Ten-year strategy for palliative care: Publication of a government report
The government recently published its ten-year strategy for the reinforcement of palliative care. The report had been expected for some weeks. Launched in 2023, a Commission headed by Professor Franck Chauvin, ex-President of the High Council for Public Health, submitted its report in December. It recommended using new terminology: “accompaniment care” which is defined as “all the tasks involved in the overall care for the sick and their entourage, undertaken by a multidisciplinary team, in order to preserve the patient’s quality of life and well-being”. This notion is intended to be further reaching than palliative care.
However, the WHO (World Health Organisation), together with the palliative care companies and associations in France, already adopt an overall approach and philosophy of the person. It has defined palliative care as “An approach intended to improve the quality of life of patients (adults and children) and their families, confronted with problems associated with potentially fatal diseases. They prevent and relieve suffering through early identification, correct evaluation and treatment of pain and other problems, whether physical, psychosocial or spiritual”.
Moreover “Palliative care is explicitly recognised under human rights for health. It must be provided in the context of integrated health services and centred on the person, granting special attention to the specific needs and preferences of the individual”.
The report intends to make this new terminology “accompaniment care” the trademark of “the singularity of the French model” at a time when it is pushing its bill to legalise euthanasia and assisted suicide.
A few figures
Based on the report by the Cour des Comptes (Court of Auditors) dated June 2023, the report recognises that 190,000 people are currently being cared for, which represents a mere 50% of requirements. Demographic forecasts of the ageing population predict increasing needs. In 2035, some 440,000 people will be in need. On the sensitive subject of paediatric palliative care, the report estimates that 2,500 children are being cared for, representing a mere third of requirements.
The “key figures” for the palliative care domain are also provided:
- 10,000 carers (doctors, nurses, and nursing auxiliaries)
- 166 palliative care units, some 20 French departments have none
- 412 mobile palliative care teams
The hospital environment (with specialised units as well as beds allocated to palliative care) and the home environment (either HAD hospitalisation in the home, or local care) are sharing the care for patients.
The objectives
After summarising the situation and giving a few definitions, the report is presented as a catalogue of 30 measures grouped under 4 objectives.
The prime objective: “Fairer access to accompaniment care”. 950 million euros, i.e. most of the promised 1.1 billion euros budget, is devoted to this. It is intended, following an “invitation to tender” to create, by the end of 2025, eight “accompaniment establishments”, hybrid care structures providing “a suitable environment and specialised care for patients whose treatment is stabilised, and who are no longer able or no longer wish to remain at home, in particular when they have nobody to help them”.
24 palliative care units, and 460 hospital palliative care beds will supplement the existing care facilities by 2034, as well as a paediatric palliative care unit per region (18 in total). In response to the call by the court of auditors, Advance Directives will be the subject of an advertising campaign “in particular aimed at 18-35 year-olds, those over 55 and health workers”.
The other objectives are described as “Mobilisation of territories and society” (104 million euros), “Development of research and training” (33 million euros), and “Management of all the players” (4 million euros).
The means
Alliance VITA, in its press release for 6th April 2024, already raised an important question on these announcements: The means allocated are probably insufficient to cover the needs. A sensible calculation makes it likely: If a mere half of needs are covered today, logically the existing means would need to be doubled in order to cover the needs, and quite soon. However, the final intention is an increase of only two thirds over 10 years. With the increasing needs (indicated above) and the erosion due to inflation, it is probable that the intended result will not be achieved.
When interviewed by France Culture on the difficult balance between budgetary constraints and the need to have enough personnel in the palliative care departments, the Health Minister stated that: “This plan, submitted to the Council of Ministers, is not a commitment by the public authorities”.
The means allocated are therefore a proposed projection and not a commitment. The summary budgetary table, published in the appendix, incidentally shows the distribution of the means: 89 million in 2024, 106 in 2025, 97 in 2026 etc.
The scissor effect between the increasing needs and the insufficient means could therefore lead to a further deterioration of the services which are needed by those at their end of life.
It is obvious that this report does not meet the ethical requirement for the provision in France of palliative care to match the needs at a moment when discussions are in progress on the legalisation of euthanasia and assisted suicide.
