Science

“Crazy logic, which was going to end in crisis”: why the hospital is cracking

In recent years, tremendous advances have been made in the treatment of stroke. New technologies make it possible to save more patients and prevent them from suffering from serious disabilities. “But today, in Paris, we are experiencing a real tragedy, because we often have to turn away patients,” laments Professor Pierre Amarenco. Head of the neurology department of the Bichat hospital, he saw 18 of the 24 nurses leave in a few months, and had to resolve the closure of 6 of the 10 intensive care beds and its 18 hospital beds. In other Parisian neurovascular units, 30% of the beds on average are closed, according to those responsible. “We can start treatment in the emergency room, but then we cannot accommodate patients in our departments, while the immediate consequences of a stroke require special skills to limit complications,” laments Professor Amarenco.

Beyond the controversies over the number of beds closed, on which Health Minister Olivier Véran promises full transparency at the end of November, many doctors and hospital officials are now alarmed to see caregivers leave ship. According to a survey carried out this summer by the French Hospitals Federation, 25,000 positions for nurses and nursing assistants remain vacant, to which must be added a third of the positions for hospital doctors. Not counting absenteeism, also on the rise, “around 11.5% instead of the usual 10%,” says Professor François-René Pruvot, head of the National Conference of Presidents of the CHU Establishment Medical Commission.

“Shortage management cells replace Covid cells”

All regions are affected, to varying degrees: emergencies that no longer open at night, units that close, operations postponed, patients sent home – and always these same images of stretchers in the corridors … The cost of living forces , tensions are even more marked in Ile-de-France. “In our establishments, staff shortages and deficit management cells have replaced Covid crisis cells,” Martin Hirsch, General Director of Public Assistance – Paris Hospitals, confirms to L’Express.

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With the arrival of winter viruses and the threat of a wave of Covid, the specter of establishments going bankrupt a few months before the presidential elections puts the government on the grill. “We must collectively mobilize with immediate responses, capable of producing results for the coming weeks,” pleaded Olivier Véran in front of an audience of hospitalists on November 9 at the Santexpo fair in Paris, freeing them in the process a budget extension of more than one billion euros by 2021, and the extension of crisis measures (increase in overtime, combining employment and retirement, etc.). Hospital representatives were also urgently summoned by the ministry this week to “reflect on actions that can be quickly implemented to deal with tensions.”

With the Ségur de la santé, however, significant resources have been released: 9 billion euros in salary increases, 19 billion in investments, 7,500 net job creations to come, 6,000 new places in nursing schools and nursing assistants , but also more consultations in the management of establishments … “We must ask ourselves why we feel good or not in a profession: a salary at the fair value of their work, resources at the level of their mission, enough colleagues, the impression of participate in decisions. four points, all the decisions have been made that allow tomorrow to improve the health system ”, says Olivier Véran’s cabinet.

Working conditions crystallize resentment

However, on the ground, the effects are struggling to be felt. “All this is nothing. But, in the organization of the hospital, for example, nothing really changes: we will listen to the doctors and nurses, but the bureaucratic millefeuille remains in place, and the director continues to make the decision.” “Maker. It is not yet about co-management with professionals and the participation of patient representatives,” laments Professor André Grimaldi, author of the Health Manifesto 2022, subtitled 20 years of deviations: it is time to change (Odile Jacob). “At the height of the crisis, even the most politically experienced caregivers believed in a new world. Seeing managers come back with their savings requests and more activity is even worse,” says Dr. Olivier Milleron of the Interhospital Collective (CIH).

Working conditions, above all, crystallize resentment. Always with the same concerns: unanswered absences, leave reminders, paid night work … 1 additional euro per hour. “We must take in more and more patients, with tired teams and colleagues detained for exhaustion,” testifies Fred, an emergency nurse in Rennes. Above all, the feeling of being a tradable pawn from one service to another weighs on morale. “For the staff, this is a source of great stress, because the risk of error is greater when working in units for which we do not know the protocols,” explains Fabienne Eymard, health manager of Public Assistance – Marseille Hospitals. A survey of the order of nurses indicates that 40% of them plan to change profession. “Some departments even ask Pôle Emploi to try to find former nurses to convince them to come back,” says Pruvot.

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The origin of these evils is known: a growing demand for care, due to the aging of the population and an insufficient response from liberal medicine, itself in difficulty; Financing by activity of hospitals, which pushes them to do more and more procedures to try to fill the coffers and, at the same time, savings policies that have resulted in a reduction in the prices at which these same acts are paid. “Crazy logic, which was going to end in crisis,” laments Professor Grimaldi. Much remains to be done to save the hospital …

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By David Baverez

L’Express Expert Group

The last French nuclear reactor started up in 2004.Cécile Maisonneuve is Senior Fellow at Institut Montaigne and advisor to the IFRI energy-climate center

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