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 Spanish palliative care physician Emilio Herrera received this year’s EJPC Palliative Care Policy Development Award on 10 May 2015 at the 14th World Congress of the European Association for Palliative Care in Copenhagen. Passionate about relieving suffering, his way of contributing is by setting up innovative programmes and models of palliative care delivery. He tells us more about his efforts to transform healthcare systems
How do you feel about winning the EJPC Palliative Care Policy Development Award?
I am extremely grateful, happy and honoured. To transform our health systems and create more effective, efficient and fair models of care is a permanent fight against the odds. The EJPC Award validates the path I and others have followed and contributes to spreading the word so that more healthcare professionals are aware of what we do. This in turn will help in ensuring that our approach is more widely adopted, which ultimately is our aim. So this recognition from the scientific community is a huge boost and provides important support for all our teams.
What made you decide to follow a career in palliative care?
I had started my career as a doctor in family and community medicine. I got into palliative care when I was looking for a solution to relieve the suffering experienced by some of my loved ones, and in doing so I found my true vocation. Through the experience of my relatives, I was given to understand that neither the education and training I had received so far, nor the health system I was working in, were capable of providing adequate solutions to alleviate their suffering. Palliative care offered the responses I was looking for. I realised what a marvellous profession it was and decided to live and fight for it on a daily basis!
Later I learned to design and implement programmes that could provide answers from a public health perspective. Contributing to improve health systems by implementing models and programmes able to alleviate the suffering of thousands of people has been a dream come true.
How do you shape palliative care programmes so they are successful?
A number of essential elements must come together to make these programmes work: values, rights, scientific competency and resource management. To set up successful programmes one must create a common vision, select methods that work and motivate people so that they show resilience when confronted with the difficulties inherent to change.
It is ‘leadership by serving others’: we need leaders with a transparent and compassionate approach, who are well trained scientifically and administratively, who care deeply about what they do, and who are sufficiently humble to feel happy empowering others.
We need to create networks, ‘tribes’ that share the same goals and values. We need to be able to look beyond our own area of expertise and learn from other professionals, sectors and experiences.
The central aim of these palliative care programmes is to provide good-quality care to all who need it. ‘Don José’ – the Spanish ‘John Smith’ or ‘man in the street’ – must be able to access the best possible palliative care, whenever and wherever he needs it. This means that the palliative care team has to reach beyond the hospital or even the patient’s home, and work in care networks with different levels of complexity. Truly integrated care will take place when healthcare services at all levels are able to team up with social care services, and when people in the community – families, friends, neighbours – are involved.
The exact design of palliative care programmes may be different for each team or setting, but ultimately the programme must achieve the same goal everywhere.
From the point of view of system mobilisation, we work both top-down and bottom-up, with a structured and planned approach but sufficient flexibility to adapt to changing circumstances. We need to be prudent and proactive at the same time. We need to evaluate impact and measure results. And the teams at local level must be made aware of the value of what they are achieving.
There are doubtless many barriers along the way, but there are also many people able to take up the challenges, professionals who are keen to make change happen. It is simply a matter of finding them and start working with – and for – them.
You are President of the NewHealth Foundation. What are the aims and activities of this organisation?
The NewHealth Foundation, created in February 2013, is a not-for-profit organisation devoted to exploring and promoting new models of care for people with advanced chronic conditions who need palliative care.1 We are a group of professionals based in the beautiful city of Seville and we are passionate about what we do. We are working in three areas:
- Developing high-quality palliative care networks and resources. We have designed NewPalex, a tool to develop programmes and organise palliative care teams in integrated networks using a new certification methodology. It is applicable to both large territories and small organisations, and we are implementing it in various settings in Spain and Latin America.
- Working towards the integration of health- and social care services. We have set up the Spanish Observatory on Integrated Care Models (or OMIS, Observatorio de Modelos Integrados en Salud).2 Its aim is to identify and analyse integrated care experiences in Spain, and possibly extend them to other countries.
- Rolling out the ‘Compassionate Communities and Cities’ movement. We have set up the project ‘Todos contigo’ (‘We are all with you’), which aims to increase the public’s awareness of, and involvement in, their cities and communities through collective learning networks.
You are also involved in the Lucy project in Colombia. Can you tell us more about it?
The Lucy project received its name from a clinical case written a few years ago, which described the story of a Colombian friend of mine who did not receive the end-of-life care she needed. The project was subsequently set up to help develop palliative care in Colombia. It entails:
- The formulation of a national strategy of palliative care
- The reorganisation of the funding model by which health insurers pay for care services
- The establishment of specific palliative care programmes and resources at provider level
- The development of education, as well as basic and intermediate training, for palliative care specialists
- The generation of public awareness through ‘Compassionate Cities’ projects.
After just one year, we are working with Colombian health insurance companies which, between them, provide coverage for 16 million people; that is, a third of the country’s population. More than ten hospitals and healthcare providers are applying the NewPalex methodology to design and implement palliative care resources and programmes; this includes, crucially, a phase of quality accreditation. A number of municipalities are promoting ‘Compassionate Cities’ projects.
Our plan is to continue working over the next three years with the aim of achieving sufficient critical mass to roll out the project and models across the country.
It is a complex project, but at the same time a wonderful one: if successful, it could demonstrate how vast transformations are possible when a country decides collectively that it wants to improve people’s experience at the end of life, provided changes are sustained with the right methodology. It could help other countries understand that it is possible to undergo, at high speed, fundamental tranformations that lead to improvements in the quality of care, and save public funds. It should hopefully demonstrate the economic benefits of palliative care while creating quality, integrated palliative care services.
How would you describe the palliative care landscape in Spain?
Spain has a legislation that guarantees access to palliative care. A few years ago, a national palliative care strategy was launched and a model integrating the different care levels was put in place. But we are going through a difficult moment. Spain has a large number of dedicated palliative care teams, both home- and hospital-based, which means that, in theory, access to care is excellent: over 82% of the Spanish population lives within 25 minutes of a palliative care team. However, more than 80% of teams are under-resourced so, to make that coverage a reality, the number of professionals working in those teams needs to be increased. There are also issues around the model of professional accreditation for specialists, and around care for vulnerable groups, in particular paediatric patients.
The biggest challenge could be to get politicians, health managers and professionals to share a common mission: improving the national network of palliative care and making it readily accessible to all. We need to measure how we are doing at regional level using agreed indicators, and we need to be open in recognising inequalities in access to care. This will enable us to identify areas where improvement is needed, establish what measures need to be taken … and get things moving!
And what is the palliative care situation in Latin America?
The situation in Latin America is completely different to Spain, and cannot be easily summarised because there are a variety of healthcare models and systems, and palliative care is at different stages of development in different countries. Organisations such as the Latin American Association for Palliative Care (Asociación Latinoamericana de Cuidados Paliativos)3 and International Association for Hospice and Palliative Care4 have brought crucial support in providing regional leadership.
There are countries with a 20-year tradition of palliative care and excellent resources, which have not been able to roll out services across their territories, because their health systems have not yet appreciated the benefits of a countrywide expansion (for example, Argentina), or because they have not found an adequate model to integrate palliative care within mainstream healthcare services. Some countries (for example, Panama) have launched national strategies that, if implemented across their national territories, would become great examples for others, even so-called developed countries.
How do you see the global future of palliative care?
As palliative care professionals, we have a role to play in the overall changes that health systems need to undertake. We must recognise this opportunity and believe in ourselves! Palliative care models of managing chronic conditions, with their integrated, person-centred approach, could become examples to follow.
Palliative care needs to become an integral part of mainstream health- and social care services, and involve communities, so that we can address people’s needs in a truly efficient and accessible manner. We need to encourage the birth of new generations of palliative care professionals and healthcare managers who can make the most of what has already been achieved, and achieve even more. If we get the focus right, there is a bright future ahead.
References
2. www.newhealthfoundation.org (last accessed 21/05/2015)
3. www.omis-nh.org (last accessed 21/05/2015)
4. http://cuidadospaliativos.org/home/ (last accessed 21/05/2015)
5. http://hospicecare.com/home/ (last accessed 21/05/2015)
We have a role to play in the overall changes that health systems need to undertake
This interview with Emilio Herrera has also been published in the EJPC22.4 (July/August 2015 issue).
2016 nominations
Nominations for the 2016 EJPC Award will open on 1 October 2015. The submission form will be available on the EJPC Award pages of the EJPC website, www.ejpc.eu.com/ejpcaward
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