Faced with the demands of caregivers, who have been asking for more resources and wage increases for months, in particular, the government has promised to increase salaries and develop a major plan for the hospital by summer. front line against the Covid-19 epidemic. As we approach the "Ségur de la santé", which is to be launched on May 25, an overview of the main ills of the French hospital system.
1. Too low wages
On September 28, 1988, for the first time, 100,000 angry hospital nurses swept the streets chanting, "Neither good, nor nuns, nor assholes." Thirty years later, dissatisfaction has spread throughout the hospital floors to the point where candidates for employment are becoming increasingly rare. First cause, wages. “In 2012, recalls Frédéric Bizard, economist expert in social protection, the average monthly salary at the hospital, all professions combined, was 2,250 euros; in 2017, it had risen to 2,280 euros. Plus 30 euros in six years! " The 300,000 hospital nurses are also the lowest paid in developed countries. In a ranking made in 2017 by the OECD (Organization for Economic Cooperation and Development), our country ranks 26th out of 29, far behind the United Kingdom, Germany, Greece, the United States and Mexico. The French nurse thus receives 500 euros less than her German colleague, 300 euros less than in Spain. "A graduate nurse Bac + 3 is hired 1340 euros net per month and ends at 2400 euros", denounces Mireille Stivala, secretary general of the Federation CGT health - social action, first union in the sector. “To return to the OECD average, nurses should be increased by 400 euros net per month. It costs nearly two billion euros / year, "calculated Frédéric Bizard, who invites" to not forget the 250,000 nursing assistants! "
2. A dangerous shortage of personnel
Between sluggish wages and degraded working conditions, the public hospital with 1.2 million staff no longer attracts: 27.4% of vacancies for doctors, nurses who turn to the liberal or abroad ... To find staff and avoid the closure of entire departments, the hospital must resort to temporary workers who cost him more than 500 million euros / year. The Assistance Publique - Hôpitaux de Paris deplores the vacancy of 500 nurse positions and 120 radio manipulator positions…
3. The 35 hour puzzle
Among the solutions to the staff shortage, Olivier Véran half-opened Sunday, May 17, in the Journal du Dimanche, the door to a relaxation of the 35 hours in the hospital. Only "for volunteers", hastened to add the Minister of Health, and for additional compensation. "He has been thinking about it for a long time," says a relative. But how can you work more when you are exhausted? Shouldn't the number of RTTs be standardized first? Because in 2003, the government allowed local negotiations to produce major disparities. According to the French Hospital Federation (FHF), 48% of establishments have validated 15 days or less of RTT per year, while 12% have granted more than 20 days. Finally, says Frédéric Bizard, “the volume of unpaid overtime is already enormous. In 2012, the stock was two million hours ”. We should start by balancing these hours.
4. Too many closed beds
Of its 3,036 healthcare establishments, France lost 17,690 beds between 2013 and 2019, including 13,631 in the public hospital where there are 395,693, according to the Ministry of Health. In six years, the hospital has thus lost 5.3% of its hotel capacity. Officially, this is the logical consequence of the deployment of ambulatory medicine: day care, without hospitalization. Unofficially, many are closed for lack of caregivers "at the foot of the bed". At the AP-HP, 900 beds are on the loose for lack of staff!
5. The perverse effects of fee-for-service
It was Jean-François Mattei, Minister of Health for Jacques Chirac, who in 2003 established the “T2A”, to stem the “hole of the Safely”. Gone are the "global endowments", health establishments are essentially remunerated according to their activity, each act having its reimbursement rate. Some directors quickly understood the value of favoring the most profitable care. Except that, from 2010 to 2018, reimbursement rates have continued to drop ... "Hospitals found themselves in deficit, denounces Mireille Stivala for CGT-health. We no longer want this management by numbers ”. Without counting the perverse threshold effects: "In psychiatry, notes Frédéric Bizard, sometimes the reimbursed rate drops on the 4th day of hospitalization, the directors then push to change the patient on duty ...". The legislator has since started a partial reverse. "The State pays blindly: there is no quality control of care", regrets Professor Guy Vallancien, surgeon and member of the Academy of Medicine.
6. Powerful administration
For many, the Hospital, Patients, Health, Territories Law (HPST) of 2009, known as the “Bachelot Law”, completed placing a public hospital under administrative supervision, where the guidelines were fairly well shared between management and the establishment's medical commission, who represents the doctors. With the HPST law, the director took the upper hand, but was imposed by regional hospital agencies on sometimes insurmountable budgetary constraints. "Between 2005 and 2018, the hospital had to find eight billion euros in savings," recalls the Fédération hospitalière de France. Balance sheet: 57% of establishments are in deficit. For Professor Guy Vallancien, this weight of administration is counterproductive: “The Valenciennes hospital (North) has reduced administrative staff to 5% against 20% on a national average. And they are in surplus every year… ”
VIDEO. Visit to the Pitié Salpêtrière: Macron promised a revaluation "of remuneration and careers"
7. A throbbing debt
The accumulated debt of hospitals reaches 30 billion euros and costs them 850 million euros of interest each year! The government announced in November the resumption by the State and over three years of a third of this debt, with the hope of a positive trickle down on wages. "Insufficient", judges the Inter-hospital Collective, which wants immediate and strong measures. Why not take over all the debt, as for the SNCF? “It is possible, there is a crazy cash in health, quips Guy Vallancien. The OECD says that there is 20% waste in care: 20% of 200 billion annual expenses, that makes 40 billion euros per year to be freed up by avoiding unnecessary acts and drugs.