Palliative care: barrier to access and wide territorial disparities

Access to palliative care and assistance for people suffering from chronic and incurable diseases, although on an upward trend, is still well below sufficient levels, standing at 33% as the national average, with clear regional differences. According to data from the Ministry of Health, coverage has exceeded 70% in Trentino and 55% in Veneto, while in Lombardy, Liguria and Emilia Romagna it is above 40%. Latium and Umbria are between 39% and 36%, Apulia 33%, Friuli-Venezia Giulia 31%, and Sicily 23%. By contrast, Sardinia is below 5% (4.3%), Calabria just 6.4%, Campania and Marche around 8.5%.

Yet, Law 197/2022, approved with the Budget Law 2023, has set the goal of guaranteeing access to palliative care by 2028, throughout the country, to 90 per cent of the people who need it, committing the Regions and Autonomous Provinces to a progressive strengthening of services.

On the occasion of the National Day of Relief promoted by the Ministry of Health and the Gigi Ghirotti Foundation, which has always been attentive to the theme of suffering and palliative care, to be celebrated on Sunday 25 May, the SICP - Italian Palliative Care Society and the FCP - Palliative Care Federation, emphasise how, despite the steps forward, the right to care and relief in the presence of chronic and incurable diseases is still not guaranteed.

"We are in a constantly evolving scenario," explains Gianpaolo Fortini, SICP president, "we have achieved many results, but there is still a long way to go. Suffice it to think of the positive effects of Law 106/2021, which obliged the Regions that had not yet done so, to guarantee the provision of home and residential palliative care through the implementation of Palliative Care Networks. It is essential that national and especially regional health policies focus on strengthening palliative care facilities and services, especially in areas with less supply, to ensure fair and uniform access to all citizens, as President of the Republic Sergio Mattarella pointed out in his recent meeting with the Regions and Autonomous Provinces.

"The territorial and regional gap is one of the main challenges and criticalities with respect to the need to guarantee and provide adequate therapeutic support to sick people suffering from chronic and incurable diseases," says Tania Piccione, FCP president. "Some regions have developed advanced services, while others struggle to guarantee access to palliative care, both home and residential. This disparity compromises the equity of the national healthcare system, leaves many patients without the necessary support, and represents one of the main obstacles to guaranteeing care that is not an extreme act, but a right of continuity and therapeutic appropriateness. In this scenario, the Third Sector, with its rootedness in the communities and its wealth of skills acquired in the field, is still too little involved in the processes of co-programming and co-planning of territorial networks: a precious resource that must become a structural part of regional policies for palliative care."