French Public Health Code
In forceI A. - All the healthcare players in a given area are responsible for improving the health of the population in that area and for providing optimum care for patients in that area.
I. - The Director General of the Regional Health Agency shall set up a Territorial Health Board in each of the territories defined in 1° of article L. 1434-9.
The territorial health council is made up, in particular, of the deputies and senators elected within the jurisdiction of the territory concerned, representatives of the elected representatives of the local and regional authorities, the departmental maternal and child protection services mentioned in article L. 2112-1, the various categories of players in the healthcare system in the territory concerned and a member of the relevant "comité de massif". It ensures that the specific nature of local health systems and approaches based on the participation of local residents is preserved. It guarantees the participation of users, particularly people living in poverty, in precarious situations or with disabilities. It also includes a specialised mental health commission.
II. - Without prejudice to article L. 3221-2, the Territorial Health Board participates in carrying out the shared territorial diagnosis referred to in III of this article by drawing in particular on the projects of the primary care teams defined in article L. 1411-11-1 and the territorial professional health communities defined in article L. 1434-12, as well as on the shared medical projects referred to in article L. 6132-1 and the local health contracts. It also takes into account the medical projects of private health establishments and the establishment projects of medico-social establishments and services mentioned in article L. 312-1 of the Social Action and Family Code.
It contributes to the preparation, implementation, monitoring and evaluation of the regional health project, particularly with regard to the provisions concerning the organisation of healthcare pathways.
It is informed of the creation of coordination support mechanisms and specific regional mechanisms mentioned in articles L. 6327-2 and L. 6327-6 of this code, as well as the signing of territorial and local health contracts. It contributes to their monitoring, in conjunction with the regional union of healthcare professionals.
The Regional Health Agency informs primary care teams and territorial professional communities of all this work.
III. - The purpose of the shared territorial diagnosis is to identify the health, social and medico-social needs of the population concerned, based on observational data. It takes into account the geographical and seasonal characteristics of the area concerned and the needs of people working on a seasonal basis. It identifies shortcomings in terms of the supply, accessibility, coordination and continuity of health, social and medico-social services, particularly in terms of palliative care, paying particular attention to non-housed care. Where they exist, it identifies the armed forces hospitals and other elements of the armed forces health service contributing to the regional health project. Where they exist, it draws on the work and proposals of local health councils, local mental health councils or any other committee set up by local authorities to deal with health issues. It pays particular attention to priority urban policy districts, mountain areas and rural revitalisation zones.
The shared territorial diagnosis gives rise to the establishment of territorial health projects, drawn up and implemented by the territorial professional health communities referred to in article L. 1434-12 and by health, social and medico-social establishments and services, in order to coordinate their actions. The development of a territorial health project is initiated by at least one territorial health professional community whose health project has been validated, with the possible assistance of the regional union of health professionals mentioned in article L. 4031-1, and a health, social or medico-social establishment or service.
The territorial health project takes into account the health projects of the territorial health professional communities referred to in article L. 1434-12, the shared medical project of the territorial hospital groups referred to in article L. 6132-1, the territorial mental health project referred to in article L. 3221-2, the medical projects of private health establishments, the projects of medico-social establishments and services and local health contracts.
Armed forces hospitals and other elements of the armed forces health service may participate in the development and implementation of a territorial health project, subject to authorisation by the Minister for Defence.
The approved associations mentioned in article L. 1114-1 and the local authorities and their groupings participate in the development and implementation of the territorial health project, in accordance with the procedures defined by decree.
The territorial health project defines the relevant territory for the implementation by its stakeholders of the organisation of healthcare pathways referred to in 5° of article L. 1411-1.
The territorial health project describes the procedures for improving access to care, continuity of care and coordination of healthcare pathways, in particular the organisation of access to prevention, screening, local care, unscheduled care and specialist care, throughout the territory. It may also describe the inter-professional cooperation arrangements relating to medical or care practices.
The territorial health project is forwarded to the Director General of the Regional Health Agency. The Director General may object, within two months, on the grounds of failure to comply with the objectives of the regional health project referred to in article L. 1434-1 or on the relevance of the territory covered by the territorial health project, after obtaining the opinion of the territorial health council.
Territorial health projects are evaluated by the territorial health council.
In the case of mental health, the territorial diagnosis is drawn up in accordance with II of article L. 3221-2.
IV. - The implementation of the regional health project may be the subject of local health contracts concluded by the agency, in particular with local authorities and their groupings, guaranteeing the participation of users, in particular people experiencing poverty, precariousness or disability, and covering health promotion, prevention, healthcare policies and medico-social and social support. Local health contracts include a section devoted to mental health, which takes account of the territorial mental health project. They are concluded as a priority in areas characterised by insufficient healthcare provision or difficulties in accessing healthcare, as defined in 1° of article L. 1434-4. The health projects of territorial professional health communities are based on local health contracts, where these exist.
