Трансформация паллиативной помощи в Москве: нужны медицинские «мощности» и люди
Why is it that less than half of people in need of palliative care in Moscow are being given the support they need? What are the chances of improving this situation? These were the issues discussed at the ‘Healthy Moscow Assembly’. The organisers have described the event as a major platform for debating the delivery of healthcare in a digital world and considering innovative ways of providing medical care and prophylactic treatment.
Addressing the Assembly with a talk entitled ‘Moscow’s Transformation of Palliative Care’, Tatyana Kravchenko, chief independent expert on palliative care at the Moscow Department of Health, reported that around 81,000 Muscovites currently require palliative care. Her full statement is available here – сообщила. The data used is calculated based on the methodology used by the World Health Organisation and the Russian Ministry of Health. Kravchenko stressed: ‘Currently, around 43% of people who need palliative care are receiving it… That is not to say that the remainder are being denied the support they need; it is simply that not all the patients who potentially need palliative care are coming forward.’
Working towards the model of hospice care in the home
Important measures are being taken to develop Moscow’s palliative care service. The Centre for Palliative Care within the Moscow Department of Health is using outreach services to bring care into people’s homes. In 2018 the centre’s staff made over 77,000 home visits. In 2019 the figure rose to 99,000. Arif Ibraginov, deputy chief physician responsible for collaboration with the Moscow Department of Health’s Centre for Palliative Care, described the service: ‘We offer 24-hour telephone support and our lines are manned round the clock. Since 2018 we have been developing respiratory support in the home. We are following the hospice in the home model. By the end of 2019 we had set up 12 outreach programmes, throughout 2020 we expect to open six more. This will allow us to provide this service across the whole of Moscow, including the newer regions.’
Lack of information
Anna Skorobogatova, Director of the Hospice Charity Faith (‘Vera’), gave her comments to the Agency of Strategic Initiatives on the data provided by the Moscow Department of Health: ‘Providing palliative care to 43% of Muscovites in need of it should be seen as a major achievement. There are several reasons why we have not yet been able to offer palliative care to the others, including the fact that too few people know that our service exists. Medical staff have a major role to play in making people aware of our system of palliative care, unfortunately, they do not all have sufficient information to answer the questions. This is why one of our main priorities is to train our own medical staff in our palliative care system. We also need to involve the media to get out message out. Fortunately, society has moved on considerably in this regard. For instance, state television channels are now willing to cover the concerts held in hospices to raise funds, and glossy magazines print interviews with celebrities and other senior figures who campaign on behalf of our charities.’
Palliative care for children
Tatyana Krachenkoreported that Moscow has only 77 beds for children who need palliative care. There are 7 in Filatovsk hospital, 40 in Morozovsk hospital and another 30 beds in one of the branches of the Centre for Palliative Care. Staffing problems in paediatric palliative care is particularly acute compared with the provision for adults. She explained: ‘The greatest problem we face is the lack of paediatricians who are able and willing to work in palliative care. We do not have enough trained specialists but we are willing to train them in everything we know. We have a great deal of work to do in many areas; improving communication with primary care units to ensure children receive the palliative care they need and are kept under observation at the right time, giving them everything they need in the home and, where necessary, transferring them to hospital.
Another problem to be addressed is the lack of an official statement from the government showing the exact support a young patient can expect to receive in terms of palliative care. Anna Skorobogatova noted: ‘There is still no official list. We still have problems in training doctors and there are no clear guidelines on the kind of equipment and medical supplies we should be giving to young patients. There is still much to be done, by NGOs, government agencies and, most of all, by doctors.’
‘Of course, we need to build up our medical ‘capacity’. We need to open up beds and establish outreach teams with fully trained professionals. Above all, we need to recruit people who have compassion and knowledge, who are selfless and willing to help people at the end of their lives, who have the ability and the desire to alleviate their suffering, to support them, take them by the hand, comfort them and listen to them. These are exceptional, spiritual qualities. We also need medical knowledge and professional training.’