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13 January 2025 | Policy Analysis
Palliative care as part of long-term care in the General Health System of Cyprus
5.10. Palliative care
Palliative care services are provided by two non-profit entities, PASYKAF and the Cyprus Anticancer Society. These services are offered only to cancer patients, supporting them at all stages of the illness, in a holistic way. Services are provided by multidisciplinary teams of health professionals, including doctors, physiotherapists, psychologists, social workers and nurses, who are remunerated by the two non-profit organizations mentioned above. The involvement of volunteers in palliative care provision is minimal and usually their services are limited to keeping the patient company or transporting them to a hospital.
Palliative care facilities run by the Cyprus Anticancer Society are the Arodaphnousa Palliative Care Centre in Nicosia, with 26 beds for inpatient care, and the Evagorio palliative care unit in Limassol, for day care services. PASYKAF runs two inpatient palliative care centres, one in Paphos with nine beds (Archangelos Michael) and one in Larnaka (Edem) with 11 beds. In addition to inpatient and day care services, home care services by specially trained health professionals are provided by both non-profit organizations. Home care services include blood drawing, wound care and administration of drugs and serums, etc. It should be mentioned that most patients choose to stay at home within their family. This was especially the case during the pandemic period, during which visits to patients in hospices were prohibited.
All plans related to the care of the patient are drawn up with the participation of family members and the patient. In fact, in many cases, family members are trained by the health professionals on matters of management and behaviour towards patients. In those cases where palliative care professionals need to collaborate with someone who specializes in a specific patient problem (e.g. acute pain management), they usually collaborate either with anaesthesiologists or oncologists, or with any other specialty deemed necessary.
The most important change made in the field of palliative care in recent years is its inclusion in the GeSY benefit package, which now covers a significant part of the cost of care for each patient, up to a ceiling of €350 per night in palliative care facilities. A further important change is the assumption of responsibility for the provision of palliative care exclusively by the two non-profit organizations PASYKAF and the Cyprus Anticancer Society, which have contracted with the HIO. Other agencies, such as the oncology departments of Nicosia and Limassol General Hospitals, as well as the Bank of Cyprus Oncology Centre, no longer offer palliative care services. Also worth mentioning is the significant increase in the numbers of trained staff, the use of innovative drugs for pain control and the use of modern tools that facilitate the work of health professionals and patients themselves, such as oxygen concentrators.
Despite the positive steps made in recent years, especially the inclusion of palliative care in the GeSY benefit package, there are still challenges for palliative care provision, such as: i) the lack of any institutional framework that defines the provision of palliative care, the specialties and the qualifications of the health professionals involved; ii) although the 46 beds for inpatient care are considered sufficient for Cyprus, more teams with trained health professionals are needed in home care; iii) there are shortages of trained staff and a lack of certified training programmes. This gap may be filled by a new postgraduate programme on palliative care that will soon be offered by the Department of Nursing at the CUT.
In early 2023, the Cypriot General Health System (GHS) expanded coverage of rehabilitative and palliative care services, though since then the implementation of palliative care services has faced delays and limitations, particularly due to the COVID-19 pandemic and logistical challenges.
As of this writing, palliative care services are available only to cancer patients, which restricts access for individuals suffering from other conditions requiring end-of-life or chronic disease management.
Key challenges in the current system include:
- Limited coverage: Access to palliative care is restricted primarily to cancer patients, excluding many individuals with chronic conditions, severe disabilities, and non-cancer-related terminal illnesses.
- Insufficient providers: There are few providers contracted under the new GHS system, which limits patient access to palliative care services. Home care, physiotherapy, and speech therapy remain underdeveloped, with many patients unable to access adequate care.
- Fragmented service delivery: The long-term care system remains fragmented between the Ministry of Health and the Social Welfare Services, exacerbating inefficiencies and disparities in care.
- Workforce and training gaps: The palliative care workforce is insufficiently trained, and the existing quality-assurance frameworks are weak, impacting the delivery of high-quality services. The absence of national regulations for home and residential care creates challenges in ensuring consistent care standards.
- Data collection and reporting deficiencies: The lack of systematic data collection, particularly from private and home care providers, hinders effective monitoring, policy development, and quality control.
In response to these challenges, a draft bill is awaiting enactment in Cypriot Parliament to modernize and regulate palliative care within long-term care. The draft bill includes guidelines for the training, employment, and practice of healthcare workers. It also introduces provisions for the regular reporting of data by all providers, which is essential for improving monitoring and quality assurance. The adoption of the new legislative framework remains delayed but is expected to occur in 2025.
References
Theodorou M., Kantaris M., Koutsampelas C., (2018), European Social Policy Network, Thematic Report on Challenges in Long-term care: Cyprus, https://ec.europa.eu/social/BlobServlet?docId=19842&langId=en, European Commission.
Republic of Cyprus, Press Information Office, (2023), Minister of Health speech on palliative care, https://www.pio.gov.cy/%CE%B1%CE%BD%CE%B1%CE%BA%CE%BF%CE%B9%CE%BD%CF%89%CE%B8%CE%AD%CE%BD%CF%84%CE%B1-%CE%AC%CF%81%CE%B8%CF%81%CE%BF.html?id=37579#flat (in Greek).
Health Insurance Organisation, (2024), Palliative Care Circular, https://www.gesy.org.cy/el-gr/announcementdef/20240925-palliative-care-circular-0.pdf (in Greek).