A “Ségur de la santé” to think about the French hospital after Covid

On Monday, the Ministry of Health calls on representatives of hospital staff, nursing homes and city medicine. Expectations are high for this concert, which aims to clean up the French health system, which has already weakened before this unique health crisis.

“We will go fast, we will go strong,” said Health Minister Olivier Véran on Wednesday during the presentation of “Ségur de la santé”, named after the avenue where the ministry is located in Paris. Less than a week later, on Monday, May 25, the government is preparing to begin a consultation that the health care staff is eagerly awaiting, which aims to map tomorrow’s new roadmap.

The Covid-19 crisis highlighted the weaknesses of the French health system, especially in the caregivers’ working conditions and the ability to receive patients. At the end of March, President Emmanuel Macron had promised “a huge investment and upgrade plan”. As of Monday, about 300 members of trade unions and health care groups will meet through video conferencing.

For this, the government has put in an ally to channel these negotiations. Nicole Notat, former head of the CFDT trade union and support for Emmanuel Macron during the presidential election, was responsible for coordinating the discussions.

“This election is a negative signal,” responded to Twitter doctor Jérôme Marty, president of the French Union Syndicate for Free Medicine (UFML), which recalls the support Nicole Notat brought to the Juppé plan in 1995. This one focused on the reform of social protection. Critics say he got a serious blow to the hospital budget. Very controversial, he had led to a social protest movement that has not seen since 1968.

Further pressure on the government, which must respond to several demands from the health care sector. Most are well ahead of the 2020 health crisis.

The premiums announced by the government for caregivers were considered insufficient. Olivier Véran responded positively to a salary increase on May 17 in an interview with Journal du Dimanche. Meanwhile, Emmanuel Macron had promised to “put a stop” on the “impoverishment” of the health care staff.

As an indication, the remuneration of a nurse at the beginning of a career is around EUR 1,500 net per month. It is among the lowest among the OECD countries in the EU 28th of 32. In a survey on behalf of the Federation of Private Hospitalization (FHP), 55% of French people say they are for an increase in the compensation of healthcare professionals.

On the government side, Olivier Véran says he wants to raise wages in hospitals and nursing homes to “the level of compensation that at least corresponds to the European average”. Trade unions fear that the measure will only apply to nurses.

In an interview grantedin the Sunday Journal, Frédéric Valletoux, President of the French Hospital Association (FHF), also asks to “reduce the pay gap between public and private, which weakens hospitals”.

The government wants to put the organization of working time on the table and says it wants to question “buoys that prevent those who want to work more.” A requirement from the FHF.

Trade unions refuse to touch the 35-hour week, which was established in 2002. They explain that vacation in reality is longer and that the shortage of staff already prevents many employees from taking advantage of reduced working hours (RTT). According to the nurse (SNPI)forwarded by France Soir, hospitals in Ile-de-France (APHP) owe just one million RTT to their employees.

“It’s hard work, with a psychological and physical burden, because we help people. You really have to integrate everything that is the profession in the hospital,” insistedat the microphone on RFIGeneral Secretary of the Force Ouvrière Union, Yves Veyrier.

  • The hospital, “the first medical desert”

Frédéric Valletoux points out that 30% of positions in French hospitals are unfilled. “The first medical desert in France is the hospital,” he condemns. The CEO aims to “increase the value of all careers and develop new professional paths” to make the public hospital more attractive.

For Thierry Amouroux, SNPI spokesman: “30% of newly trained nurses leave the profession within five years”. The unions point to the working conditions, but also insufficient management of human resources.

This deficiency leads to bed closures. It also requires the employment of temporary employees, whose salary is higher than the salary scales.

The lack of staff and activity saturation seemed to be the biggest challenge for the health care system in France. A crisis that reached its peak during the epidemic crisis of 2020. In December last year, France gave 24 words to an emergency physician who resigned. He explained that he no longer wanted to “walk on a wire without a safety net”.

  • Hospital Financing

Today, hospitals are in debt close to EUR 30 billion. Before the crisis, the government announced that a third of this amount was recovered in its Social Security Financing Bill (PLFSS) for 2020. On May 20, Olivier Véran spoke of a “€ 13 billion effort”.

As to the “massive investment plan” mentioned by the president, the amount of the envelope for the hospital and nursing home has not been specified. In March, Cécile Vigneau, Head of Nephrology at Rennes University Hospital, responded to the announcement from Emmanuel Macronin France 3, claims that the “ONDAM envelope [objectif national de dépense maladie, NDLR] is 2.3% this year. While the forecast expenditure was 4%. We ask for her realignment. “She and 51 department heads from her hospital had resigned in protest before the Covid-19 crisis.

Another possible reform is activity pricing (T2A). This method of financing health facilities, introduced in 2003, is widely criticized. It consists of classifying medical procedures according to codes, each code having a specific tariff, which social insurance subsequently replaces. Its disadvantages are that T2A is dangerous because it would encourage companies to multiply documents or choose the most expensive to increase their funding. Some are also considering itmake money on careand sign them up for a “profitability contest”.

A group of 66 parliamentarians, including some former LREMs, voted in favor of a measure that would reduce “the share of the fee in the hospital budget”, in a manifesto called “Le Jour après” and published May 13.

Olivier Véran said he wanted to include the “Ségur de la santé” conclusions in the next social security budget in September. A calendar that is already a problem for trade unions. “If everything has to be completed by July 15, the scope of action will be very limited for negotiations,” one union official laments.

A national demonstration is scheduled for June 16. “We will continue with our demands,” the Inter-urgences collective said in its conversation on Twitter.

With “Ségur de la santé”, the question arose whether to continue or not. We finally decided to keep a milestone for a time in the event that the wage negotiations that Véran has to start end, “he said. at the liberation, Hugo Huon, co-founder of the collective.