After more than two years of an unprecedented health crisis, a shortage of staff, a rescue plan of nearly 20 billion euros, the public hospital is trying to heal its wounds. And the French are aware of this: the health system appears to be the second major issue in the presidential campaign (after purchasing power, at 51%) for nearly a third of them (31%), according to a Ipsos-Sopra Steria survey for France Inter, dated last January.
A few weeks before the first round of the presidential election, franceinfo is inaugurating a series of “focus”. Four files, made up of reports and analyses, on subjects sometimes overshadowed by public debate. This is why franceinfo has chosen to look into the public hospital crisis, in the same way as the cost of housing, the taboo of mental health and the carbon footprint of transport.
Why franceinfo talks about it
During the two years of health crisis, it was the public hospital that cared for the vast majority of patients with Covid-19 (218,000 patients in 2020, or 85% of patients hospitalized due to the virus). These long months of health and economic crisis have shown to what extent the public health system and the public hospital hold a crucial place in the lives of the French. The pandemic has also revealed the weaknesses of the institution. Two out of three respondents believe that the public hospital “is in a bad situation”according to an Ipsos-Sopra Steria survey for France Télévisions, published in early February.
Caregivers have been saying it for several years now: the hospital is in bad shape and it needs to be treated. “If the hospital falters, the whole health system is in trouble!” alerted Frédéric Valletoux, president of the French hospital federation, in December 2017. In 2019, before the emergence of Covid-19, hospital debt was estimated at 29.3 billion euros by the research, studies, evaluation and statistics (Drees).
In October 2021, the Minister of Health, Olivier Véran, revealed a damning figure: 1,300 nurses resigned after “their first internship at the hospital, in the midst of the epidemic wave of Covid-19”. “Caregivers express a crisis of meaning, which we perceive from the training”specified a few months later to franceinfo Bernard Jomier, senator from Paris (related socialist) and president of a commission of inquiry into the hospital. “Nursing schools are full, but 20-30% quit right out. Students don’t even enter professional life.”
The public hospital is struggling to attract new recruits. The French Hospital Federation (FHF) estimates the lack of paramedical staff (nurses and nursing assistants) at 25,000 positions. The National Union of Nursing Professionals (SNPI) even estimates that there is a shortage of 60,000 nurses.
The figure: more than 5,700 beds closed between 2019 and 2020
Since 2000, more than 80,000 public hospital beds have been gradually closed. This represents a 25% drop in the number of beds in twenty years, which is explained, among other things, by the “ambulatory shift” taken in the mid-2000s, thanks to advances in medicine.
Between 2019 and 2020, this drop was however a little more marked with more than 5,700 beds closed, according to the direction of research, studies, evaluation and statistics (Drees). The health crisis has weighed, with “many double rooms transformed into single rooms to limit contagion”, as well as massive deprogramming to reassign caregivers to critical care services. These fewer beds are therefore also the result of a lack of personnel, medical and non-medical.
The question to ask: why is there a shortage of staff at the public hospital?
According to data from DREES published in 2021 (PDF), on the working conditions of caregivers, more than half of hospital staff declared, in 2019, to work under pressure (51%). And 57% of them judged the workload “excessive”. The carers also denounce the staggered hours, the reminders on the days off, as well as the work on Sundays and public holidays. Finally, 13% felt they were doing tasks they disapproved of. “The working conditions are unworthy, it’s assembly line work, it’s like being in the factory. There is no recognitionconfided in November 2021 to franceinfo Andreina Zika, a nurse who left the public hospital in 2019 to set up on her own. I was always under more pressure and one day I said to myself that I didn’t want to kill someone because of it.”
The question of remuneration, with regard to these working conditions, can also explain the shortage. It was also central during the Ségur de la santé, which led to fiercely negotiated salary increases.
What are the presidential candidates saying?
The candidates do not all attach the same importance to health in their program, but all promise to transform the public hospital. Here are some of the main proposals:
Recruit thousands of caregivers. On the right, Valérie Pécresse proposes the hiring of 25,000 caregivers at the hospital in five years, when Eric Zemmour envisages the recruitment of “40,000 nursing staff” and Marine Le Pen proposes “mass recruitment of nursing staff”. Anne Hidalgo wants to train more doctors, midwives, nurses, caregivers and recruit “25,000 additional nurses and caregivers”. Jean-Luc Mélenchon wants “to have 100,000 additional caregivers and doctors in the hospital”while Yannick Jadot promises “100,000 nurses” additional jobs in three years and Fabien Roussel 100,000 jobs for nurses, caregivers, carers and home helps.
Raise salaries. Fabien Roussel defends a multiplication by 1.5 or even 2 of the salary of essential professions, such as caregivers and nurses. Yannick Jadot proposes to increase the net salary of nurses by 10%, like Marine Le Pen. Jean-Luc Mélenchon promises to “immediately raise wages” caregivers and Eric Zemmour is committed to “immediately increase by 12% the remuneration of nursing assistants and nurses”. Rather, Valérie Pécresse intends to help staff with accommodation, transport or crèches.
Stop or create bed closures. If staff recruitment should make it possible to limit bed closures, some candidates are proposing specific measures on this point. Marine Le Pen suggests a “moratorium” on closures, just like Philippe Poutou or Fabien Roussel. Jean-Luc Mélenchon and Yannick Jadot promise to increase the number of beds. Jean Lassalle advances a figure: “open 20,000 beds”.
Review hospital funding. Activity-based pricing (T2A), which consists of remunerating hospitals according to the acts performed, must be repealed, according to Nicolas Dupont-Aignan, Marine Le Pen and Fabien Roussel. Anne Hidalgo, Valérie Pécresse and Eric Zemmour say they want to “to modify” Where “adapt” the T2A, just like Jean-Luc Mélenchon and Yannick Jadot, who want the “Reserve” to certain acts.