Developing a template to plan palliative care services: the Welsh experience

Much specialist palliative care in the U.K. is provided through the voluntary sector, with funding in part from the National Health Service and the remainder from donations. Service development has been ad hoc to date. In Wales, with a population of just under three million, the Minister has allocated specific ring fenced funding for the voluntary sector, to ensure that there is equity of evidence-based care provision. To do this, a formula has been developed to meet the specialist palliative care needs across Wales, appropriate to both urban and rural settings, for populations of all ages and to take into account the requirements for hospital support teams and those working in cancer centers. In addition, where hospice inpatient beds exist, a funding formula has been developed to guide reimbursement for basic care costs. Where there are no beds, hospice-at-home provision provides an alternative model of care, with funding adjusted pro rata. The formula aims to ensure fairness of specialist palliative care provision, available out of hours as well as during the working day, providing patient-focused evidence-based care. This means that the specialist team must meet specialist education standards, act as a resource to generalist teams and use a core clinical data set to allow comparable audits against agreed all-Wales standards.