The Budapest Commitments: A view from the UK

Dr Bee Wee, President of the Association for Palliative Medicine of Great Britain and Ireland, and Head of WHO Collaborating Centre for Palliative Care in Oxford, UK, continues our series that looks at how different countries are improving palliative care within the framework of the Budapest Commitments.

Dr Bee Wee

Dr Bee Wee

So how is the UK doing? Reasonably well, but with plenty more to do I think. The areas of the Budapest Commitments I would like to review are:

Access to medication
We are lucky in the UK. Generally, access to medication is not a problem. However, for some of the more expensive and newer drugs restrictions may be imposed by the commissioners of health services, making them slightly less easily accessible. This might well become more of a problem, as the financial restrictions within our health service get even tougher.

Policy
Palliative care has been widely accepted as an area of national policy, firstly as part of the national cancer strategies and in recent years, as part of end of life care strategies in each of the four countries that make up the UK. Many developments and initiatives have resulted from these strategies. The only thing we need to watch out for is that in the midst of increasing provision of end of life care at a generic level, we do not dilute the focus on the need for specialist palliative care for patients who have particularly complex needs. The Association for Palliative Medicine of Great Britain and Ireland (APM), Consultant Nurse in Palliative Care Reference Group, Marie Curie Cancer Care, National Council for Palliative Care and the Palliative Care Section of the Royal Society of Medicine have just jointly launched a document entitled ‘Commissioning guidance for specialist palliative care: Helping to deliver commissioning objectives’. 

Education
The verdict on this is quite good. All medical schools across the UK now include some palliative care teaching. Many pre-qualifying courses for nursing, allied health professionals and social work do too, but this is not yet universal. Palliative medicine is a recognised specialty within the Royal College of Physicians, so this gives us the chance to influence the curriculum for other postgraduate training programmes. We’ll continue to work on this.

Quality
The NICE Quality Standard for End of Life Care  was published in November 2011 and is very useful for helping to keep our focus on improving end of life care wherever the patient is, and whatever the underlying condition. It includes a quality statement about the importance of access to specialist palliative care.

Research
There’s a lot going on and lots more to do. Much of the infrastructure funding for research is focused on a few centres, so there is a great deal of high quality output from those centres. However, outside those centres, the lack of reliable infrastructure funding and support makes it difficult for any sustainable research progress to be made. This is an area that requires a lot more development and greater spread.

So… not a bad report card but we just need to keep soldiering on.

To find out more …
Other useful resources on palliative and end of life care in the UK:

Click here to read how other national organisations have used the framework of the Budapest Commitments to develop palliative care.

Coming up…
Follow the blog in the coming weeks to read more about the Budapest Commitments. Published material will be summarised by Dr David Oliver in his guest editorial in the May/June 2013 issue of the European Journal of Palliative Care and will be presented at the 13th World Congress of the European Association for Palliative Care in Prague 2013.

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