An alarming observation: caregivers are at the end of their rope and many beds are closed in public hospitals. In a context of hospital tension and the start of winter viral epidemics, the situation worries the Covid-19 Scientific Council. The group of experts responsible for enlightening the government since the start of the health crisis reported, in its opinion dated 5 October (PDF), of“a significant percentage of closed beds, estimated at around 20%”, according to a flash survey conducted by Professor Jean-François Delfraissy. And this, despite a “already significant and increasing use of overtime and temporary work”, reminds the Scientific Council in its publication.
These 20%, the Minister of Health challenges them. “For the moment, the only figure I have is on a very fragmented sample of 16 CHUs. With all the biases that we can recognize, on 16 CHU, lhe last data that came back to me is 5% of medicine beds temporarily closed. We would therefore be quite far from 20% of the general hospital stock “, assured Olivier Véran Wednesday during a hearing at the National Assembly on the 2022 finance bill.
In order to verify the figures put forward by the Scientific Council, the government spokesperson, Gabriel Attal, announced that an investigation into the real number of closed beds had been launched. While waiting for the government recount, franceinfo is trying to understand why the public hospital is facing a growing shortage of staff, leading to massive bed closures.
Because the exhaustion of caregivers reduces the capacity for care
If the Minister of Health refutes the closure rate put forward by the Scientific Council, he recognizes that “the situation is complicated” in the hospital. “We see an increase of nearly a third of vacant positions in paramedics compared to fall 2019”, he said in an interview with Release (subscribers article) published Wednesday.
Because the health crisis has been straining hospital staff for many months. “Many of our caregivers are exhausted by the mental load and the pace of work of the crisis”, emphasizes Olivier Véran. It has also left many traces in the white coats. And this exhaustion of caregivers “reduced [leur] patient care capacity “, underlines the Scientific Council in its opinion of 5 October.
A situation also described by the spokesperson for the National Union of Nursing Professionals (SNPI), Thierry Amouroux, who figures the increase in the workload in a year and a half to “30%”. “THEhen from the first peak, we had six patients with Covid-19 for an intensive care nurse, he explains. In the last wave, we were already at eight patients per nurse. ”
Because the bed closure policy continues
The closure of beds began long before the Covid-19 epidemic, before recently accelerating. During the last seven years, and by virtue of political decisions, the number of beds “full hospitalization” fell by 6.5%, notes the Directorate of Research, Studies, Evaluation and Statistics (DREES) in a report published in September (PDF). With an annual average of 0.9%, no less than 27,000 full hospital beds have been closed across the country since 2013, recalls this study (for a total of nearly 387,000 today). However, this phenomenon was accentuated with the health crisis, passing to a closure rate of 1.5%, between the end of 2019 and the end of 2020, where 5,700 full hospital beds were closed.
If these closures “reflect the desire to reorganize the offer in a context of ambulatory shift”, they are also the result of “staff constraints not allowing the beds to be maintained”, writes the Drees (attached to the Ministry of Health) in its report. For Thierry Amouroux, it is a “infernal circle” that the government initiated by continuing “to close beds and reduce hospital budgets” in times of health crisis.
Because absenteeism and resignations are increasing
In 2020, the absenteeism rate in French hospitals increased by one point. It stood on average Between 9.5% and 11.5% according to figures from the survey of the French Hospital Federation (FHF), against a level oscillating between 8.5% and 10% in 2019, before the Covid-19 crisis. As for absenteeism for lack of compulsory vaccination, even if disorganization of services is still possible, they should decrease because only “0.6% of the staff” was not vaccinated in mid-October.
Minister of Health also recognizes that resignations “increase more significantly between 2020 and 2021 than between 2019 and 2020”. But they “nevertheless remain in moderate proportions”, he assured at Release. During a press point at Blois hospital, Thursday, October 28, the minister specified that “Among nurses, there are 1,300 registered resignations.” An analysis that does not share Thierry Amouroux, for whom there is “a very significant wave of departures since June 1”. The union spokesperson adds that “the more departures there are, the more the working conditions deteriorate and the more you have new departures.”
Last point: until September 2020 – the FHF study ending at this date – retirements were not fully covered by recruitments, leaving 1,152 nursing positions and 816 nursing staff. vacant caregivers. This causes the vacancy rate in hospitals and public medico-social establishments to oscillate between 2% and 5%.
Because the profession attracts less
Recruitment difficulties are also weighing on the closure of beds. Not less than 80% dhe some 300 public health establishments (80%) which took part in the survey carried out by the FHF declared that they were actively seeking to strengthen their staff and the vast majority of them encountered difficulties. An example to illustrate this shortage of caregivers, that of Marseille, where 448 beds out of 2,700 are closed, or 16% of capacity, according to figures provided by the management of AP-HM to France Televisions. At the Timone hospital, which wanted to recruit six night nurses in October, not a single post was filled.
As for training, although the government has released an envelope of 200 million euros (PDF) within the framework of the Ségur de la santé to open 16,000 new places by 2022 within training institutes (including 6,600 for nurses and 6,600 for nursing assistants), not all nursing students stay. Just over a thousand of them have “resigned before the end of their studies” between 2018 and 2021, specifies the Minister of Health in Release. “An investigation will be launched to understand the reasons”, he added.
The government also hopes to stimulate the attractiveness of the profession with, among other things, the revaluation of salaries recorded during the health Ségur, in July 2020. But if the government plan (19 billion over ten years for the health system) overcomes them “investments which did not take place”, on the background, “the governance of hospitals has not changed”, judged from last March the Inter-hospitals collective. And the working (and reception) conditions at the public hospital therefore continue to deteriorate in the face of the growing shortage of staff.