2023-07-06 14:23:31
July 06, 2023
According to the report of the Court of Auditors submitted Wednesday to the National Assembly, more than half of the patients who need palliative care do not have access to it.
At a time when the debate on the end of life is relaunched in France, the Court of Auditors publishes a report on the conditions of access to palliative care in the country. Its conclusions are without appeal, “the supply of palliative care remains largely insufficient to cover needs since only 48% of them are provided”.
A very low figure while access to palliative care is a universal right, recognized by the Claeys-Leonetti law (1999). As a reminder, palliative care is defined by the French Society for Support and Palliative Care as “active care delivered in a comprehensive approach to the person suffering from a serious, progressive or terminal illness. The objective of palliative care is to relieve physical pain and other symptoms, but also to take into account psychological, social and spiritual suffering”.
A hospital-centric offer
However, the Elders of rue Cambon recognize a marked improvement in the situation, with an offer that has increased by 30% compared to 2015, “when France was one of the poor students of the OECD”. In hospitals, the palliative care offer has been greatly expanded with the opening of dedicated beds and services. However, territorial disparities persist with another 22 departments which still do not have beds in a specialized unit.
But it is at home and in Ehpad that the shoe pinches. For what ? “The lack of GPs attending at home, their poor training in palliative care and the insufficient number of coordinating doctors in establishments for dependent elderly people, as well as the lack of training for medical auxiliaries, for their part, slow down the development of care in these places of life”, details the Court of Auditors.
Thus, it recommends a major training plan for medical auxiliaries in nursing homes, adequate funding for home nursing services and the establishment of mobile teams, ready to intervene, at home, throughout the territory. .
The little-known principle of advance directives
As for the general public, it is not sufficiently informed according to the Court of Auditors. Financial jurisdiction directly targets the action of the National Center for Palliative and End-of-Life Care (CNSPFV). The French are not sufficiently aware of the concept of end-of-life palliative support and only 18% of those over 18 have written advance directives.
Finally, the report lists the many administrative, national and regional obstacles that prevent everyone from having access to end-of-life medicine: the lack of a global strategy and management tools, the absence of a single management at national level and Regional Health Agencies which lack autonomy.
To note : the Court of Auditors estimates in its report that in 2017, nearly 60% of people at the end of life needed to receive palliative care. And she expects a significant increase in this figure in the coming years due to the aging of the population.
Source: Report of the Court of Auditors on palliative care (July 5, 2023), French Society for Support and Palliative Care
Written by: Dorothée Duchemin – Edited by Emmanuel Ducreuzet
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