Half of the patients who received palliative care in private or social institutions died without a place to stay.

Almost half (48%) of patients referred to private or social sector contracted palliative care units last year died before they were offered a place, according to analysis by the Healthcare Regulation Authority (ERS).

The ERS report, published this Wednesday, highlights the lack of supply of these units in the regions of the Centre and Algarve, stating that 77% is concentrated in Lisbon and the Tagus Valley region.

It also concludes that the adjusted bed rate per 1,000,000 inhabitants is “below the threshold recommended by the European Association of Palliative Care”, which ranges from 80 to 100, covering both inpatient and long-term care.

In terms of supply, only in Alentejo does the supply of palliative care exceed the recommended minimum threshold.

The National Network for Palliative Care (RNCP) comprises two types of inpatient palliative care units (UCPs): hospital-based UCPs, which provide palliative care to patients with serious and/or advanced and progressive illnesses requiring hospitalisation, and RNCCI UCPs. [Rede Nacional de Cuidados Continuados Integrados]who have entered into an agreement with social or private sector organisations and provide assistance in situations of low and medium complexity.

“Given that the nature of palliative care provided in each of the types of OGP (UCP-RNPP and hospital OGP) is clinically complex, there may remain a problem of access to palliative care for users requiring low-complexity palliative care, especially in the Centro and Algarve health regions,” ERS reports.

The monitoring carried out by the regulator, which analyses data from 2021 to 2023, focused on access to the OGP-RNPP “due to the impossibility of obtaining complete and systematized information on other types of assistance integrated into the RNPP,” the document says. states.

Of the users who contacted the OGP-RNPP in 2023, more than a third (37%) were accepted into SNS units. About 48% of users referred during this period “were not hospitalized due to death before hospitalization,” he concludes.

The average wait time for acceptance for users referred in 2022 and 2023 was less than one month: those referred and accepted in 2022 waited an average of 20 days, while in 2023 this value increased to 21 days.

“Dead users, who made up the largest share of referenced users, spent an average of 12 days waiting for a job opening over the two years analyzed,” the regulator said.

However, with regard to the average waiting time for patients admitted to the OGP-RNPP, ERS states that it is lower than in the RNPP typologies.

“The average length of stay for users admitted to ECCI, which is the second highest proportion of hospitalized users with palliative care needs, is more than double the average length of stay for users admitted to UCP-RNCCI,” he adds.

ERS also found that more than one in 10 (12%) users referred and admitted in 2023 lived more than an hour’s drive from the unit where they were admitted.

The report, published this Wednesday, also notes that not all users referred to the UCP-RNCCI are necessarily admitted to units of this type or another type of RNCP, highlighting that only 32% were eventually accepted into units of this type.

According to the National Health Service Executive Directorate (NHS Executive Directorate), there were 14 NHS-OGPs in the period 2021-2023, a figure that did not change over the three years in question.

The RNCP consists of a range of services and departments that provide palliative care to people with serious and/or advanced and progressive illnesses, wherever they are, whether in primary, hospital or complex continuing care.

Users are admitted to the RNCP teams upon referral from the healthcare professional providing care to the patient, and based on criteria of complexity, severity, and clinical priority.