Proposition 53K0330

Proposition de résolution relative à une amélioration de l'offre de soins palliatifs en vue d'une meilleure adéquation aux besoins.

General information ¶

Authors

CD&V Nathalie Muylle
LE Catherine Fonck, Annick Van Den Ende

Submission date

Oct. 8, 2010

Official page

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Status

Adopted

Requirement

Simple

Subjects

resolution of parliament palliative care

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP ∉ Open Vld N-VA MR VB

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Discussion ¶

June 23, 2011 | Plenary session (Chamber of representatives)

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Mr. Speaker, Ladies and Gentlemen, Ladies and Gentlemen, Ladies and Gentlemen, the subject of this proposed resolution is a real cause for each and every one of us. I am, therefore, very honored to be a “resonance box” as a rapporteur.

This proposal for a resolution on palliative care was adopted unanimously by the members of the Chamber’s Public Health Committee. This proposal has already been discussed in the previous legislature and is an opportunity for Parliament to express its commitment to an organization of palliative care which is now structurally anchored in health care. Indeed, for more than a quarter of a century, the medical world and society have regained awareness that death constitutes a very important event in the life of a human being and that, for any person suffering from an incurable disease and condemned to die soon, the quality of life prevails over the duration.

Over the past twenty years, the financing of palliative care has evolved since, today, pilot projects take the place of structural financing, in particular with regard to multidisciplinary monitoring teams. The practice of palliative care is therefore recent and, like any new discipline, it is likely to be improved in many aspects. For example, this proposal expresses Parliament’s desire to see the financing of palliative care improved in accordance with the conditions of the various studies conducted on the subject.

In this same spirit, point 18 of the proposal expresses the need to know and evaluate the needs of the first line of care in the end of life problem. The proposal also emphasizes training and exchange of knowledge on this subject among all relevant professionals, whether nurses or staff in rest and care homes. Furthermore, several amendments to the text emphasize the need to see future policies carried out in consultation with the partially competent federal entities in the matter.

The Public Health Committee is currently considering the possibility of changing the legal definition of palliative care.

Many valuable initiatives have already been taken in this country to organize palliative care. These are collaborative relationships within the home care, possibly supplemented with the palliative day centers, but also in the intramural facilities, i.e. in the hospitals and the rest and care homes. I would like to emphasize here that in this area, too, a lot of volunteers every day do truly exceptionally valuable work and for this they deserve all praise.

Because part of the health care offer is not yet structurally financed – we think of the palliative day centers – in many of these settings it is still about genuine pioneering work. In any case, our group shares one of the main concerns of the authors of this resolution, in this case, that the offer of palliative care should be better aligned to the effective needs and care needs of patients. It fits perfectly into our philosophy of a horizontal approach to health care, based on the patient’s need for care rather than from the pathology or the disease itself.

Because palliative concerns are currently sometimes too closely related to the actual end of life, palliative needs are not recognized in a large number of patients. In order to truly effectively recognize these palliative needs, we emphasize the importance of a solid basic training in palliative care in the curriculum of every healthcare provider. Therefore, we sign the amendment of Mr Lambert.

As Mr Seminara correctly said, the committee will soon discuss the adaptation of the definition of palliative care. When this definition is effectively adjusted, it is important for us that in addition to releasing life expectancy as a criterion, attention is also paid to the completion of operational criteria that make the new definition also proved practical in practice.

The resolution also mentions early care planning, the advanced care planning. We are very affectionate about that. As the applicants suggest, this can avoid a number of prospective treatments. It will allow the patient to make a number of choices at a much earlier stage and in full consultation with his general doctor, so that he is very clearly aware that he can distinguish between treatments he still wants to undergo and treatments he no longer wants to undergo. This can undoubtedly provide much more peace of mind for the patients themselves, but also for their immediate surroundings.

The importance of the general practitioner is mentioned in the explanation of this resolution, but in the original resolution the central role of the first line, i.e. of the general practitioners but ⁇ also of the home nurses or nurses, was not addressed at all. Here too, we signed the amendment of colleague Lambert to reinforce the central role of the family doctor and the nurses.

We also support the demand for structural financing of the palliative day centers, but consider it important that there is also an evaluation of the day centers, and then especially regarding the planning and the conditions of recognition of those centers. It cannot, as is now the case, that some day centers are underused, while in other centers places are too short. We therefore request an evaluation of the planning and recognition conditions of the day centers.

Finally, of course, I would also like to point out that the powers packages are not at all homogeneous. If we want to better organize the supply of palliative care, it is therefore of great importance that a very close consultation with the communities is undertaken. And that, of course, in anticipation of the transfer of the powers of that yet very personal subject to the communities.

President, colleagues, our group will support this present resolution because it can facilitate access to that palliative care for many patients with palliative care needs.

Mr. Speaker, Mrs. Minister, dear colleagues, for the Reform Movement, the real challenge of palliative care is to be able to give the possibility to each patient wherever he wishes, whether in his home, in a rest home or in the hospital, to organize as best as possible the end of his existence by giving priority to the quality of life. In all cases, the patient’s free choice, in particular between intra-wall or extra-wall care, must be respected. Public authorities should do everything they can to ensure this.

Specific care to be provided to palliative patients, in particular to alleviate pain, is part of a comprehensive approach that includes psychological, moral, spiritual, family and social support. This transversal support requires coordination in order to harmonise policies between the federal entities and the federal. This is why all the axes defined in this proposal for a resolution should be part of a collaboration with the ministers responsible for public health.

This resolution laid the foundation for a comprehensive reform in palliative care that we endorse. It is the result of a long-term work undertaken during the previous legislature. Without going into all the details of the text, I will allow myself to highlight the points that we find primary and which are in the number of four.

First, an adequate financing of the supply of palliative care according to the actual needs must be able to be ensured. The sector is suffering from chronic underfinancing, which has been shown to us at will. Therefore, it is important for patients to establish a realistic, multiannual plan that promotes the proper functioning of the palliative care sector.

Second, the involvement of frontline actors should not be overlooked in the palliative care policy we intend to support. Given the privileged place among first-line caregivers, it is important, as the previous speaker pointed out, that the general practitioner has a central place in the management of palliative care. All front-line actors, doctors, nurses or kinesiologists have a crucial role to play for the proper progress of palliative care.

That is why point 18 has been introduced. We must evaluate the involvement of the first line in the end-of-life problem, as well as the needs of both patients and professionals.

Third, the cooperation between the three competent levels of power must be improved in order to raise awareness and improve the training of medical and paramedical staff. The aim is to develop a sustainable culture of these palliative care.

Fourth, the establishment of palliative function in rest and care homes must be supported and strengthened. It is necessary to develop in MRS a palliative culture, still too often missing.

These are the various comments I wanted to make during this debate. I will support this text.

Dear colleagues, death is a part of life. The Federation of Palliative Care Flanders advocates on its website “to give the death and farewell again into the own hands of the affected persons and to give each one the opportunity in his own way and where he wishes to live to the end.” It is a broad definition, which makes me notice that, like in other parts of the Welfare and Public Health domain, the decision-making right is returned to the patient and his environment.

The Federation of Palliative Care Flanders aims to improve the quality of life of patients suffering from life-threatening diseases, and their relatives, by preventing and alleviating suffering through early detection and careful assessment and treatment of pain and other problems of physical, psychosocial and spiritual nature.

Belgium has already achieved a lot compared to other countries. However, as in many domains, there are still many needs here, both financially and in terms of sufficient hands. The resolution sets out a number of priorities that we ⁇ support.

For example, removing pain points in financing cooperative unions and palliative care federations, within a realistic multiannual programme. We also pay attention to palliative care in rest disorders, which is not insignificant, as many people spend their last years of life in rest disorders and often die there. The pursuit of more knowledge, the recording of data and the sharing of knowledge are also important.

For Open Vld, some elements in this resolution are very important.

First and foremost, we approve this resolution without reducing palliative care to curative care, and without reducing palliative care to euthanasia. The definition of palliative care with which I started my argument makes this out of the evil.

As liberals, we advocate that people have control and take control of their lives. We have the ambition to want the same for people who are facing their end of life.

Important in this resolution is that we emphasize that palliative care is a shared responsibility with communities and regions. It is therefore logical that we jointly assume our financial responsibility to eliminate the pain points that exist today. The communities are already doing this and logically we should intensify and continue this cooperation in the further expansion of palliative care. The Flemish Parliament recently recognized this in a resolution.

We like to die at home. In this sense, the importance of palliative cooperation cannot be underestimated. We should not make the mistake of underestimating the importance of palliative care in rest and care homes. People go to rest disorder for the last two or three years of their lives, often because they can no longer stay at home due to a lack of personal network or because the concerns have become too big. Whether we like it or not, in the future more people will die in a rest disorder.

I will briefly submit two amendments. The first amendment, which has not been adopted, calls into question the subsidisation of day centers. We wanted to remove this in the resolution, because the State Council has made it clear that palliative day centers belong to the competence of the communities and because we believe that they should therefore be financially responsible. The second amendment on registration and administrative arrangements was adopted, ensuring that the majority of money is effectively spent on healthcare and that less is used by the administration.

Mr. Speaker, colleagues, as you could already infer from the arguments of the other colleagues, this proposal for a resolution deals with the expansion of palliative care. The civil society, patients and their families, doctors, nurses, as well as the Flemish Interest have long been demanding parties for an extension of palliative care and to provide the necessary resources for this.

From this, the Chairman of the Commission, Mr. Bonte, who, unfortunately, is not here, may be able to deduce the answer to his concern. After the discussions, he wondered why the majority parties should put these 18 questions to their own government in a resolution. A threshold of thought. They may have taken over the old proposal of the Flemish Interest without further consideration, because we are never in the government.

In any case, my group can be pleased with this proposal and will therefore support it with conviction. We submitted an amendment that was not taken into account in the committee. Per ⁇ this is a mistake. Seven out of ten cancer patients with a terminal tumor indicate that they want to die at home, and yet this is only possible for 28% of them. This is the so-called palliative paradox of home care.

This paradox was further accentuated because home care for terminal patients, compared to dying in the hospital, is more expensive for the patient but less expensive for society. In the hospital, the federal government is responsible for providing palliative care, but outside the walls of the hospital, communities are competent to do so. The cooperation unions play an important role in this. Each regional palliative cooperation association has one or more multidisciplinary counselling teams, but this is absolutely insufficient, especially if one wants to expand the definition of palliative care.

On the basis of the Act of 14 June 2002 on palliative care, a federal assessment cell for palliative care was established. That cell should regularly evaluate the need for quality care and the solutions offered and report on this every two years.

The majority of the observed obstacles belong to the Flemish jurisdiction, but the Flemish government itself is not involved in the evaluation. It is not only due to a lack of money that not all needs can be satisfied, but also the non-homogeneous power packages are ⁇ counterproductive.

There is an important problem in the financing of day centers, which has been mentioned several times. These day centers are very popular especially in Flanders. Indeed, its recognition and financing still stands on the slope to this day and is still not structurally regulated, due to the fact that various public authorities are involved and competent to do so.

Flanders wish to develop a vision on the desired supply within the palliative function, but does not have sufficient powers to do so. This is also the case for Wallonia. Therefore, in an amendment, in point 19, we have addressed an additional question to the government to transfer, in anticipation of an independent Flanders, the full competence for health care to the counties.

It was, of course, no surprise to me that the French-speaking colleagues voted against this amendment, although they would also benefit from homogeneous powers. This is a recommendation from the OECD. What surprised me was that the colleagues of the Flemish parties who voted for the five resolutions of the Flemish Parliament could not support our amendment.

I thought the resolutions of 3 March 1999 were still valid.

In the resolutions it is very clear, I quote, that “the standardisation, implementation and financing powers concerning the entire health and family policy should be transferred in its entirety to the states”, including, among other things, health insurance and family contributions.

The N-VA also abstained from our amendment in the committee, while she just said that she was waiting for the removal of the powers. But waiting alone will not come.

Maybe she was somewhat scattered or maybe I should think, like my colleague from the Flemish Parliament, Wim Wienen, that she was wrong. Mr. Vienna thought that, when the N-VA also in the Flemish Parliament stumbled to support a draft decree that was fully in accordance with their principles and their party program.

Their group chairman, Mr. Kris Van Dijck, contradicted this assumption. He had a certain excuse for this. He said: “The N-VA just wanted to show how strongly the majority is attached to each other.”

Mr. Jambon, I do not know if you will use the same change, but as far as I know there is no majority in the federal Parliament, or yet no majority of which we are aware. I assume that your group has made a mistake. This mistake can be corrected immediately.

I would say, colleagues of the N-VA, think of your credibility. Mr. Bracke is not here, but a few weeks ago he said on the radio that the Flaming votes for the N-VA because of its credibility.

People, friends of the N-VA, I think you cannot disappoint your friends of the Flemish Movement or the Flemish Social Security Action Committee.

In any case, with or without an amendment, the Flemish Interest ⁇ does not leave behind the many patients and their families who urgently need better palliative care.

Palliative care as a creative overall care for patients whose disease no longer responds to curative therapies is ⁇ preferable to unthinked therapeutic tenacity.

Communicating about palliative care and introducing a palliative culture can lead the family and the patient to learn to live together at the end of life, making it less easy for them to turn to more drastic measures such as euthanasia.

This resolution is therefore, in any case, an important step in the right direction and can ⁇ count on the support of my group. If we can count on your support for our amendment, it can only get better.

Mr. Speaker, Mrs. Minister, Mr. Minister, dear colleagues, I would like to thank, first of all, the parliamentarians who sit in the Health Committee for their support, and in particular Mrs. Muylle (from CD&V) and Van Den Ende who co-signed the draft resolution under consideration.

Obviously – I am convinced – we die in the same way in all Regions of Belgium; this text is a reflection of this and I am delighted that we have been able to work together.

The criteria for quality palliative care are the quality of the work of the multidisciplinary teams, the taking into account by these teams the key role of the general practitioner, the training of caregivers, including in terms of communication both at the level of initial and continuous training.

Furthermore, it is also essential that sufficient resources be allocated for all these multidisciplinary teams.

However, it is worth noting that the reality of the field is far from being obvious since it sometimes happens that in May, the teams have already engaged all the packages of the year, thus risking to create a problem in terms of access to palliative care. And I could give you other examples such as that of day centers that do not benefit from structural funding.

Although progress has already been made in this area, other important steps still need to be taken to ensure access to palliative care for all those in need.

It is up to our Parliament, every day, to advance the cause of patients and their rights; here it is more specifically about patients in palliative care. We insist on relieving pain, but also on improving the quality of life, both of patients and their loved ones, in the face of the consequences of a deadly disease. Palliative care is not second-zone care, but real health care.

For the future, we hope to be able to move forward so that palliative care is no longer only linked to the end of life, but rather focused on the needs of the patient, regardless of his life prognosis. This joins both the study of the KCE, the Federal Assessment Cell for Palliative Care and the palliative care federations. I have submitted a bill in this regard.

In the near future, we will organize hearings and I hope that together, we will move forward in this area.

As a member of the Parliament, I will speak on behalf of my group on this proposal.

Of course, my group will support this resolution, because the importance and support of palliative care cannot be sufficiently emphasized, reinforced and realised.

Dignity should be the starting point. After all, pain, suffering, farewell and death also deserve a place in our society. Therefore, cooperation, expertise promotion, expansion and reinforcement are central to the proposal.

Palliative care has already undergone a whole evolution. Today man wants to be approached in all its aspects, both physically, emotionally, psychically and spiritually. However, it is also very important that the environment should take part in this crucial phase of life.

Our group chooses a palliative function, in which the palliative care and guidance must be seen separately from certain settings. Care and guidance should be able to be given in the places where people ask for it. Their demands and their needs are of course central.

The present resolution is a step closer towards a more human-worthy society, in which death and farewell should no longer be taboo and in which one of the most important moments in life can be experienced in a professional and warm manner. That is why we are in favor of the resolution.