Created by the “Bien Vieillir” (“Aging Well”) law of April 8, 20241French Republic. (2025, May 28). Order of 28 May 2025 relating to the specifications for the departmental public autonomy service. Légifrance. https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000051684801, the Departmental Public Autonomy Service (Service public départemental de l’autonomie, SPDA) aims to simplify the pathways of people experiencing loss of autonomy and their caregivers, within a medico-social system that is often complex and hard to navigate. Initially conceived as a single integrated access point, it has evolved into a governance model built around four core missions, designed to better coordinate stakeholders and make public action more coherent2French Republic. (2025, May 28). Order of 28 May 2025 relating to the specifications for the departmental public autonomy service. Légifrance. https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000051684801. Its ambition is simple: to provide clearer information and more consistent guidance, regardless of the entry point.
Yet, its implementation across territories remains complex. It must contend with a wide range of stakeholders, sometimes differing approaches, a dense institutional landscape, with often unaligned territorial responsibilities. Against this backdrop, a central question arises: how can a three level governance structure, strategic, operational, and territorial, function effectively to deploy the SPDA and meet the needs of each territory? In this article, Alcimed looks at the main challenges facing the SPDA and the concrete solutions taking shape across territories.
The main challenge facing the SPDA is building shared governance among autonomy stakeholders who differ in their areas of expertise, their scope of action, their resources, and the constraints they face.
Autonomy policy is jointly overseen by the Regional Health Agency (Agence Régionale de Santé, ARS), which steers healthcare and medico-social provision at the regional level and funds a number of innovative initiatives through calls for projects, and by the Departmental Councils, which lead social action policy and fund the benefits and services linked to loss of autonomy while assisting users directly. Around them sit other key governance players, including the Departmental Centers for People with Disabilities (Maisons Départementales des Personnes Handicapées, MDPH), responsible for granting individual disability rights, and the various insurance funds and mutual organizations, such as the Primary Health Insurance Fund (Caisse Primaire d’Assurance Maladie, CPAM), the Regional Pension and Occupational Health Insurance Fund (Caisse d’Assurance Retraite et de la Santé au Travail, CARSAT), and the Agricultural Social Mutual Fund (Mutualité Sociale Agricole, MSA).
This multitude of stakeholders, whose approaches sometimes diverge, calls for better coordination of interventions. The goal is to move beyond siloed operations and build a more coherent, more efficient collective response. Within this framework, the Territorial Autonomy Committee (Comité Territorial de l’Autonomie, CTA) plays a structuring role, enabling stakeholders to share a common diagnosis, clarify roles, and define shared priorities. The aim is to streamline pathways, increase the use of benefits, and limit breaks in the continuity of care.
Beyond governance, the SPDA faces a major operational challenge: making the range of available services clear to both users and professionals. While the diversity of stakeholders is a strength, it becomes a difficulty when coordination or understanding falls short.
For users, this translates into complex pathways involving multiple points of contact (the town hall, the Municipal Center for Social Action (Centre Communal d’Action Sociale, CCAS), the Local Information and Coordination Center (Centre Local d’Information et de Coordination, CLIC), the France Services Center (Maison France Services), Solidarity Centers/the Territorial Social Action Unit (Unité Territoriale d’Action Sociale, UTAS), community centers, nonprofit organizations, and more), without always being able to identify the right entry point or a single dedicated contact. This fragmentation can lead to redundant procedures, added delays, and, in some cases, people giving up on benefits they are entitled to.
For professionals, a lack of shared reference points also complicates the process of directing people to the right services. Differences in tools, practices, and understanding of each other’s roles fuel ongoing uncertainty about who does what. Cooperation still too often depends on personal relationships rather than structured, shared frameworks.
The SPDA is specifically designed to address these shortcomings by structuring interactions between stakeholders. This involves setting up forums for exchange, cooperation protocols, shared tools, and a common language. It also means clarifying each stakeholder’s scope of action and strengthening the visibility of the services offered through the SPDA.
In some territories, another difficulty emerges: the coexistence of numerous programs, often siloed between policies for the elderly and policies for people with disabilities. The lack of coordination, particularly during age-related transitions, can weaken continuity of care. Initiatives such as joint training programs bridging the older adult and disability cultures can help facilitate these hand offs.
The challenge, then, is to move from a fragmented system to one that is more legible, better coordinated, and centered on users’ needs.
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Deploying the SPDA also raises a significant territorial challenge: balancing equitable service delivery with adaptation to local specificities1Caisse nationale de solidarité pour l’autonomie. (2025, April 17). Support for deployment engineering of the Departmental Public Autonomy Service. CNSA. https://www.cnsa.fr/appels-projets/soutien-lingenierie-de-deploiement-du-service-public-departemental-de-lautonomie. The goal is not to standardize practices, but to guarantee a coherent, accessible organization that takes each territory’s realities into account.
In practice, territorial dynamics vary considerably from one department to another.
In rural areas, the main stakes relate to outreach and local accessibility, aiming to offset the distance to available services and the low density of professionals2Caisse nationale de solidarité pour l’autonomie. (2025, April 17). Support for deployment engineering of the Departmental Public Autonomy Service. CNSA. https://www.cnsa.fr/appels-projets/soutien-lingenierie-de-deploiement-du-service-public-departemental-de-lautonomie.
In urban areas, the difficulty lies instead in the sheer abundance and complexity of services, sometimes conflicting messages about which stakeholder should lead a given case, and more specialized programs that consequently require greater coordination3Polton, D., Chaput, H., & Portela, M. (2021, décembre). Remédier aux pénuries de médecins dans certaines zones géographiques : Les leçons de la littérature internationale (Les Dossiers de la DREES, n° 89). Direction de la recherche, des études, de l’évaluation et des statistiques. https://drees.solidarites-sante.gouv.fr/sites/default/files/2021-12/DD89.pdf.
On top of this, population-specific factors, such as an aging population, the prevalence of certain chronic conditions, social issues, economic hardship or the impoverishment of certain areas, further shape each territory’s priorities.
It is therefore essential to define the right scale for territorial coordination and identify the stakeholders best placed to lead committees and working groups, or those best able to mobilize mainstream services and users themselves.
In this context, territorial coordination of the SPDA cannot be standardized. In some places, this coordination will be organized at the level of local living areas; in others, around health territories or Territorial Social Action Units (UTAS), Public Establishments for Intercommunal Cooperation (Établissements Publics de Coopération Intercommunale, EPCI), or simpler geographic divisions (north/south, east/west). The challenge is to build effective coordination as close to the local reality as possible, mobilizing local stakeholders around shared objectives.
The SPDA is not another one stop shop, nor a new service for users. It is a way of organizing collective action so that autonomy stakeholders work better together, in a more coherent and more effective way. Its purpose is concrete: to simplify pathways, make them clearer, and better coordinate them, for the benefit of people experiencing loss of autonomy, their caregivers, and partner organizations.
In our view, its success rests on three conditions:
It is with this in mind that Alcimed supports ARSs, Departmental Councils, and their partners in turning the SPDA into a concrete reality, one that is useful to users and tailored to each territory. Feel free to reach out to our team!
About the authors,
Marion and Camille, Senior Consultants within the Innovation and Public Policy team in France
Elsa and Agnès, Project Managers within the Innovation and Public Policy team in France
Marie, Director of the Innovation and Public Policy department in France
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