Many of us are now surviving into old age AND very old age i.e. 80 years plus.
But old age will often lead into multiple pathologies, especially as individuals become frailer towards the end of life. The challenge for services is to address each specific condition, and the complexity of the whole within the unique well-being experience of the individual. This palliative stage of care can be difficult to get right. Unless this is achieved then the prospect of a ‘good-death’ is unlikely, leaving the possibility that as they approach their last day’s individuals may experience isolation, distress, pain and discomfort.
Palliative Care in Wales and Catalonia, Spain
Fortunately the UK with its network of hospices and specialist practitioners is frequently ranked ‘best in world’ for palliative care. However variability exists and complaints to the Ombudsman about fundamentals of care for the old and frail in hospital, formed the basis of a critical report (Care and Compassion?), in 2011. The Welsh Government is sponsoring The Palliative Care Wales network to promote best practice. However in 2014 Ann Clwyd caused controversy by slating the standard of care given to her husband. So let’s take a look at an area of Spain which has an exemplary approach to palliative care.
Catalonia is in the north-east corner of Spain and is bordered to the north by the Pyrenees and France and to the east by the Mediterranean. It is home to the magnificent city of Barcelona and the autonomous community has a population of around 7.5 million people. It has considerable freedom to decide its own health and social priorities.
Early Developments
The first programme of palliative care in Catalonia was developed in 1985 for patients in terminal stages of cancer. This was expanded in 1989 into the Societat Catalano Balear de Cures Paliatives (SCBCP – Catalonian-Balearic Palliative Care Society). This publicly funded programme drew upon a multidisciplinary group of healthcare professionals, some trained in the UK. In 1990, this became a WHO pilot palliative care programme, under which palliative care teams were created in the region.
The objectives were to develop research, promote ethical conduct, disseminate best practice and to raise public awareness. Above all, to ensure that people in end-stage illness, were comfortable and compassionately cared for in a skilled manner.
Today
Today, Catalonia is well served by this programme which reaches around 80% of cancer patients and 50% of patients with other long-term and life-limiting conditions. It is supported at senior levels in academia and civic society and it networks through palliative care teams into primary care, acute hospitals, long term care-centres, nursing homes and domiciliary home care. It offers an excellent model of multi-disciplinary, principled and person-centred best-practice.
For more detail about palliative care in Catalonia please see;
http://www.eapcnet.eu/Portals/0/Organization/Publications/European%20Insights/EJPC21(3)_Insight.pdf
For information about Palliative Care Wales and practice guidelines see;
