Palliative Care

Palliative CareWhat is palliative care?

Palliative care has been defined by the World Health Organization as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life limiting illness, through the prevention of, and relief of, suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical and spiritual.’
 
Palliative care differs in philosophy from curative strategies in focusing primarily on the consequences of a disease rather than its cause or specific cure. Approaches are therefore necessarily holistic, pragmatic and multidisciplinary. The approach therefore complements oncological or antiviral treatments; it does not substitute for or replace them.
 

Background

Historically palliative care services had arisen from voluntary sector fundraising efforts. It was not until the late 1970s that government funding was given to support hospices; hospices funded by the National Health Service (NHS) then joined those funded by Marie Curie Cancer Care, Sue Ryder Foundation and other independent charities. So the main drive to hospice development has come from the non-statutory sector. This has often resulted in the ad hoc development of services which the NHS was then asked to support.
 
The Calman-Hine report set out a policy framework for the commissioning of cancer services. The document went on to highlight the need for planning since hospice units had developed in an ad hoc manner, not necessarily in areas of greatest need. Although the report focused on cancer, it was recognized that palliative care is required by patients with any progressive life-limiting disease, so that the principles outlined applied also to those with AIDS, motor neuron disease, end-stage cardiorespiratory failure and so on. Most of the crucial strategic developments have taken place in relation to cancer care provision, but data from cancer workload alone underestimate the need for the services. The report recognized the specialist nature of palliative care provision and declared skills in a palliative care approach to be a core requirement of every health professional.

 

Policy Context

The Welsh Assembly Government's Strategy below was produced in close co-operation with the Welsh Association for Hospice and Specialist Palliative Care. It sought to provide a distinctly Welsh strategy to meet the needs of the people of Wales but drew on the work done by the Department of Health in England and the Association’s parent body  the National Council for Hospice and Specialist Palliative Care.

The Welsh Health Circular 2006 030 formally endorsed the All Wales Care Pathway for the Last Days of Life following the Minister for Health and Social Services’ commitment to ensure that health care encompasses the needs and wishes of those at the end of life.

The standards and key actions in the document below are written from an all Wales perspective and therefore apply to all children and young people with this particular health need wherever they live in Wales.

Cancer Standards define the core aspects of the service that should be provided for cancer patients throughout Wales.

The Palliative Care Cymru Implementation Board has published a report on progress made in the last three years.

 

Service Planning

The All Wales Palliative Care Planning Group was set up by the Minister for Health and Social Services to establish the elements of a core palliative care service for children and adults, and a means by which the service will demonstrate quality. The Group chaired by Vivienne Sugar reported their findings to the Minister in June 2008.

 

Palliative Care Funding

Following the report of the palliative care planning group for Wales, the Minister established a working group to implement the report.

 

Service Delivery

Palliative care itself can be split into two categories:
  • General palliative care: Delivered by Health Professionals in a generalist setting
  • Specialist palliative care: Delivered by Specialist Multidisciplinary Teams dedicated to palliative care

This care can be delivered in a number of settings including in hospitals, at home, in hospices and in the local community at day centres and in residential and nursing homes 

Following the Sugar report a Palliative Care Implementation Group was established to take forward the Report's recommendations.

The teams delivering Palliative Care services across Wales all use iWantGreatCare to understand the experience of their care. Every patient, and their family, is invited to give their open feedback whenever they wish.

Palliative Care Services

 

Spiritual Support Services

The diagnosis of life-threatening disease can raise unsettling questions for patients. Some people will seek to re-examine their beliefs, whether philosophical, religious or spiritual in nature.

Healthcare chaplaincy has long played a key role in providing a spiritual care service to patients, their families, carers and staff. Throughout the NHS today chaplains/spiritual care-givers not only offer religious ministry to members of faith communities but are also called upon to give wider spiritual care to those who have no association whatsoever with religious groups.

NHS Wales Informatics Service

The NHS Wales Informatics Service - Palliative Care project is about providing holistic specialist palliative care to patients.

The project has objectives which include ensuring all hospices are able to access CANISC (the cancer computer information system) to allow a continuation of care to the patient without duplicating previous treatment.

The Palliative Care in Wales website is part of the Palliative Care Matters network of sites. It is aimed at health-care professionals working in the palliative care field.

Review of Palliative Care Services

Healthcare Inspectorate Wales is helping to drive through improvement by independent and object review of palliative care services. Following the completion of the work currently being led by Baroness Finlay to develop quality standards for the delivery of palliative care services, they will undertake an all-Wales baseline review against these standards.

Evidence

Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting. They are designed to facilitate the choices that doctors, patients, policy makers and others face in health care.

NHS Evidence - supportive and palliative care is a unique resource which aims to provide access to good quality, up-to-date, relevant information on supportive and palliative care.

 

Statistics/Data

The National End of Life Care Intelligence Network (NEoLCIN) aims to improve the collection and analysis of information related to the quality, volume and costs of care provided by the NHS, social services and the third sector, to adults approaching the end of life.