If you look at jurisdictions that have done very well in exercising palliative care, they've developed specialist palliative care services and have also ensured that all health care professionals are getting basic training so that they can identify earlier the patients who would benefit from palliative care. They can start addressing the psychosocial, spiritual and physical distress those patients are experiencing, and as a result, patients then have a lot more access to palliative care.
There was an earlier assertion that there has been considerable funding going into palliative care across the country. That may be true in some jurisdictions, but not in all. In my region, for example, we don't have enough specialist funding for specialist palliative care physicians. I know of another hospital in Ontario that has been trying for years to get extra funding to build palliative care specialists.
We also struggle with funding to make sure that we train up health care professionals in practice, the very professionals who are going to be asked by patients “What choices do I have?” and “What are my options?” When they don't know what palliative care is, when they keep equating it to only the very end of life and when the patients and the public still think of palliative care only at the very end of life, we have a problem, and I think we do need to address that.