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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.

Published: 10 April 2024 11:37 CEST

French government’s seven-step plan to improve end-of-life care

The French government plans to improve palliative care across the country. (Photo by CHRISTOPHE SIMON / AFP)

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.

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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Azerbaijan vehemently rejects the accusation it bears responsibility for the riots that have led to the deaths of five people and rattled the Paris government.

But it is just the latest in a litany of tensions between Paris and Baku and not the first time France has accused Azerbaijan of being behind an alleged disinformation campaign.

The riots in New Caledonia, a French territory lying between Australia and Fiji, were sparked by moves to agree a new voting law that supporters of independence from France say discriminates against the indigenous Kanak population.

Paris points to the sudden emergence of Azerbaijani flags alongside Kanak symbols in the protests, while a group linked to the Baku authorities is openly backing separatists while condemning Paris.

“This isn’t a fantasy. It’s a reality,” interior minister Gérald Darmanin told television channel France 2 when asked if Azerbaijan, China and Russia were interfering in New Caledonia.

“I regret that some of the Caledonian pro-independence leaders have made a deal with Azerbaijan. It’s indisputable,” he alleged.

But he added: “Even if there are attempts at interference… France is sovereign on its own territory, and so much the better”.

“We completely reject the baseless accusations,” Azerbaijan’s foreign ministry spokesman Ayhan Hajizadeh said.

“We refute any connection between the leaders of the struggle for freedom in Caledonia and Azerbaijan.”

In images widely shared on social media, a reportage broadcast Wednesday on the French channel TF1 showed some pro-independence supporters wearing T-shirts adorned with the Azerbaijani flag.

Tensions between Paris and Baku have grown in the wake of the 2020 war and 2023 lightning offensive that Azerbaijan waged to regain control of its breakaway Nagorno-Karabakh region from ethnic Armenian separatists.

France is a traditional ally of Christian Armenia, Azerbaijan’s neighbour and historic rival, and is also home to a large Armenian diaspora.

Darmanin said Azerbaijan – led since 2003 by President Ilham Aliyev, who succeeded his father Heydar – was a “dictatorship”.

On Wednesday, the Paris government also banned social network TikTok from operating in New Caledonia.

Tiktok, whose parent company is Chinese, has been widely used by protesters. Critics fear it is being employed to spread disinformation coming from foreign countries.

Azerbaijan invited separatists from the French territories of Martinique, French Guiana, New Caledonia and French Polynesia to Baku for a conference in July 2023.

The meeting saw the creation of the “Baku Initiative Group”, whose stated aim is to support “French liberation and anti-colonialist movements”.

The group published a statement this week condemning the French parliament’s proposed change to New Caledonia’s constitution, which would allow outsiders who moved to the territory at least 10 years ago the right to vote in its elections.

Pro-independence forces say that would dilute the vote of Kanaks, who make up about 40 percent of the population.

“We stand in solidarity with our Kanak friends and support their fair struggle,” the Baku Initiative Group said.

Raphael Glucksmann, the lawmaker heading the list for the French Socialists in June’s European Parliament elections, told Public Senat television that Azerbaijan had made “attempts to interfere… for months”.

He said the underlying problem behind the unrest was a domestic dispute over election reform, not agitation fomented by “foreign actors”.

But he accused Azerbaijan of “seizing on internal problems.”

A French government source, who asked not to be named, said pro-Azerbaijani social media accounts had on Wednesday posted an edited montage purporting to show two white police officers with rifles aimed at dead Kanaks.

“It’s a pretty massive campaign, with around 4,000 posts generated by (these) accounts,” the source told AFP.

“They are reusing techniques already used during a previous smear campaign called Olympia.”

In November, France had already accused actors linked to Azerbaijan of carrying out a disinformation campaign aimed at damaging its reputation over its ability to host the Olympic Games in Paris. Baku also rejected these accusations.