HOSPICE (AND PALLIATIVE CARE NETWORK) IN ITALY AN UNMPREDICTABLE GROWTH

HOSPICE (AND PALLIATIVE CARE NETWORK) IN ITALY AN UNMPREDICTABLE GROWTH Furio Zucco Past President Italian Society for Palliative Care Past President Italian Federation for Palliative Care Director of Anesthesia, Intensive Care, Palliative Care and Pain Therapy Garbagnate MilaneseHospital Trustee - Milano European Association of Palliative Care Research Network Glasgow, June 2010

H.T. G. Salvini PCPMU GARBAGNATE H LHA GARBAGNATE 236.000 inhab. BOLLATE H RHO H MILANO LHA RHO 160.000 inhab

GARBAGNATE MILANO LOMBARDIA HOSPICE FACILITY in HOSPITAL 250 Pts/year

PALLIATIVE CARE HOSPITAL AT HOME PCPM UNIT 24 HOURS A DAY, 365 DAYS 600 Pts/year

Italy - 60 million inhabitants - National Health System - 21 Regional Administrations - 155 Local Health Authorities 250.000 new Terminally ill Pts/year - 160.000 oncological - 90.000 non oncological PALLIATIVE CARE NATIONAL PLAN PTS SET 75 % HOME CARE 25 % HOSPICE

Italy Patients Assisted in PCN/ Year 40.000? / 250.000 97 % are Oncological Pts

Società Italiana di Cure Palliative Fondazione Isabella Seràgnoli Fondazione Floriani FERS Foundation ITALIAN HOSPICE NETWORK PROJECT (RETE DEGLI HOSPICE ITALIANI ) European Association of Palliative Care Research Network Glasgow, June 2010 7

Objective The objective of Italian hospice network Project is monitoring all hospices financed by a specific National Fund (Law 39/99) or by resources coming from other Subjects, in particular from the No Profit Organisations (NPO)

Partners involved Isabella Seràgnoli Foundation Floriani Foundation; SICP - Italian Society of Palliative Care Scientific Cohordinator Furio Zucco Past President of SICP

1 st Publication in 2007 Hospice in Italia. Prima Rilevazione ufficiale (2006)

Hospice in Italy 2009 2013 Hospice 2nd Book Scientific Cohordinator F.Zucco in Print June 2010 300 n N. di Hospice operativi H o s p i c e s 250 200 150 100 50 dati reali n. of working Hospices (Real data: June 2009) n. of planned Hospices (2006 Regional previsioni stimate nel 2006 administrations plans) n. of planned Hospices (2009 Regional previsioni aggiornate al 2009 administrations plans) 105 206 165 243 229 256 0 5 20 1999 2000 2001 2002 Law n.39/1999 208 million Euros only for Hospices 2003 2004 2005 2006 2007 Anno 2008 2009 2010 2011 2012 2013 Law n.38/ March 2010 100 million EuroS/year for Palliative Care and Pain Therapy 2 different networks

Hospice in Italy 2009-2013 165 Hospices working at June 2009 10 Hospices working at April 2010 54 Hospice working on 31 Dec 2010 27 Hospices working (2011-2013) 2013 256 HOSPICES 2010 Mean 11 beds 17 days in Hospice Staying Mean 11 beds 17 days in Hospice Staying Hospice in Italy 2nd Book 2009 Furio Zucco in priint June 2010

THE GLASS CAN BE SEEN AS HALF EMPTY OR HALF FULL

Fig. 2 Hospice working at June 2009 Regional Administrations N of Hospices n of Beds Beds/ 10.000 inhabitants. Hospices probably providing palliative care (31 Dec 2010) N of Hospices n. of Beds Beds/ 10.000 inhabitants. Inhabitants ISTAT 1 Genuary 09 Abruzzo - 2 20 0,15 1.334.675 Basilicata 4 44 0,75 5 51 0,86 590.601 Calabria 2 18 0,09 4 48 0,24 2.008.709 Campania 2 18 0,03 9 111 0,19 5.812.962 Emilia-Romagna 18 216 0,50 24 288 0,66 4.337.979 Friuli Venezia Giulia 4 52 0,42 4 52 0,42 1.230.936 Lazio 15 252 0,45 17 295 0,52 5.626.710 Liguria 5 52 0,32 7 82 0,51 1.615.064 Lombardia 51 610 0,62 57 678 0,70 9.742.676 Marche 5 42 0,27 8 76 0,48 1.569.578 Molise 1 16 0,50 1 16 0,50 320.795 Piemonte 11 114 0,26 16 166 0,37 4.432.571 Puglia 6 96 0,24 9 132 0,32 4.079.702 Sardegna 3 33 0,20 5 58 0,35 1.671.001 Sicilia 5 51 0,10 14 157 0,31 5.037.799 Toscana 12 86 0,23 21 139 0,37 3.707.818 Trentino Alto Adige 2 18 0,18 2 18 0,18 1.018.657 Umbria 2 19 0,21 4 34 0,38 894.222 Valle d'aosta - 1 7 0,55 127.065 Veneto 17 151 0,31 19 164 0,34 4.885.548 Italy 165 1.888 0,31 229 2.592 0,43 60.045.068

Law n.38 6 March 2010 Palliative Care and Pain Therapy Published on G.U. n 65 19 March 2010 Rules to guarantee acces to the Palliative Care Network and Pain Therapy Network

Art. 1 Objectives Art.2 Definitions Law 38 9th March 2010 GU 19th March 2010 Art. 3 Ministery of Health and Permanent State and Regional Adinistrations Council Art. 4 Information campaignes Art. 5 Palliative Care Network and Pain Therapy Network Art. 6 From Hospital to Home No pain project

Law n. 38 9 March 2010 Art. 7 Pain daily monitoring into the Inpatient Clinical Diary Art. 8 Professional Education in PC and PT Art. 9 Monitoring of the 2 networks development Art. 10 Simplifing procedures for prescribing analgesic drugs (opioids) Art. 11 Report to the Parlament Art. 12 Financial Support

Strong lobbing action Italian Society For Palliave Care www.fedcp.org 2.500 Members www.sicp.it Italian Federation of Charityes Organisations for Palliative Care 63 NPO s affiliated

Palliative Care in Italy Critical Aspects - Hospice and Home Care PC Low integration (National Model) - Difficulties in integration between Public, Charities and For Profit Palliative Care providers in Local Palliative Care Network (LPCN) - Low GP s integration in the LPCC Network (even if in continuous improvement)

Palliative Care in Italy Critical Aspects - Leak of: - National standards for accreditation of PC Providers, quantitative and qualitative - Omogenous Reimbursement System (NHS Tariffs for Hospice and Home Palliative Care) - National Educational Program (University and Continuous) - National and Regionals Communication plans - Permanent Public Funds for Research in PC

Palliative Care in Italy Critical Aspetcts - Very Low strong Opioids prescription and consumption - Very low awareness of Prognosis and end of life situation - Cultural bias - Negative meaning and awareness for palliative - Confusion between Pallitive Care and Pain Therapy

THE GLASS CAN BE SEEN AS HALF EMPTY OR HALF FULL

THERE IS A LONG WAY

VITTORIO VENTAFRIDDA From roots to the future fzucco@aogarbagnate.lombardia.it