PRESS RELEASE
05 July 2023
Communication to the Social Affairs Committee of the National Assembly
PALLIATIVE CARE
A healthcare offering that requires improvement
The report published today on the structure of palliative and end-of-life care is being
submitted to the National Assembly to form part of the public debate on the end of life. The
Court of Account analyses the details of access to palliative care and administrative and
health structures for end-of-life care.
France has made progress in terms of access to palliative care in hospitals.
In 2015, France was one of the OECD's worst performers, but it has made progress and is now
in the top half of the league table, mainly thanks to the efforts made in hospitals. Whether in
the form of specialised beds or hospital departments entirely dedicated to palliative care,
palliative care provision in hospitals has increased significantly, despite the continuing existence
of regional disparities. The situation for palliative care at home is different from the situation in
nursing homes, despite an increase of 60% in the number of palliative care days spent in hospital
at home between 2018 and 2021. Lastly, although public spending on palliative care (€1.45
billion in 2021) has increased by 24.6% since 2017, the supply of palliative care remains greatly
insufficient to cover needs, with only 48% of needs being addressed.
A proactive public policy, but overly tentative administrative action
The inadequacy of palliative care provision is due in part to weaknesses in its national and
regional administrative structure. The lack of an overall strategy and the inadequacy of
management tools (absence of quantitative targets, lack of a timetable, failure to integrate
these plans into the national health strategy) are affecting the effectiveness of the structure
for accessing care. The targeted plans require better coordination, with explicit reference to
the multi-year palliative care plan, to ensure greater consistency. The management of palliative
care also needs to be reviewed, by simplifying national governance through the explicit
identification of a single governing body: the General Directorate for Healthcare Provision
(DGOS) of the Ministry of Health, which should be the sole lead body for drawing up planning
documents, and should therefore be responsible for coordinating and summarising the
contributions of the other directorates.
In the regions, the regional health agencies (ARS) must be given a strengthened role as driving
forces behind regional palliative care policy, and must endeavour, in their regional health plans,
to give greater prominence to the objectives for developing palliative care. This should be
achieved by setting implementation dates for the entire duration of the regional health plan (5
years) for all local stakeholders, and by improving the tools for steering palliative care provision.
Developing a culture of palliative care and “living wills”
The communication and information policy aimed at the general public, which is necessary to
raise awareness of the concept of palliative care at the end of life, has not had the desired
effect, mainly because of structural difficulties and weaknesses in the governance
of France’s
national centre for palliative and end-of-life care (the CNSPFV). Recent changes to its
organisational structure should improve the impact of its communication and public
information campaigns. With regard to living wills, which enable any person over 18 to make a
written statement of their end-of-life wishes, regardless of their state of health, only 18% of
French people surveyed over the age of 18 had drawn up such statements. French people
should therefore be made more aware of the need to draw up advance directives, thereby
encouraging the promotion of a culture of end-of-life support.
Care pathways that are overly hospital-centric and inadequate in towns and nursing homes
The circular of 25 March 2008 on the structure of palliative care, which is currently being
revised by the Ministry of Health, needs to be updated to effectively implement the concept of
a graduated palliative approach, from home to hospital. The lack of GPs treating patients at
home, their inadequate training in palliative care and the insufficient number of coordinating
doctors in establishments for dependent elderly people, plus the lack of training for medical
auxiliaries, are all stifling the growth of care provision in these living environments. A major
training plan for medical assistants in nursing homes, appropriate funding for home nursing
services and the widespread use of mobile palliative care teams working in people's own homes
throughout France are essential if we are to improve this care and implement the principle of
graduated palliative care.
Read the
report
PRESS CONTACTS:
Julie Poissier
◼
Head of Media Unit
◼
T +33 (0)6 87 36 52 21
◼
julie.poissier@ccomptes.fr
Eran Guterman
◼
Press Relations & Social Networks Officer
◼
T +33 (0)6 11 41 46 64
◼
eran.guterman@ccomptes.fr
@Courdescomptes
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