French government’s seven-step plan to improve end-of-life care
Alongside the French government’s assisted dying bill, ministers are due to examine a multibillion-euro plan intended to improve and develop end of life support for terminally ill patients, and their families. Here's what it says.
A couple of months ago, French President Emmanuel Macron announced in an interview with two newspapers that a bill on assisted dying would go before parliament in May.
Only adults with full control of their judgement, suffering an incurable and life-threatening illness in the short to medium term and whose pain cannot be relieved will be able to "ask to be helped to die", Macron told the La Croix and Libération newspapers at the time.
The government was due to present its bill on assisted dying for certain patients who have no hope of recovery to the Council of Ministers on Wednesday. There are, it’s safe to say, strong views on both sides of the argument in the medical world to work through.
READ ALSO How does France's proposed assisted dying law compare to the rest of Europe?
At the same time, and rather less controversially, it will present its 10-year strategy for supportive care for end-of-life patients across the country.
The supportive care strategy is designed to strengthen access to palliative care in France. Its budget is set to increase to €2.7 billion per year over the duration of the scheme.
Here are its seven main points:
Palliative care units in every département
Today, some 20 départements – Ardennes, Meuse, Haute-Marne, Vosges, Haute-Saône, Jura, Orne, Eure-et-Loir, Mayenne, Sarthe, Cher, Indre, Creuse, Lozère, Lot, Tarn-et-Garonne, Gers and Pyrénées-Orientales plus the overseas départements of Mayotte and French Guiana - have no palliative care units (unité de soins palliatifs).
The government intends that dedicated units with 10 beds to care for end-of-life patients for a limited period will open in 11 of these unserved départements in 2024, and in the remaining nine in 2025.
As well as specialised services, the strategy also includes plans to strengthen the palliative care offer in curative services where “identified palliative care beds” already exist, notably in cancer units.
Units for sick children
The Ministry of Health wants to create paediatric palliative care units (unités de soins palliatifs pédiatriques – USPP), two of which will open by the end of the year to care for terminally ill children, whose needs are different from adults. The government aims to create a total of 17 units, serving every region, by 2030.
The government also intends to increase the number of regional teams “who share their palliative expertise with all caregivers confronted with children requiring palliative care”. These resource teams will increase from 23 to 28 within the 10-year period.
Improved palliative care at home and in care homes
At present, “expenditure on palliative care is mainly related to hospital stays”, which are costly and not always appropriate for patients, according to the government. To facilitate a shift towards home care, 100 “mobile palliative care teams” – usually a doctor, two nurses and a psychologist – will be created by 2034, taking the total number past 500.
These teams will support professionals working in the community, helping patients return home and stay there. At the same time, a system of on-call specialist teams will be set up to provide advice and support to attending physicians at all times.
Home hospitalisation services will also be “reinforced”, under the government’s plans. This is set to rise from 70,000 patients today to 120,000 in 10 years.
The government also plans to recruit an additional 6,000 staff, including psychologists to improve end-of-life care in care homes.
Support homes to be set up throughout France
For patients who cannot remain at home, but whose condition does not require hospitalisation, a series of “support homes” will be developed across the country to care for those who cannot or do not wish to stay at home.
The first eight homes will open in 2025, and every département should have one by 2034.
Personalised support plans
The government intends to promote the notion of “supportive care”, rather than merely palliative care. The aim is to “anticipate patient care from the moment the disease is diagnosed” and “extend it to cover all medical and non-medical needs, as well as support for family and friends”.
From 2025, some 50,000 patients will be offered a “personalised plan” after their diagnosis. Patients will be involved at every stage of the plan which, the proposed bill says, will be adopted to their needs.
Support for families
Some 11 million family members in France are caregivers. The bill outlines plans to offer dedicated consultations for them, as well as patients, at the time of diagnosis.
“Within five years, we will simplify their access to caregiver leave via the daily support allowance, develop respite solutions and provide reinforced psychological support”, the government promises.
Training for professionals and students
The government recognises the urgent need to train additional staff for its palliative care plans. Around 20 senior clinician, academic and assistant posts will be created annually from 2024 to teach and train workers in what is to all intents and purposes an emerging university training programme in palliative medicine.
A specific module focused on support care will be included in student training, and a “diploma of specialised studies in palliative medicine and supportive care” will be created, putting palliative care on a par with cardiology, pneumology or neurology. Continuing education “will be developed”, according the the bill’s outline, and three medical research teams will be recruited to improve knowledge in this field.
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A couple of months ago, French President Emmanuel Macron announced in an interview with two newspapers that a bill on assisted dying would go before parliament in May.
Only adults with full control of their judgement, suffering an incurable and life-threatening illness in the short to medium term and whose pain cannot be relieved will be able to "ask to be helped to die", Macron told the La Croix and Libération newspapers at the time.
The government was due to present its bill on assisted dying for certain patients who have no hope of recovery to the Council of Ministers on Wednesday. There are, it’s safe to say, strong views on both sides of the argument in the medical world to work through.
READ ALSO How does France's proposed assisted dying law compare to the rest of Europe?
At the same time, and rather less controversially, it will present its 10-year strategy for supportive care for end-of-life patients across the country.
The supportive care strategy is designed to strengthen access to palliative care in France. Its budget is set to increase to €2.7 billion per year over the duration of the scheme.
Here are its seven main points:
Palliative care units in every département
Today, some 20 départements – Ardennes, Meuse, Haute-Marne, Vosges, Haute-Saône, Jura, Orne, Eure-et-Loir, Mayenne, Sarthe, Cher, Indre, Creuse, Lozère, Lot, Tarn-et-Garonne, Gers and Pyrénées-Orientales plus the overseas départements of Mayotte and French Guiana - have no palliative care units (unité de soins palliatifs).
The government intends that dedicated units with 10 beds to care for end-of-life patients for a limited period will open in 11 of these unserved départements in 2024, and in the remaining nine in 2025.
As well as specialised services, the strategy also includes plans to strengthen the palliative care offer in curative services where “identified palliative care beds” already exist, notably in cancer units.
Units for sick children
The Ministry of Health wants to create paediatric palliative care units (unités de soins palliatifs pédiatriques – USPP), two of which will open by the end of the year to care for terminally ill children, whose needs are different from adults. The government aims to create a total of 17 units, serving every region, by 2030.
The government also intends to increase the number of regional teams “who share their palliative expertise with all caregivers confronted with children requiring palliative care”. These resource teams will increase from 23 to 28 within the 10-year period.
Improved palliative care at home and in care homes
At present, “expenditure on palliative care is mainly related to hospital stays”, which are costly and not always appropriate for patients, according to the government. To facilitate a shift towards home care, 100 “mobile palliative care teams” – usually a doctor, two nurses and a psychologist – will be created by 2034, taking the total number past 500.
These teams will support professionals working in the community, helping patients return home and stay there. At the same time, a system of on-call specialist teams will be set up to provide advice and support to attending physicians at all times.
Home hospitalisation services will also be “reinforced”, under the government’s plans. This is set to rise from 70,000 patients today to 120,000 in 10 years.
The government also plans to recruit an additional 6,000 staff, including psychologists to improve end-of-life care in care homes.
Support homes to be set up throughout France
For patients who cannot remain at home, but whose condition does not require hospitalisation, a series of “support homes” will be developed across the country to care for those who cannot or do not wish to stay at home.
The first eight homes will open in 2025, and every département should have one by 2034.
Personalised support plans
The government intends to promote the notion of “supportive care”, rather than merely palliative care. The aim is to “anticipate patient care from the moment the disease is diagnosed” and “extend it to cover all medical and non-medical needs, as well as support for family and friends”.
From 2025, some 50,000 patients will be offered a “personalised plan” after their diagnosis. Patients will be involved at every stage of the plan which, the proposed bill says, will be adopted to their needs.
Support for families
Some 11 million family members in France are caregivers. The bill outlines plans to offer dedicated consultations for them, as well as patients, at the time of diagnosis.
“Within five years, we will simplify their access to caregiver leave via the daily support allowance, develop respite solutions and provide reinforced psychological support”, the government promises.
Training for professionals and students
The government recognises the urgent need to train additional staff for its palliative care plans. Around 20 senior clinician, academic and assistant posts will be created annually from 2024 to teach and train workers in what is to all intents and purposes an emerging university training programme in palliative medicine.
A specific module focused on support care will be included in student training, and a “diploma of specialised studies in palliative medicine and supportive care” will be created, putting palliative care on a par with cardiology, pneumology or neurology. Continuing education “will be developed”, according the the bill’s outline, and three medical research teams will be recruited to improve knowledge in this field.
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