NIK: Palliative and hospice care still not for all those in need

The definition in current legislation of a closed catalog of diseases entitling adults to palliative and hospice care (OPH) limits access to this form of assistance for many patients at the end of life. According to a recent report by the Supreme Audit Office, the Health Minister's actions have not resulted in an improvement in the availability of OPH services, although the increase in their valuation and the abolition of limits have been viewed positively.

Palliative and hospice care aims to improve the quality of life of patients and their loved ones, relieving pain, disease symptoms and emotional support. In 2022, a total of nearly 100,000 patients in 545 facilities - in home, outpatient and inpatient settings - benefited from this care.

Staff shortages and lack of planning

The NIK points out that despite having access to NHF data on the number of patients, providers and staff, the health minister did not analyze the medical staffing needs necessary to provide OPH services. The missing number of doctors, nurses and other specialists was not determined, despite the fact that the national consultant regularly submitted staffing recommendations to the ministry.

Although palliative medicine has been given priority status since 2020, this has not translated into greater interest among doctors in this specialty. According to the NIK, the number of doctors would need to more than double to meet patient needs. Meanwhile, only 30-40 pass the specialty exam annually.

No evaluation and a closed catalog of diseases

The chamber accuses the Health Ministry of failing to develop tools to evaluate the effectiveness of the regulation on outpatient pain management, introduced in 2023. Moreover, a limited catalog of eight diseases that qualify adult patients for palliative and hospice care is still in place.

According to the NIK, despite the appointment of an advisory team and a ministerial plenipotentiary for palliative care, no steps have been taken to expand this catalog in 2022-2024. The draft strategy for the development of OPH in Poland has still not been adopted, and the ministry refused to let the inspectors see the document, explaining that analytical work is still underway.

An overly narrow list of diseases was also, according to hospice managers, one of the main reasons for denying services. Several of the inspected facilities reported cases of patients who were denied care because their disease unit was not included in the regulations.

Funding increases, but problems remain

Between 2022 and 2024, the value of billed services increased - from PLN 1 billion in 2022 to PLN 1.7 billion in 2023, and already to PLN 0.9 billion in the first half of 2024. The number of patients covered also increased during this period - from 98,000 in 2022 to 105,000 a year later.

However, the NIK notes that despite the abolition of caps on OPH services as of April 2024, the minister did not conduct analyses of the scale and value of overcontracting or the readiness of facilities to provide services without caps. As a result, there have been delays in payments for overdeliveries, which hospices and palliative units have complained about.

Quality and organizational concerns

Most of the audited hospices provided proper conditions for patients, but the NIK found numerous organizational deficiencies. Some of the facilities had out-of-date medications, doors that were too narrow, making it impossible to transport a patient on a bed, and some had shortcomings in recording doctors' time or reporting data to the National Health Service.

Eight of the ten facilities that provided services over the limit did not receive due funds from the National Health Service.

NIK conclusion

The Supreme Audit Office has called on the Health Minister to speed up and coordinate work on solutions that will improve access to palliative and hospice care for all patients in need.

Source: NIK