Palliative care: mixed results for the initial achievements of the 10-year strategy
The world day for palliative care on 7th October was an opportunity to look again at the announcements made by Catherine Vautrin in April 2024 when the Government presented its “10-year strategy for the development of care and accompaniment.” The strategy was intended to “guarantee better access to accompaniment care for all citizens” at a time when the needs for palliative care are only 50 % covered. Eighteen months later, although some means have been provided and some progress has been noted, in particular in the development of outcare hospitalisation services, it has to be admitted that access to palliative care in France remains fragile and that the efforts made to achieve the declared objectives remain timid.
The 10-year strategy presented in April 2024
In April 2024, the Health Minister revealed a 10-year strategy for the development of accompaniment care, or palliative care, intended to meet the immense challenge of making palliative care available to the entire French population, whereas at the time, a mere 50 % of French people who would need it had access to it. In an interview for Le Monde, the Minister certified that “before opening up access to assisted dying, palliative care will have increased.”
The strategy earmarked an additional budget of 1.1 billion euros over ten years. The yearly funding would thus increase from 1.6 billion euros to 2.7 billion in 2034. Whereas 22 French departments had no palliative care unit at the end of 2023, the Minister announced the opening by 2024 of palliative care units in 9 of the departments which had none, and that all departments would have palliative care units by 2025. She also intended to increase the number of mobile palliative care teams (EMSP) from 421 to 427 by 2025. Alongside hospital services, the Minister also announced the intention to develop hospital outcare services which would increase from 55,000 beds in 2021 to 70,000 in 2024.
An initial progress report a year and a half later
Where are we some eighteen months later? As soon as the 10-year strategy was announced, Alliance VITA issued a press release denouncing the lack of ambition and inadequacies of the strategy. The billion euros earmarked over ten years is clearly insufficient to meet all the needs, insofar as 50 % of needs are not being met today. The very minimum required would have been a doubling of the budget. Neither does this increase consider the ageing of the population which is set to further increase the need for palliative care.
Additionally, the means announced can only truly be established through the Social Security funding law which is put to the vote every year. The Social Security funding law for 2025 provided an additional hundred million euros for palliative care. Nevertheless, Claire Fourcade, the ex-president of SFAP (the French Society for accompaniment and palliative care) reported during her audition by the French Senate in July that in fact less than 50 million euros had actually been spent.
Last March, the 10-year strategy was the subject of a “progress report” by a monitoring committee in the presence of Catherine Vautrin, still in charge of the same ministerial portfolio extended to families, and Yannick Neuder, the Minister in charge of Health and Access to Care. The progress report evaluated the state of progress in relation to the objectives announced a year beforehand.
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Opening of palliative care units in all French departments
One year down the road, the promises have not been held. Only three departments have been provided with a USP (palliative care unit) in 2024, in the Jura, the Lot and the Cher out of the 9 announced and all the departments have not been equipped. During the “progress report”, the Government announced that “6 departments lacking a USP would be provided with a USP by the end of 2025 and a further 4 by the end of 2026.” However, in parallel with these new openings, other units are being closed down elsewhere due to a lack of personnel: in Guérande (44) at the beginning of the year, at Chambon (17) and more recently at La Roche-sur-Yon (85), for example. “The development needs to be speeded up, we cannot see the announced progress in the field, whether in the Paris region, where my colleague is working, nor in Narbonne, where I work“, deplored Claire Fourcade during her audition to the Senate in July.
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427 EMSP (Mobile Palliative Care Teams) by 2025
In March 2025, the Government announced a figure of 420 mobile palliative care teams, a figure which is less than the stated objective of 427 EMSP.
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Development of Hospital outcare services in the home (HAD)
Hospital outcare services in the home (HAD) have undeniably enjoyed an expansion indicative of a true political will. Since 2022, the number of patients admitted into palliative care has increased by 22 %. In the context of the 10-year strategy, the ministry initially deployed 15 first ERI-SP (Rapid Intervention Palliative Care Teams) to reinforce access to palliative care, particularly in emergency situations, and in order to avoid transfers to A&E. These multi-disciplinary teams were able to maintain 90 % of patients within 48 hours following their intervention. Fifteen more rapid response teams are to be funded in 2025. A call for tenders was issued last June.
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Opening of USPP (Paediatric palliative care units)
Among the other objectives of the 10-year strategy was the opening of a paediatric palliative care unit per region by 2034. The first two units are due to open in 2025 in Lyon and Cayenne.
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The challenge of training
One of the pillars of the 10-year strategy concerned the training of carers. Indeed, during her audition by the Senate, Claire Fourcade reported that currently, out of ten years of instruction, “doctors receive on average between seven and ten hours’ training on pain relief and palliative care.” In 2018, a specialised training course (FST) was created to instruct palliative medicine to specialist doctors from all medical specialities. 112 posts were opened at the beginning of the 2024-2025 session. Unfortunately, the course is having difficulty in attracting students. However, the training of professionals is an essential condition for the opening of new palliative care beds.
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Expectations and uncertainties surrounding accompaniment homes
Presently, the Government intends to advance with measure No. 12 of the 10-year strategy which concerns the creation of “accompaniment homes”, hybrid organisations between sanitary and medico-social establishments for the admission of seriously ill patients whose treatment is stable but who cannot remain at home, for example because they live alone. During the audition in July, the SFAP stressed the urgency for establishing such homes which could accommodate a large proportion of the patients currently hospitalised in palliative care units whereas such establishments would be far less costly. In April 2024, Catherine Vautrin had announced that an “Invitation To Tender” would be issued during the year. There again, the project has been delayed since the requirements were only issued in September 2025. The Regional Health Agencies have been invited to issue a “project invitation”. Each establishment is set to receive 1 million euros funding.
Nevertheless, the project for creating accompaniment homes is subject to questioning on the possibility of their practicing euthanasia or assisted suicide, if the proposed bill on “assistance in dying” were to be adopted. This possibility, confirmed by the Minister Catherine Vautrin in May 2024 during the debates at the special commission, caused strong divisions among MPs. Carers are also strongly opposed to the idea.
Nevertheless, the delays already accumulated for the implementation of the measures included in the 10-year strategy should alert the future Government in the context of increasing difficulty of access to treatments and an acute shortage of personnel. The pursuit of the parliamentary process on the text authorising “assistance in dying” as early as October appears indecent in view of the state of progress with the 10-year strategy. The priority is for all French people who so require, to have effective access to palliative care. The Social Security funding bill for 2026 should respect the funding commitment of 200 million extra euros for their further development nationwide.
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