes Directorate, the palliative care team consists of 1.8 full-time equivalent positions; there are 4.5 full-time equivalent roles dedicated to the assisted dying programme.\u00a0<\/p>\n

McAllum says that illustrates a slightly \u201cweird\u201d inversion of priorities, given that only a tiny proportion of New Zealanders will make use of the assisted dying programme \u2013 344 people had an assisted death between April 1, 2023 and March 31, 2024 \u2013 but that a huge majority of people would benefit from some form of palliative care. Almost nine out of ten New Zealanders die natural deaths, most after an illness of variable length, and thus we all have an interest in making the process of death as pain- and fear-free as possible. That those naked statistics aren\u2019t reflected in funding, McAllum says, leaves those in the hospice sector feeling forgotten. And vulnerable people bear the brunt.\u00a0<\/p>\n

She recalled the weekend that she had just spent on duty, some hours of which she worked with a family whose father and husband was dying and had elected to do so at home. His condition had deteriorated faster than expected, and his adult children and his wife, who were his primary carers, were struggling to cope \u2014 fighting exhaustion, uncertainty, fear, second-guessing all of their decisions.<\/p>\n

Before the funding crisis had really begun to bite, McAllum says, Hospice NZ had had the resources to put a nurse into people\u2019s homes for what was expected to be the last three nights of someone\u2019s life. And that is all this family needed, McAllum says: someone to be there as a constant, calming presence through the night, to reassure the family through the final stages of their father\u2019s life \u2013 his delirium, his laboured, noisy breathing \u2013 and to ease the situation for everyone by keeping him comfortable throughout his last days and hours. But no one was available. The children\u2019s last memories of their father, she says, will forever be of a \u201creally hard night\u201d. She worries about the legacy of those memories. \u201cWhat\u2019s that going to do for them when their mother dies? They\u2019re going to be apprehensive that the same thing is going to happen.<\/p>\n

\u201cAll they wanted was a nurse.\u201d\u00a0<\/p>\n

\"\"\/<\/p>\n

The last time Kim Stephen, a clinical nurse specialist of M\u0101ori health at Mercy Hospice, stepped into Margy Tawhi\u2019s home \u2013 a small second-storey flat on a scruffy \u014ct\u0101huhu backstreet \u2013 the curtains were drawn, the door was closed, and she had found Tawhi (Tuhoe, Tainui, Ng\u0101ti T\u016bwharetoa, Ng\u0101ti Raukawa, Ng\u0101ti Hine) curled around a hot-water bottle under a blanket on the couch, doing her best not to inflame the aching pain emanating from the tumours on her spine, to which her original breast cancer had spread. The oxycodone wasn\u2019t doing enough and Tawhi found herself suffering towards the end of every four-hour period, when she was finally allowed to take another dose. \u201cI was a complete mess,\u201d Tawhi says.\u00a0<\/p>\n

Stephen (Te Aupouri, Te Rarawa) explained how that previous visit had resulted in \u201ca bit of a korero. I went back to our nurse-practitioner who agreed, yes, we\u2019ll increase the\u2026 medication\u201d. Stephen motioned around the room: the door was ajar, the curtains were open to reveal Nala, a pitbull puppy, pawing playfully at the glass, and Tawhi was up and chatting animatedly, offering cups of tea or water. \u201cLife is living\u2026 From a medication change, a really significant impact,\u201d Stephen said. \u201cThat\u2019s so true,\u201d Tawhi agreed, a small black vape clasped in one fist and a tissue in the other, which she absentmindedly passed back and forth throughout the visit. <\/p>\n

When I saw her again a month later, Tawhi explained how she\u2019d been able to taper her medication down, describing the increased energy the lower dose gave her as a reclamation of her \u201cmana\u201d.<\/p>\n

\"\"\/Photo: James Borrowdale<\/p>\n

One of Stephen\u2019s earliest memories is being scolded as she ran through the wharenui, interrupting the preparations for her grandmother\u2019s tangi. She says M\u0101ori, often exposed to dying and tangihanga on the marae \u201cvery, very early\u201d have a different relationship to death, one that draws on ongoing relationships with departed ancestors. \u201cThey are always in our thoughts. They are always in our everyday conversations. Like when I die, my mum\u2019s going to be there to come and get me. That is not a scary concept for me.\u201d <\/p>\n

Stephen says it gives her and patients like Tawhi a common cultural understanding on which to draw. \u201cThis is the longest frickin\u2019 illness I\u2019ve ever had in my whole life,\u201d Tawhi says, \u201cand a lot of people have come onto that journey with me.\u201d She mentioned the team of healthcare professionals \u2013 surgeons, nurses, oncologists \u2013 into whose orbit cancer has brought her. It is with Stephen, however, Tawhi feels like she can \u201cbe an open book. Kim pretty much knows who I am and what I\u2019m going through.\u201d\u00a0<\/p>\n

Stephen sees the barriers dissolve when a M\u0101ori patient encounters a M\u0101ori nurse on their doorstep. Where there might be awkwardness or even embarrassment, she says, if a P\u0101keh\u0101 nurse was to ask whether someone had enough money to catch a taxi to their next early-morning appointment, with her nothing is off the table. There is never any need to explain whanau situations that might be unfamiliar to someone from a different cultural background, and it is a given that Stephen will arrive with a packet of chocolate biscuits as a koha. \u201cIt\u2019s just that knowing,\u201d Stephen says. <\/p>\n

Her European-sounding name, she thinks, gives her an insight into how patients\u2019 attitudes might change depending on the background of who they are dealing with. Initial communication might be over the phone or via text, and can feel stilted. \u201cBut once they see my face, they\u2019re like, \u2018Oh, come in girl\u2019 and there\u2019s no explanation needed.\u201d The comfort of Stephen and Tawhi\u2019s relationship, both believe, allowed for the frictionless resolution of Tawhi\u2019s medication issue, and for their general closeness. \u201cShe\u2019s like the big sister,\u201d Tawhi says.\u00a0<\/p>\n

Tawhi regards herself as lucky to have found Stephen \u2013\u00a0and hospice in general. Despite having herself nursed relatives through death by cancer in the past, she was only dimly aware of the service that hospice offered before being referred by her oncologist in April 2025. Stephen posits that lack of awareness as an extension of the well-documented inequity in access to primary healthcare faced by M\u0101ori in New Zealand. Her own mother, she explained, had had such poor engagement with the healthcare service that her death from cancer occurred only six weeks after she had finally taken her complaints to a GP.\u00a0<\/p>\n

It is worth considering, for a moment, what \u201cnot reaching\u201d people might mean: unmanaged pain and lonely terror, an unrelieved struggle with the existential limits of being human when all the biggest questions about what that means are magnified by the fact of coming to the end of being one.\u00a0<\/p>\n

A 2024 report by Te \u0100rai Palliative Care and End of Life Research Group, detailed the experiences of the New Zealand demographics that have been underserved by hospice care: rural communities, children, the homeless, and M\u0101ori, as well as many others. As Dr McAllum earlier told me: \u201cWe\u2019re not reaching people who have the need; we\u2019re largely reaching people who have the ability to access us.\u201d <\/p>\n

A 2025 article in the New Zealand Medical Journal estimated that in 2023 between 21,490 and 27,914 people required specialist palliative care, but that only 10,800 people had any involvement with the country\u2019s hospices. Naylor lamented the yawning gap between demand and capacity: \u201cWe definitely think hospices could be reaching more people directly than hospices do.\u201d<\/p>\n

It is worth considering, for a moment, what \u201cnot reaching\u201d people might mean: unmanaged pain and lonely terror, an unrelieved struggle with the existential limits of being human when all the biggest questions about what that means are magnified by the fact of coming to the end of being one. Poet Philip Larkin called the fear of death \u201ca special way of being afraid \/ No trick dispels\u201d. He\u2019s right, of course \u2013 no trick dispels. But the care and the support, the kindness and expertise, of professionals like Stephen and McAllum, the community that Evans has found: that is no trick. One senses that the simple human kindness at the core of those services might be the only secular antidote to that fear. If only more New Zealanders \u2013 and a wider spectrum of New Zealanders \u2013 could access it. <\/p>\n

\u201cPeople,\u201d says Naylor, \u201ccould be suffering unnecessarily simply because there\u2019s not enough resources to allow them to go on to the hospice service. And that shouldn\u2019t be acceptable to a government or to a health agency, and certainly it is very challenging for hospice staff who are in this work, because that\u2019s what they\u2019ve come to do, to look after these people and make sure they don\u2019t suffer.\u201d<\/p>\n

\"\"\/<\/p>\n

The funding shortfalls projected by the Martin Jenkins report are based, it states, on the assumption that a third of New Zealanders, about the number Hospice NZ currently reaches, will \u00a0require \u201cpalliative care in a hospice setting\u201d as they die. But the real need, Naylor estimates, of people who need specialist palliative care is probably closer to 45 percent \u2013 it\u2019s just that Hospice NZ currently lacks the resources to expand its reach. <\/p>\n

Essentially, then, the funding crisis that is forecast is actually already upon us \u2013 it\u2019s just that we as a society have been conditioned to the limitations of our palliative care system as it currently functions. And unless something is done, that crisis will only compound from here.<\/p>\n

\"\"\/<\/p>\n

Health New Zealand (HNZ) declined to be interviewed on the topic, instead issuing a statement to The Spinoff from Martin Hefford, HNZ\u2019s director living well, that acknowledged \u201cthere are areas where the system can do better. We are committed to improving access to palliative care so that every person, regardless of where they live, can receive the care they need.\u201d As part of that work, HNZ has been developing a National Palliative Care Work Programme since 2023, which will \u201csupport a nationally consistent approach to palliative and end-of-life care planning, funding, service delivery, and outcomes\u201d. <\/p>\n

Naylor sits on the steering group that is guiding the development of that programme, which he hopes will provide, when its work is complete later this year,\u00a0\u201csome real clarity about what services should be available to everybody in New Zealand, how they will be funded, and who will be delivering them\u201d.\u00a0<\/p>\n

Minister of Health Simeon Brown told The Spinoff that he wants \u201cto make sure that all New Zealanders have access to palliative care, and to make sure that they can get that care in a way that delivers according to their needs\u201d. But he repeatedly deferred to the progress of the National Palliative Care Work Programme when pressed on any details as to what his government would provide in terms of extra funding for the sector, and wouldn\u2019t be drawn on further details \u2013 other than to acknowledge that \u201cover time [it] will require further investment to make sure that we can deliver the right type of care\u201d. \u201cIt\u2019s really important that we enable services which allow New Zealanders to die in a way which gives them dignity,\u201d Brown says. Naylor welcomes Brown\u2019s interest in, and support of, hospice, but notes that \u2013 so far, at least \u2013 it \u201chasn\u2019t translated into more funding, which is what we\u2019d really like\u201d.\u00a0<\/p>\n

As with so much of New Zealand\u2019s creaking public healthcare system, it is a matter of money \u2013 or the lack thereof. Naylor believes that Hospice NZ\u2019s origins as a charitably funded service have allowed successive governments and their administrative structures to more easily justify the fact that, even as it has increased its importance to the overall healthcare system, it still needs to rely on donations, volunteer labour and a nationwide retail operation to sustain itself. If it is truly seen as the vital cog in New Zealand\u2019s healthcare system that Brown insists it is, would that model be acceptable? Naylor thinks not: \u201cWe have been pushed to the margins a bit, and that\u2019s why we don\u2019t have sufficient funding to meet the needs of people who are dying around the country,\u201d he says. \u201cDeath has been pushed to the margins of healthcare.\u201d\u00a0<\/p>\n

For Evans, her experiences with hospice have, in some ways, liberated death from that location on the margins, allowing her to face the subject head on. Whereas much of society might recoil from discussion of the topic, within the walls of hospice one need not sugarcoat the reality. Hospice friendships, she says, offer real comfort as spaces in which to confess and confront one\u2019s fears, as do regular sessions with the hospice-supplied psychologist who, for the best part of two years, has been visiting Evans in her home to talk with her about her concerns, assuage her fears. <\/p>\n

\u201cThey will listen to you, and they encourage you to talk about the things that are worrying you. They help you understand what you\u2019re going through, and it helps you to face thoughts,\u201d she says. \u201cYou do worry about how you are going to die, and how it\u2019s going to happen.\u201d\u00a0<\/p>\n

The recent death of a dear friend reignited some of those thoughts and fears. Maurice had volunteered as a driver for Mercy Hospice, and soon decided that he would primarily be Evans\u2019 chauffeur, shuttling her to and from her appointments at Mercy Hospice. The two became firm friends, his portrait displayed so prominently in Evans\u2019 home I initially took it to be that of her late second husband. <\/p>\n

When he died suddenly last year, aged just 74, it left Evans \u201cbewildered\u201d, she says, and once again re-examining the existential questions about death\u2019s finality that every examined life must sometimes \u2013 in dark fretful sleepless hours, or in calm private contemplation \u2013 fall into. \u201cYou\u2019re there, you\u2019re alive,\u201d Evans says. \u201cAnd then you get cremated and there\u2019s nothing left, only the ashes.\u201d<\/p>\n

But those are questions for each of us to settle to our own satisfaction; society should have other priorities, and it would do us well to carefully consider what those are. Evans: \u201cSome people die in their own homes without anyone around them. With hospice, you know, you\u2019ve always got someone to comfort you.\u201d<\/p>\n

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