BMJ 2015;350:h1012 doi: 10.1136/bmj.h1012 (Published 24 February 2015)
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Letters
LETTERS IF I RULED THE NHS
Improving access to specialist palliative care Sébastien Moine general practitioner and PhD student Multi-professional Primary Health Care Center “The Vines of the Abbey”, 60130 Saint Just en Chaussée, France
The massive cultural shift that Lakhani calls for has to occur at various levels in health systems.1 In France, for example, after several national strategies to develop palliative care (lastly in 2008-12), access to specialist palliative care remains poor. A recent report by the French Court of Audit highlights that access to palliative care remains generally limited; the development of graduated care provision in hospitals failed to reduce regional inequalities; and palliative care outside of hospitals lacks support and is insufficient, whether at home or in nursing homes.2
Until now, solutions to the problem of palliative care in France have come from within hospitals, and the central role of primary care has been neglected. Thus, the report’s conclusions are a vivid example of what it entails to respond to massively widespread needs with scarce resources.
Furthermore, one of the major challenges that Lakhani points out is the urgent need for health professionals to work as genuine “unified teams,” especially in the community. In France, the method of payment for primary care professionals (fee for
service) is a serious barrier to multi-professional teamwork if new forms of remuneration that promote coordination and collaboration are not used more widely.
At a time where the strengthening of palliative care as a core component of health systems has been identified as a major goal globally,3 these facts must be urgently taken into account to adapt service provision to the needs of the people. Competing interests: None declared. Full response at: www.bmj.com/content/350/bmj.h605/rr-3. 1 2 3
Lakhani M. Palliative care for everyone with advanced progressive incurable illness. BMJ 2015;350:h605. (5 February.) Cour des Comptes. Les soins palliatifs : une prise en charge toujours très incomplète. In Le rapport public annuel 2015. Tome II : L’organisation, les missions, les résultats (p. 221-248). 2015. Cour des Comptes. WHO. Strengthening of palliative care as a component of comprehensive care throughout the life course. Resolution WHA67.19. 2014. http://apps.who.int/medicinedocs/en/d/ Js21454ar/.
Cite this as: BMJ 2015;350:h1012 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS IF I RULED THE NHS
Improving access to specialist palliative care Sébastien Moine general practitioner and PhD student Multi-professional Primary Health Care Center “The Vines of the Abbey”, 60130 Saint Just en Chaussée, France
The massive cultural shift that Lakhani calls for has to occur at various levels in health systems.1 In France, for example, after several national strategies to develop palliative care (lastly in 2008-12), access to specialist palliative care remains poor. A recent report by the French Court of Audit highlights that access to palliative care remains generally limited; the development of graduated care provision in hospitals failed to reduce regional inequalities; and palliative care outside of hospitals lacks support and is insufficient, whether at home or in nursing homes.2
Until now, solutions to the problem of palliative care in France have come from within hospitals, and the central role of primary care has been neglected. Thus, the report’s conclusions are a vivid example of what it entails to respond to massively widespread needs with scarce resources.
Furthermore, one of the major challenges that Lakhani points out is the urgent need for health professionals to work as genuine “unified teams,” especially in the community. In France, the method of payment for primary care professionals (fee for
service) is a serious barrier to multi-professional teamwork if new forms of remuneration that promote coordination and collaboration are not used more widely.
At a time where the strengthening of palliative care as a core component of health systems has been identified as a major goal globally,3 these facts must be urgently taken into account to adapt service provision to the needs of the people. Competing interests: None declared. Full response at: www.bmj.com/content/350/bmj.h605/rr-3. 1 2 3
Lakhani M. Palliative care for everyone with advanced progressive incurable illness. BMJ 2015;350:h605. (5 February.) Cour des Comptes. Les soins palliatifs : une prise en charge toujours très incomplète. In Le rapport public annuel 2015. Tome II : L’organisation, les missions, les résultats (p. 221-248). 2015. Cour des Comptes. WHO. Strengthening of palliative care as a component of comprehensive care throughout the life course. Resolution WHA67.19. 2014. http://apps.who.int/medicinedocs/en/d/ Js21454ar/.
Cite this as: BMJ 2015;350:h1012 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
