Relieving suffering and maintaining the quality of life of patients suffering from a handicap or a potentially fatal serious pathology: these are the objectives of palliative care. An essential issue to support the end of life when 60% of deaths remain linked to incurable diseases accompanied by physical or psychological pain. However, in France, half of the patients concerned would still not have access to such care according to a new report from the Court of Auditors published this Wednesday, July 5, and commissioned by the Social Affairs Committee of the National Assembly.
However, the offer of this medical support has increased by 30% since 2015, but this increase has mainly been limited to hospitals. In 2021, 7,500 beds were dedicated to palliative care. A budget of 1.5 billion euros had been invested in order to establish “coverage of all needs”. This objective, set by the Claeys-Leonetti law, is currently out of reach despite an improvement. In particular, the distribution on the territory still remains heterogeneous. In about twenty departments, palliative care units (USP) simply do not exist.
At the same time, the report of the Court of Auditors challenges the critical situation “outside the hospital”. Care at home and in retirement homes remains “lacunary” and insufficient according to the report and fails to take care of all the sick.
Only 2% of practitioners in France had taken continuing training in palliative care between 2020 and 2022 according to the Court of Auditors. Similarly, the number of nursing acts and physiotherapy follow-up (massages, medical gymnastics, pain relief, etc.) decreased by 27.8% between 2017 and 2021. However, even in the event of therapeutic abstention, this support remains essential to help patients leave with dignity by limiting suffering and discomfort. Even in the event of discontinuation of care, this follow-up also makes it possible to be present “differently” and requires training of health personnel to listen to patients, in particular to remedy the suffering and psychological distress often neglected in care. end of life.
More teams, more training
However, only 50% of the 380,000 patients meeting the palliative criteria would currently be supported in an appropriate manner. A worrying fact when the French demographic aging dooms this figure to skyrocket in the coming years. The report of the Court of Auditors therefore recommends “about 200 additional extra-hospital palliative care mobile teams (EMSP) to cover all the needs of the territory, i.e. a cost of approximately 73.6 million euros”.
These PMSCs, made up of doctors, nurses, psychologists, physiotherapists, would make it possible to smooth out the current territorial inequalities but also to take care of more patients at home. A way to follow in palliative earlier with a complete and personalized support course towards the end of life. The report also recommends the training of 88,000 caregivers and 24,000 nurses in nursing homes. A budget estimated at 56 million euros which would cover half of the staff of retirement homes.
The President of the Republic announced, on April 3, 2023, the development of a ten-year “pain and palliative care” plan as well as a bill relating to the end of life. Certain recommendations of the report of the Court of Auditors could thus make their way into the measures of the ten-year strategy which will be presented in December by the Ministry of Territorial Organization and Health Professions.
Subject of inextinguishable debate, euthanasia is considered by the executive as a new option to help “die better” in France. A bill opening this “aid in dying” and co-constructed between the government and Parliament will be presented before the end of the summer, Emmanuel Macron had indicated in the spring before the 184 citizens of the Convention on the end of life received at the Élysée to present their work.