The EAPC Task Force Development of PC in Europe

The EAPC Task Force Development of PC in Europe

PC in Austria and the surrounding countries. A 2005 preliminary report.

Carlos CentenoUniversity of Navarra

Spain

01/10/2005 2EAPC Task ForceDevelopment of PC in Europe

EAPC

1988

Palliative care to all who need it

ONLUS

32 National Associations

21 European Countries

50.000 health care workers

One voice one vision


The World Health Organization (WHO) definition of the European region was

considered in order to determine the 52

countries to be included in the study

EPAC Task Force on The Development of PC in Europe

• to assess the degreedegree of development of palliative care in Europe


Objectives

• Facilitate and spread informationinformation about the situation of PC in each country and in a global European context

• Facilitate access to relevant information and communicationFacilitate access to relevant information and communication between hospice and palliative care associations as well as societies or policy makers that operate in Europe

• Identify key peopleIdentify key people who have studied the process of palliative care development in their own setting


A Combination of 4 Research Methods

• LITERATURE REVIEWLITERATURE REVIEW of any published work about the development of PC in each of the countries

• Research reviewing the national Research reviewing the national DIRECTORIESDIRECTORIES of Services, whether published, printed or online

• EURO-BAROMETER– International survey to boards of

National Associations of Palliative Care.

– Qualitative study addressing opinions, strong and soft points of palliative care, challenges, etc.

• FACTS IN EUROPE 2005– International survey to an expert

within each country

• Quantitative study addressing facts, numbers of teams or beds, etc.


OUTCOMES

• COUNTRIES REPORTS

• COMPREHENSIVE ANALYSIS

• ATLAS OF PC

• TF RECOMENDATIONS

• A PERMANENT NET OF INFORMANTS

PC in Austria and the surrounding countries. A 2005 preliminary report


Introduction

Others studies about PC Development in Europe

Country IOELC 2003 Giessen University 2005

Pallium 7 countries

Council of Europe 2002

Others

AUSTRIA G Baumgartne 2003

CZEECH REP O G

GERMANY G P

HUNGARY O G CE

ITALY G P

SLOVAKIA O G

SLOVENIA O

SWIZERLAND CE

UNITED KINGDOM

G P CE Nat. Council 2005


Introduction

EPAC TASK FORCE on The Development of PC in Europe Survey, September 2005

Country Bibliographic review

Printed Directories

On line directories

Euro-barometer Fact Q

AUSTRIA + +

CZEECH REP + +

GERMANY + + + + +

HUNGARY + + +

ITALY + + + + +

SLOVAKIA +

SLOVENIA + +

SWIZERLAND + + +

UNITED KINGDOM

+ + + +


337

11

3939

48

337

7



16.0 services / million h


ESTIMATION

20%



55.4 pc beds / mill.

3326 beds



ESTIMATION



MEASURES TO PROMOTE PC


ESTIMATION

1 MONTH


PC Units 13

Hospices 7

Hospital Supp 7

Home Care 12

Serv. /mill h 4.9

Beds 153

Paediatric PC 0

Coverage 20%

Articles on NA

Society Yes

Directory Online

Accreditation NA

Goverm. plan Yes

Morphine NA

Oxycodone NA

Fentanyl NA

HABITANTS 8 mill.

1997 educational pregraduate program for all nursing students

2000 palliative care into the national plan for acute care hospitals

2001 Declaration in the Austrian Parliament: 2001 May against Euthanasia, 2001 for Palliative Care

2003 PC Programme in University Graz

Source: Baumgartner (Budapest, 2003)


PC Units 1

Hospices 8

Hospital Supp 1

Home Care 1

Serv. /mill h 1.1

Beds 244

Paediatric PC 1

Coverage 32%

Articles on

Society No

Directory No

Accreditation Project

Goverm. plan no yet

Morphine 27€

Oxycodone 42€

Fentanyl 100 €

HABITANTS 10 mill.

development of PC is obstructed by complex obstacles the level of care for the dying is a problem not yet fully recognized major changes should be expected the availability of strong opioids in the country is very good, similar to Germany or Austria Cesta domů OSI Project team presented a PC project in Parliament

CZECH REP.

Informants: Zdenek Bystricky & Martina Spinkova


PC Units 16

Hospices -

Hospital Supp 4

Home Care 28

Serv. /mill h 4.8

Beds 179

Paediatric PC 0

Coverage 6%?

Articles on

Society Yes

Directory

Accreditation No

Goverm. plan Yes

Morphine Free

Oxycodone Free

Fentanyl Free

HABITANTS 10

Hungarian hospice movement started in 1991. A few teams began their works between 1994 and 1995 with the help of Soros Foundation.

Hungarian Health Law declared the Human Right of Palliative Care in 1997. After a slow increase there were around 22 teams in 2003.

But lack of acceptable financing has weakened many organizations From September 2004 Health Ministry launched the new special hospice financing system.

This new situation resulted in a rapid development of Hungarian hospice movement.

INFORMANTS: Csaba Simko & Katalin Hedeus


PC Units 114

Hospices 50

Hospital Supp 30

Home Care 143

Serv. /mill h 5.7

Beds 900

Paediatric PC 10

Coverage 55%?

Articles on

Society Yes

Directory Yes

Accreditation No

Goverm. plan Yes

Morphine 70 €

Oxycodone NA

Fentanyl 190 €

HABITANTS 59 INFORMANTS: Augusto Carazenni & Oscar Corli

In 1999 when PC was developed mostly on Home Care and a few units, a strong development of new services began. The reason was the 99 law for funding hospices.Now there is a significant development of services but hospital-based palliative care programs is much less available. Also the opioids are more available since the change of the legislation on opioids in 2001. But, on the other hand, there are deficiencies in training and accreditation.


1996 Core Instruments for PCU (Ministry of Health & PC professionals)

2004 Study, commissioned by the German Bundestag, discussing at governmental level

2005 Aachen EAPC Congress

PC Units 106

Hospices 129

Hospital Supp 56

Home Care 30

Serv. /mill h 3.9

Beds 2084

Paedriatic PC 16

Coverage 20%

Articles on

Society Yes

Directory Yes

Accreditation Project

Goverm. plan Yes

Morphine 39 €

Oxycodone 80 €

Fentanyl 263 €

HABITANTS 83 mill.Informants:

Friedemann Nauck & Birgit Jaspers


Services 39

Serv. /mill h 5.6

Beds NA INFORMANT: Francoise Porchet

PC has been increasing in the past 5 years, but there are still many cantons that do not have services.One of milestones was The Consensus Day in 2001. The Swiss Society held a consensus day in collaboration with the Swiss Cancer League on the development of PC in the country that resulted in the Manifeste de Fribourg with the basis for a PC development plan in “5 years – 5 goals”


INFORMANTS: Csaba Simko & Katalin Hedeus

The first freestanding hospice in Slovakia was expected to open in 2003, probably in Bardejov or Nitra. There is one paediatric service, called ‘Flicker’, and one adult home care service. It is estimated that the country requires 550 palliative care beds: 27 exist.

SLOVAKIA

At the moment PC, mostly in home settings, is provided only by one hospice as an NGO. The PC Development Institute, as NGO, is mostly providing training in this field.The commission named by the Ministry of Health has prepared National guidelines on palliative care development in the country.

SLOVENIA

Services 5

PC Serv. / H 3.5

HABITANTS 2 mill

Services 3

PC Serv / H 3.5

HABITANTS 5 mill

Source: TATJANA ZARGI & IOELC

Source: IOELC


UK 2005PC Units 64

Hospices 156

Hospital Supp 362

Home Care 376

Serv. /mill. h 16

Beds 3326 (5.5 /100.000 H)

Paediatric PC 33 (5.5 serv. / mill H)

Coverage 75%

Articles on

Society EAPC MEMBER (3)

Directory Yes

Accreditation SPECIALIZATION IN PC

Goverm. plan Yes

Opioids All available

HABITANTS 60

Informant: Ann Eve


development comparison?

• Development is…

Present (services working in pc)

+

Future: possibility to develop (the vitality of PC movement)

could we measure that?

could we build a EAPC 2005 SCORE on the development of PC in Europe?


UK 2005SCORE PC Units 64

Hospices 156

Hospital Supp 362

Home Care 376

70 Serv. /mill. h 16

Beds 3326 (5.5 /100.000 H)

Paediatric PC 33 (5.5 serv. / mill H)

Coverage 75%

5 Articles on

5 Society EAPC MEMBER (3)

5 Directory Yes

5 Accreditation SPECIALIZATION IN PC

5 Gov. messures Yes

5 Opioids All available

TOTAL SCORE

100HABITANTS 60

An EAPC SCORE on The Development of PC in EUROPE (*)

Range (0-100)

Assistance activityRange (0-70)

Vitality of PC MovementRange (0-30)

+

(+) A provisional proposal


9

13

23

39

40

42

43

44

0 20 40 60 80 100

SLOVAKIA

CZECH

SLOVENIA

HUNGARY

AUSTRIA

SWITZERLAND

ITALY

GERMANY

ASSISTENCIAL ACTIVITY (0-70) VITALITY OF PC MOVEMENT (0-30) EAPC SCORE

EAPC RANKING ON THE DEVELOPMENT OF PC (+)

UK 100

(+) A provisional proposal


CONCLUSION

• Palliative Care around Austria is developed in several different grades. In some countries, an explosion of PC has been noticed very recently and, in the others, our informants are really optimistic about the future.

• As a European citizen, I believe that the deep roots of this elder Europe have still power to send fresh sap, the sap of the movement of PC, to all those who need it in the 52 countries of our study.

“The human quality of our society can be measured by how we care for people in the last

time of their lives.

There should be enough facilities for hospice care, for all those who need it.“

Chancellor Dr. W. SCHÜSSEL 6th March 2003

http://www.austria.gv.at/regierungserklaerung.pdf




52 correspondent members: one in each countrry

30 Boards of Nationals Association

A Collaborative Effort

• David Clark LIVERPOOL (UK) IOEL• Luis Alberto Flores VALLADOLID (SPAIN) EAPC Member• Javier Rocafort BADAJOZ (SPAIN) EAPC Member• Anthony Greenwood LIVERPOOL (UK) IOEL, Research

Assistant• David Prail LONDON, (UK) HELP THE HOSPICES• Liliana de Lima HOUSTON (USA) IAHPC• Amelia Giordano MILAN (ITALY) EAPC Head Office• Silvia Paz BARCELONA, (SPAIN) EAPC Member• Tom Lynch LIVERPOOL (UK) Research Assistant• Carlos Centeno PAMPLONA, (SPAIN) EAPC Board, Chair

The International The International Observa ry Observa ry

on on End of Life Care End of Life Care (IOELC)(IOELC)

The International The International Observa ry Observa ry

on on End of Life Care End of Life Care (IOELC)(IOELC)

With partial fiancncial support of...

Documents

The EAPC Task Force Development of PC in Europe