The principal European countries have made major efforts in recent years to increase their palliative care services and specialist units to relieve pain and the emotional suffering of patients and their families at the final stage of their life. However Spain has not opened any new facilities in the past six years, and in some regions the resources have even been reduced.
As a result, the palliative care service provided by the Spanish health system is much lower than the European average, and since 2013 it has fallen 20 places on the ranking that measures the specialist services and units per 100,000 inhabitants, according to the Atlas of Palliative Care in Europe 2019. This is an internationally renowned study drawn up by the Atlantes Programme at the University of Navarra.
In 2013, Spain was the ninth European country in terms of palliative care services in relation to its population and, in fact, was among the best 25 per cent.
Now, it is 31st out of 49 with 0.6 specialist units for every 100,000 inhabitants - the European average is 0.8 - and is in the group of countries among the worst 50 and 75 per cent. The ratio of services is very similar to that of Romania, Georgia, Czech Republic and Latvia.
The main reason, according to the coordinator of the Atlas, Carlos Centeno, is that Spain has the same 260 facilities as six years ago. This is increasingly distant from the two units for every 100,000 inhabitants which specialists consider necessary, and which in Europe is only fulfilled by the Austrian health service.
"While those around us have advanced, we have stood still," says Centeno, who attributes this to several reasons, but especially "a lack of political will", because the health authorities "do not prioritise" adequate attention to these patients nor the increase in resources.
There is no national law regarding palliative care - "so that has resulted in very different situations in different regions" - and the state strategy to improve this type of care is outdated. It was drawn up 11 years ago.
"Stretched to the limit"
This stagnation in developing palliative care in Spain has a dual effect. The number of specialist services is very low, even though demand never ceases to grow because of the ageing population and increase in deaths from non-transmittable illnesses, and the existing resources are "at their limit".
The lack of specialist units meant that 61 per cent of the 130,000 people in Spain who needed palliative care in 2017 because they were affected by pain and severe physical and psychological problems didn't receive it. About 80,000 patients died suffering with a poor quality of life in Spain because of a lack of professional assistance.
This lack of adequate attention and care at the end of adults' lives in Spain is clear, but is even worse when it comes to children and teenagers with fatal illnesses.
Ricardo Martino, coordinator of the Palliative Care Unit at the Niño Jesús hospital in Madrid, says that of the approximately 1,300 youngsters who die in Spain with a clear need for this specialist care, 85 per cent do not receive it.
At present there are ten pediatric palliative care services, eight at home and two in hospitals, although Martino says, "There is a wave of young professionals putting pressure on politicians to create these units in different regions."
Carlos Centeno is calling for at least three measures to try to improve Spain's palliative care situation.
Two of them involve training. The first is to create a medical speciality or sub-speciality for this type of care, because Spain is the only major European country not to have one.
The second, that all Faculties of Medicine and Nursing Schools include palliative care as an obligatory part of the course, so GPs and hospital staff can at least be involved in the care of terminally ill patients whose needs are less severe.
The third demand is to multiply the scarce specialised services. Centeno wants every hospital to have at least one palliative care team (consisting of a doctor, nurse, psychologist and social worker) to attend to all patients and families who need them.