The Reimagined Series by Dr Julian Abel and Professor Allan Kellehear….and friends.

The Reimagined Series by Dr Julian Abel and Professor Allan Kellehear….and friends.

We have published a series of articles, sometimes with co authors, in a variety of journals that we call ‘The Reimagined Series’. These articles rose out of discussions we had in response to what we thought was needed to continue to develop the field of public health palliative care. The historical development of the public health movement within palliative care has progressed steadily from the starting point of the initial ideas of using public health principles. Our use of the phrase public health has been employed in the specific sense of what is more commonly termed the ‘new’ public health and includes privileging health and wellbeing promotion, harm reduction, early intervention, community engagement and development. Since then the practice examples have grown nationally and internationally. In the UK these approaches to policy and practice have ranged from small initiatives to nation-wide plans, such as Ambition 6 “Communities are Prepared to Help”, as published in NHS England’s Ambitions for Palliative and End of Life Care 2015-20. 

At each stage, we felt that particular ideas needed clarifying or that new topics required the application of a public health lens and vision. We believed that publishing a paper to address some basic practice issues but ‘reimagined’ as a public health matter would be helpful in developing a more rounded picture of public health palliative care for those who were interested. The articles were written with both communities and professionals involved in palliative and end of life care in mind. Most of the articles in our reimagined series are designed to re-vision our current challenges in palliative care – they are designed to inspire social and professional change.

We have other articles in the pipeline, and still others planned. At some point, we hope to publish them as a collection in a book. We believe that together these articles will help to build an overall picture of public health palliative care, focussing on the most pressing issues of the day. A more complete picture of the whole field will be published in 2022. We are editors of the first Oxford Textbook of Public Health Palliative Care. This will be an academic text which will act as a reference manual. 

Please click on the articles for a free copy.

  • Palliative care reimagined: a needed shift – This article covered the basics of the public health approach. Drawing themes together, we wanted to have an overview of what could be achieved and how this might inspire services to re-evaluate how care is delivered and how communities are an integral part of this. Communities exist whenever and wherever people gather and have they all have the potential to help make death, dying, loss and care giving everyone’s responsibility. 
  • Palliative Care – the new essentials. 2018 – The New Essentials is really part 2 of Palliative Care Reimagined. Conversations with our friends and colleagues, combined with the dominant ideas circulating in conferences, highlighted the need to build stepping stones of understanding and practice. Making the leap from ideas to service re- evaluation can be a big step and at times seem overwhelming. In addition, we wanted to make it clear that we were not suggesting that historical palliative care provision was wrong. Rather, it needed to focus on community in the first instance so that services can support what communities do well. More than simply supporting communities, it is vital that all different aspects of palliative care, from service provision to communities and especially households, are fully integrated. We included the Compassionate City Charter as one of the 4 cogs, along with compassionate communities, generalist and specialist palliative care. Deficiencies in care in one area affects all the others. 
  • Palliative Curriculum Re-imagined: A Critical Evaluation of the UK Palliative Medicine Syllabus 2018 – With the field continuing to grow, we felt it was important that new professionals coming across the ideas, practice, research and education in public health palliative care, should be familiar with it at post graduate levels. We looked at the training curriculum for palliative care specialists in the UK and found significant gaps. Much of traditional palliative care is based upon harm reduction – reducing the burden of disease, whether this be physical, social, psychological or spiritual, through the use of professional services. Familiarity with the potential of how communities can transform palliative care was absent in the training curriculum. We made a series of suggestions as to how this could be changed. Happily, these ideas have been taken up in the new training curriculum for palliative care specialists in the UK. 
  • Advance care planning re-imagined: a needed shift for COVID times and beyond 2020 – We had begun to think about writing this paper prior to the pandemic. We were spurred into action by the limitations the Covid-19 pandemic exposed in the context of having advance care planning in place when someone might deteriorate rapidly and may end up in hospital without ever seeing their family or friends again. Furthermore, we were concerned how ACP has become fixated on place of death, do not resuscitate orders and avoidance of admissions to hospital. It has not addressed how to live well for both the person with the illness and the caring networks of loved ones. This focus of harm reduction has been to the detriment of palliative care as a whole and is perhaps a marker of the need to ‘prove’ the effectiveness of palliative care by reducing admissions to hospital and therefore saving money. For patients and families, the first priority is how to make the most of whatever time remains, whether this be years or days. In addition, these conversations do not have to be owned or started by professionals, but are a normal part of a death literate society. 
  • Access to Palliative Care Reimagined – Published in the Future Health Journal, sister journal to Clinical Medicine published by the Royal College of Physicians, we teamed up with Dr Manjula Patel, one of our trustees, and Dr Jason Mills, from the University of the Sunshine Coast and editor in chief of Progress in Palliative Care. For a number of decades, palliative care has been riven by the major problem of equity of access to palliative care support. The historical analysis of why this is the case are repetitive and largely unhelpful. The problem is often conceptualised as a marketing one, in which services just need to explain more about the great work they do and then all will be welcomed into the house of palliative care. In this paper, we categorise the traditional reviews of lack of equity of access, saying it is not a problem of communities failing to understand palliative care, but a problem of professional services reflecting on how much they are engaged with, support and appreciate what communities already do and then ask themselves the question of what they can do to support this further. Part of the problem is lack of representative diversity of people who work in palliative care services, which makes understanding of different cultures problematic. Solutions to these knotty problems can be found through the practice of public health palliative care, community engagement AND development, prevention, harm reduction and early intervention.

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