In its latest annual report, the Court of Auditors deplores the fact that the care of patients at the end of their life is still incomplete.
A very bad record for France on the end of life! Our country only wins the 23th place for palliative care, which aims to relieve pain before death. Far behind the Anglo-Saxon countries which have a much more developed culture in this area, in particular Great Britain which arrives in pole position. This ranking, produced in 2010 by a think tank linked to The Economist newspaper, clearly reflects the French backwardness in palliative care. This support is “always incomplete”, deplores the Court of Auditors, in its annual public report 2015.
Still limited
In most end of life, palliative care is necessary. This concerns 64% of deaths from illness. And yet the use of this care is “still limited”, even if no overall estimate is available, regrets the Court of Auditors. In the case of the hospital where 57% of deaths occur, in 2009, only a third of patients who died during short stays who would have needed palliative care received it. The situation has improved, however, as the number of such patients increased from 78,000 to 135,000 in 2013.
It must be said that in the meantime a national program for the development of palliative care 2008-2012 with a budget of 230 million euros has been launched. And among its 18 measures, was the development of the offer of palliative care in short-stay health establishments. This program was more generally organized around three axes: the continued development of the hospital offer and the development of out-of-hospital systems, the development of a training and research policy and the support offered to relatives.
Not enough at home
However, this program has failed to meet one of the main expectations of patients and their families: palliative home care. The Court of Auditors also notes that this type of care “is still particularly deficient” in medico-social establishments, in particular in establishments accommodating dependent elderly people (nursing homes).
Finally, the 2008-2012 plan did not succeed in sufficiently correcting the territorial inequalities which remain very strong. Example for palliative care units. All regions do not yet have them, even if they are now present in all CHUs, indicates the Court of Auditors, specifying that the equipment rate is zero in Guyana and 5.45 beds per 100,000 inhabitants in the Nord-Pas-de-Calais.
The Court of Auditors recommends that a new specific action plan be launched and that priority be given to palliative care at home and in establishments housing dependent elderly people (Ehpad). Recommendations that it had already formulated in 2007. For the home, this requires better coordination of interventions and agreements between health insurance and health professions.
Among the other recommendations of the Court of Auditors, there is greater support for those around patients. She deplores the fact that it took nine years to obtain the implementation in 2008 of family solidarity leave and five years for the creation in 2010 of the daily support allowance for people at the end of their life.
In her response, the Minister of Health, Marisol Touraine, promises the development from 2015 of a new three-year plan for the development of palliative care.
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