Two texts for the same goal: building a “French end-of-life model”. The government presents its bill to the Council of Ministers on Wednesday April 10 “relating to the support of the sick and the end of life”, which aims in particular to establish assistance in dying reserved for certain patients without hope of recovery. At the same time, he must officially communicate to the Elysée his “ten-year strategy for supportive care”intended to strengthen access to palliative care in France.
Unlike the bill, which arouses strong reluctance in the medical world, the plan to develop the provision of care for patients with serious pathologies is the subject of relative consensus. It will be deployed until 2034, with a budget ultimately increased to 2.7 billion euros per year, and must know “a strong impulse” this year, without waiting for the vote on assisted dying expected in 2025, or even 2026. “Before access to assisted dying is opened, we will have already increased the supply of palliative care”promised, Saturday, the Minister of Health, Catherine Vautrin, in The world. Franceinfo presents the main measures of this strategy.
1 Palliative care units in each department
To date, 20 departments do not have any palliative care unit (USP), these cutting-edge hospital structures, with around ten beds, which accommodate the most complex cases for a limited period. The executive intends to correct the situation with the opening of a unit in 11 of these territories from 2024 (including the Ardennes, Cher, Guyana, Lot, Lozère, Mayenne, Orne, Pyrénées-Orientales and the Vosges), before creations in the nine other departments, including Creuse and Jura, in 2025.
Beyond these specialized services, the ten-year strategy also plans to strengthen the offer of palliative care in curative services where there already exist “identified palliative care beds”particularly in oncology.
2 First units created for sick children
The Ministry of Health wants the creation of pediatric palliative care units (USPP), two of which will open their doors by the end of the year. USPPs “do not exist” Again, “even though the care required by children is different from that of adults and requires a dedicated organization of care”, underlines the document presenting the strategy, consulted by franceinfo. The government aims to create before 2030 “one unit per region, or 17 in total”.
The government also intends to increase the number of regional teams “who share their palliative expertise with all caregivers faced with children requiring palliative care”. These resource teams will increase from 23 to 28 within ten years. Today, only one in three children requiring palliative care receives it, underlines the ministry.
3 Strengthening palliative care at home
At present, “palliative care expenses mainly relate to hospital stays”, which turn out to be expensive and not always suitable for patients, according to the government. To facilitate a shift towards home care, 100 new “territorial mobile palliative care teams” will be added, by 2034, to the 412 mobile teams that already exist. Generally made up of a doctor, two nurses and a psychologist, they will support city professionals and contribute to the return and keeping of patients at home. At the same time, an on-call system of specialized teams will be put in place to provide advice and support to treating doctors at any time.
The home hospitalization offer will also be “reinforced”. It must go from 70,000 people followed today to 120,000 in ten years.
“We must change our policy towards earlier and more home-oriented care.”
Catherine Vautrin, Minister of Healthin the world”
The strategy aims to emphasize care in nursing homes and in various health and medico-social establishments, where the palliative offer is often limited, or even non-existent. “We will develop agreements with players specializing in palliative care in 100% of establishments for the elderly by 2030, while a third do not have one today”, promises the ministry. A recruitment plan for 6,000 professionals, starting with psychologists, should also make it possible to“improve palliative care for residents” from 2031, following reinforcements “already planned”.
4 “Support houses” created throughout the territory
For patients who cannot stay at home, but whose condition does not require hospitalization, “support homes” will gradually spring up in the country. “These hybrid structures make it possible to offer a suitable setting and specialized care to people whose treatment has been stabilized, and who cannot or do not wish to stay at home, particularly when there is no caregiver”details the strategy document.
These places will also be a testing ground for “mutual aid collectives” aimed at families. The first eight houses will be inaugurated in 2025 and each department must be equipped within ten years.
5 A personalized support plan offered to 50,000 patients
Through its strategy, the government intends to promote the notion of “supportive care”, and no longer just palliative care. The objective is to“anticipate patient care from the diagnosis of the disease” and of “expand it to all medical and non-medical needs, as well as support for those around you”.
To promote this early and global monitoring, from 2025, around 50,000 patients will be offered each year a “personalized plan” after the announcement of their pathology. They will thus be able “express their preferences” during a consultation which will allow professionals to“develop comprehensive care adapted to their situation”.
6 Strengthened support for loved ones
To further support caregivers, some 11 million people in France today, dedicated consultations will be offered to them. “when the diagnosis is announced” of the patient they accompany. “Within five years, we will simplify their access to caregiver leave via the daily support allowance, we will develop respite solutions and provide psychological support reinforced”, with the reinforcement of hundreds of psychologists in home nursing services, also promises the government. The executive also intends deploy various measures to “simplify the journey for bereaved families”.
To promote a “new form of citizen engagement”the strategy plans to “better recognition of volunteer support” with people at the end of their lives and their loved ones, particularly at home. “Experiments are being carried out with city doctors which foreshadow service volunteering”reports the Ministry of Health, which wants to create “an operational reserve” of volunteers.
7 A training effort for professionals and students
To carry out these various projects, the government announces its intention to deploy “quickly” A “decisive training effort” of “all professionals” health. To allow “the emergence of a university training program in palliative medicine”around twenty positions for clinical heads, tenured academics and specialist assistants will be created each year from 2024.
A specific module dedicated to supportive care will be included in the training of students and a “specialized diploma in palliative medicine and supportive care” will be created, making this field a medical specialty in the same way as cardiology, pulmonology or neurology. Finally, “continuing training will be developed” and three medical research teams will be recruited to improve our knowledge in this area.