Where are we, in France, with the supply and demand for palliative care, this medicine which aims to relieve the suffering and improve the quality of life of patients – and their families – confronted with potentially fatal diseases? The 3rd edition of the Atlas put online on Wednesday March 15 by the National Center for End of Life – Palliative Care (CNFVSP), a public body affiliated with the Ministry of Health, provides an updated view of care capacities across the of the territory (1).
A growing number
This capacity increases. At the end of 2021, France thus had 7,536 hospital beds dedicated to palliative medicine, including 1,980 in the 171 palliative care units (LUSP) and 5,576 beds identified as palliative care (LISP) within “classic” departments – oncology, cardiology, geriatrics, etc. – spread over 904 establishments. A number that has been steadily increasing since 2015 when the total was 5,872 beds.
Since that date, 32 palliative care units (USP) have been created, i.e. 428 additional beds, which has raised the ratio to 3 beds per 100,000 inhabitants on average. Similarly, between 2015 and 2021, the number of LISPs increased by 526, a ratio of 8 beds per 100,000 inhabitants.
To this must be added the 420 mobile palliative care teams (EMSP). Composed of doctors, nurses, psychologists, these PMSCs do not directly provide care but provide their expertise and support to the caregivers who are in charge of the patient, at home, in nursing homes or at the hospital. Finally, there are 23 regional resource teams in pediatric palliative care who take care of minors, from newborns to adolescents.
Strong territorial inequalities that persist
“A device that allows France to remain stuck to the leading pack of European countries”, underlines Giovanna Marsico, director of the CNFVSP. But France can and must do better in this area. Firstly, because strong territorial inequalities remain in access to this palliative care. Thus 21 departments still do not have palliative care units (1) and while 80 departments have a LISP allocation equal to or greater than the national average, the others remain under-equipped.
Above all, demand will grow strongly over the next few decades. “With the increase in the proportion of elderly, even very elderly, people suffering from chronic illnesses, the end of life will become longer and will require appropriate care”, notes the Atlas. Currently, of the country’s 67.8 million inhabitants, 10% are aged 75 or over. In thirty years, projections predict a doubling of this age group, which will then represent 15% of the total.
An issue of the great national debate
In this context, the issue of end-of-life support will become increasingly crucial. A question addressed by the national plan for the development of palliative care 2021-2024, one of the axes of which is precisely to ensure better territorial coverage. But will the 171 million euros with which it is endowed be sufficient to meet the needs?
“The problem is not just the lack of structures and resources, explains Giovanna Marsico. It is not enough to have palliative care beds, you also need well-trained caregivers to be at the bedside of the sick. What would really change the game is the dissemination of a palliative culture throughout the medical world. »
A subject already widely discussed by the various bodies – Citizens’ Convention, ministerial working groups, parliamentary mission to assess the Claeys-Leonetti law – engaged in the major national debate on the end of life and on which the CNFVSP Atlas highlights opportunely a spotlight.
(1) An interactive version with geolocation is available on the Internet: https://www.parlons-fin-de-vie.fr/
(2) Ardennes, Cher, Corrèze, Creuse, Eure-et-Loir, Gers, Indre, Jura, Lot, Lozère, Haute Marne, Mayenne, Meuse, Orne, Pyrénées-Orientales, Haute-Saône, Sarthe, Tarn et Garonne, Vosges, Guyana, Mayotte.