Palliative care development in the City of Zagreb

Palijativna skrb je u zadnjih nekoliko desetljeća u fokusu medicinske, ali i drugih struka koje su važan dio pružanja palijativne skrbi (socijalni radnici, psiholozi, duhovnici). Po prvi puta je, ne samo našla mjesto u zdravstvenim politikama, nego je proglašena prioritetom. U Hrvatskoj je razvoj palijativne skrbi počeo od samog osnutka države devedesetih godina. S obzirom na ratne okolnosti u kojima smo se u to doba nalazili, tekao je polagano. Od usvajanja Nacionalne strategije razvoja zdravstva 2012. – 2020. započinje sustavni razvoj palijativne skrbi, a 2013. Godine Vlada Republike Hrvatske usvaja ključni dokument koji se odnosi samo na razvoj palijativne skrbi, a to je “Strateški plan razvoja palijativne skrbi u Republici Hrvatskoj za razdoblje od 2014. do 2016. Godine”. Plan izrađen nakon što je učinjena analiza stanja u Hrvatskoj i svakoj pojedinoj županiji, stoga se u Planu prepoznaju specifičnost svake županije, te su se u isti implementirale potrebe i zahtjevi svake zasebno. Iako je Grad Zagreb bio među prvima koji su prepoznali važnost razvoja palijativne skrbi, u novije vrijeme zaostaje za pojedinim županijama koje su već implementirale Strateške planove u svoje lokalne politike. Gradski ured za zdravstvo još od 2011. godine proglasio palijativnu skrb prioritetom projekta “Zagreb- Zdravi grad”, ali do dan danas nije uspostavljen cjelovit sustav skrbi, već su se ispunili pojedini kriteriji određeni Strateškim planovima. Najnoviji dokument „Plan razvoja palijativne skrbi u Gradu Zagrebu“, prihvaćen 2018. godine, ima cilj ispuniti kriterije postavljene u Nacionalnom programu razvoja palijativne skrbi u Republici Hrvatskoj 2017.-2020.. Posebna pažnja je posvećena specifičnostima Zagreba, kao na primjer činjenica da Grad nije nadležan svim ustanovama koje pružaju palijativnu skrb zagrebačkom stanovništvu te da je stvarni broj pacijenata koji se liječe u zagrebačkim bolnicama veći od procijenjenog prema broju stanovnika Zagreba jer u njemu gravitiraju pacijenti iz cijele Hrvatske. Također, ističu se problemi nepostojanja adekvatne palijativne skrbi za djecu i drugih vulnerabilnih skupina, što su izazovi s kojima se teško nose i druge zemlje članice.In the last few decades, palliative care has been in the focus of medical profession but also other professions that form an important part of providing palliative care (social workers, psychologists, clerics). For the first time, palliative care has not only found its place in healthcare policies, but has also been proclaimed a priority. In Croatia, the development of palliative care began already in the 1990s when the country was formed. The process was advancing slowly due to the war circumstances surrounding that period. The systematic development of palliative care began with the adoption of the National Health Care Strategy 2012-2020, while in 2012 the Government of the Republic of Croatia adopted a key document that relates exclusively to the development of palliative care, namely the "Strategic Plan for Palliative Care Development in the Republic of Croatia 2014 - 2016 ". The plan was drawn up after conducting an analysis of the situation in Croatia and each individual county and therefore it recognizes the specificity of each county and their needs and requirements are separately implemented in the Plan. Although the City of Zagreb was among the first to recognize the importance of the development of palliative care, it recently lags behind some counties that have already implemented the Strategic Plans in their local policies. Although palliative care was declared a priority of the project “Zagreb - Healthy City” by the City Office for Health already in 2011, no complete care system has been established to this date, but some criteria set by the Strategic Plans have been fulfilled. The latest Palliative Care Development Plan adopted in 2018 aims to meet the criteria set out in the National Program for the Development of Palliative Care in the Republic of Croatia, 2017-2020. The Plan analyzes the current situation in the City of Zagreb as well as its needs. Particular attention is paid to the specificities of Zagreb, such as the fact that the City is not competent authority for all institutions providing palliative care to the Zagreb population, and that the actual number of patients treated in Zagreb hospitals is higher than estimated by the number of inhabitants of Zagreb, since patients from all over Croatia are gravitating towards capital for treatment. Also, the problems of lack of adequate palliative care for children and other vulnerable groups are highlighted, which are challenges that are difficult to tackle for other EU member states as well