This is a long-awaited and very dark report that the General Inspectorate of Social Affairs (Igas) has just published. Taking stock of 4e national palliative care plan (2015-2018), it particularly criticizes its impact “Modest” in the field. “The territorial network has only partially progressed” and “The deficit in specialized personnel persists or even worsens”.
Result, the offer “Is generally insufficient”, with strong regional disparities, “And does not respond well to the demand of the population who should receive palliative care”, continues the Igas, noting that 62% of adults who died in 2014 “Should have received palliative care”.
→ SLIDE SHOW. The real faces of palliative care
“This is a critical observation, fair but faithful, which underlines that actions have been carried out and funding allocated, but whose concretization on the ground is extremely difficult to see”, comments Professor Vincent Morel, president of the monitoring committee of the national palliative care plan.
The reason: insufficient budgets, a low number of specialized professionals, permanence and poor access to healthcare in certain areas. The report was drawn up in July 2019, but only revealed now. “Why have we lost so much time?” “ questions Dr Anne de la Tour, former president of the French Society for Palliative Care. “The next plan will start at least two years late, due to a lack of resources or political will. Such a waste ! “
This future plan is all the more awaited since the Ministry of Health announced, Monday, February 10, that it would authorize within four months the city doctors to prescribe midazolam, which allows a deep and continuous sedation until ‘upon death. The High Authority for Health said it was favorable, but on one condition: that the decision be taken in collegiality and with the “Systematic collaboration of a team specializing in palliative care”. However, on reading the Igas report, the road to this effective ethical framework still seems long.
On general practitioners, the Igas notes that the appropriation of palliative care standards is “Very uneven”. As for the palliative care network, “It only covers part of the nursing homes and residents at their homes”. So, “In 2015 only one in five had a trained staff member, and less than two in three had a contract” with a mobile team. “The coordination of the courses, sometimes carried out successfully by such a doctor or such institution, has not so far found a model capable of being deployed on a larger scale”, sanctions the Igas.
“There are areas where it works well and others which are like white areas, confirms Vincent Morel. But this is not specific to palliative care: these are areas where access to medicine is complicated. End of life catalyzes these problems. “
Calling for implementation ” fast ” of a new three-year plan, the Igas makes around thirty recommendations. Among them, the opening of“At least one palliative care unit (USP) bed per 100,000 inhabitants and at least one USP per department in 2022”. It also proposes the creation of “Territorial permanence systems, in particular by telephone”, provided by specialized personnel, and the agreement of all social and medico-social establishments with specialized structures. “It is absolutely essential, notes Anne de la Tour, but there is a severe shortage of doctors to do this. “
In this regard, the Igas recommends “To appoint a hospital-university teacher in each medical unit by conditioning this appointment on the local creation of a post of head of clinic”. “A professor of palliative medicine at the university can greatly boost performance, training, attractiveness”, confirms Anne de la Tour.
“There are two major levers for progress, resumes Vincent Morel. On the one hand, the awareness of all practitioners from the initial training and training of specialists. On the other hand, access to care, so that each person can have their suffering taken care of where they live. “
While the development of the future plan is underway, it should be completed “Before the end of the first semester”, assured the ministry on Monday. Two qualified personalities were to be “Designated for this purpose in the coming days”.
Insufficient pace of development
During the 4the national palliative care plan (2015-2018), the number of beds in palliative care units increased from 1,562 to 1,776; beds identified as palliative care from 5,072 to 5,479; and mobile teams from 379 to 385.
With 2.4 palliative care unit beds per 100,000 population, France is far behind Belgium (3.4), the United Kingdom (4.2) and Quebec (10).
According to the French Society for Support and Palliative Care (Sfap), only 800 doctors work exclusively in palliative care, including 260 in palliative care units and 540 in mobile teams. This represents less than 2% of hospital practitioners.