Ségur de la Santé: "Let's not forget about local health!"

André Accary is the President of the Departmental Council of Saône-et-Loire.

This Monday, May 25, opened the famous "Ségur de la Santé" which should make it possible to improve the status and remuneration of nursing staff. A legitimate and deserved ambition with regard to the admirable investment of these personnel in the service of our fellow citizens for so many years, the Covid-19 crisis having further demonstrated it. A vast hospital plan is also announced, which is supposed to improve infrastructure and working conditions in hospitals. An essential and justified project, the obsolescence of certain equipment not being worthy of a country like ours.

However, in the vast work to reorganize our health system that is looming, the only budgetary aspect, if it is useful and necessary, will not be enough. If we want to restore coherence to our health policy, we will also have to work on its organization and not to forget local health.

First of all, there is the question of access to healthcare in our territories, and more particularly the imperative need of general practitioners, but also of liberal nurses and other paramedical professions, also on the front line during this health crisis. Let us not forget that during the great national debate post Yellow Vests, it is indeed the question of medical desertification which came at the top of the major concerns of our fellow citizens. Before the health crisis, there was no longer a week without them questioning their elected representatives everywhere in France, in particular on the absence of general practitioners, or on their impossibility of making an appointment within a reasonable time, with all the consequences that one can imagine in terms of continuity of care. In rural areas, where mobility difficulties are numerous, this question is all the more pressing since it is sometimes necessary to travel more than 50 km to benefit from a consultation. This situation has obviously not disappeared with the health crisis and may even worsen.

Many initiatives have been taken in recent months as part of "My Health 2022", with for example the removal of the Numerus Clausus. But they will only bear fruit in the long term. Local communities have also organized, each in their own corner. In Saône-et-Loire, for example, the Departmental Council that I chair took on its responsibilities in 2018 by creating, outside of jurisdiction, the first Departmental Health Center in France. In two years, this system has made it possible to recruit 55 salaried general practitioners, to open 5 territorial health centers, to deploy 19 branches in rural areas and to 15,000 Saône-et-Loiriens to find a treating doctor.

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However, we feel in our territories that we must go even further, and in a better coordinated manner. City medicine is an essential pillar of the health system. The absence of general practitioners has obvious consequences in our towns and villages: a tense situation in our emergency services, an increase in the activities of our firefighters and more generally a feeling of abandonment experienced by fellow citizens. It is therefore essential that the debates that open also take this issue into account.

The question of wages, in addition to the practice of liberal medicine, should no longer be a taboo subject. The development of telemedicine needs to be amplified. The permanence of ambulatory care by general practitioners must be facilitated to unclog our hospitals. The construction of local health partnerships between the liberal sector, hospitals and local communities is to be encouraged, which will encourage the creation of professional local health communities (CPTS), preventive actions and envisage innovative local solutions, adapted to the terrain.

Suppress the Regional Health Agencies

This requirement of proximity is also essential for the organization of the health system in our territories. Today, it is the Regional Health Agencies (ARS) which in particular manage the supply of care and the health protection of the population in our regions and departments. The numerous shortcomings of these agencies were already denounced well before the crisis. But the latter has been an indicator of the current dysfunctions. Shortage of masks, absence of tests, lack of information, coordination and anticipation were unfortunately a daily lot that our communities often had to overcome.

It is by no means a question here of questioning the people and their goodwill at the head of the ARS, but of pointing out the heaviness of a system which is probably out of breath today. This was particularly striking for our accommodation establishments for dependent elderly people (Ehpad), where the situation was already very fragile. In these local establishments, the challenges ahead are immense. The increase in dependency, the insufficient means and the pricing problem that worries each family were already there long before the crisis. And it is to be feared that the shock of the Covid-19 will have a lasting impact on these establishments.

The government has just announced the possible creation of a fifth branch of social security to finance dependency. This is good news because it is obvious that the budgetary aspect is a sine qua non of the problem. But again, this will not be enough. The medical accommodation of dependent elderly people is a shared competence between the Regional Health Agencies and the Departments. This duality is a source of slowness and undermines the consistency of decision-making.

This is the reason why it is necessary, from my point of view, to return to more simplicity and proximity. For my part, I campaign for the elimination of ARS, a level which has not demonstrated its added value since their creation ten years ago, and which is today failing in its mission aimed at preparing the health of tomorrow.

Let us give back to the Prefects of Regions and Departments the competence to organize the provision of care in the territories. And let the Departments manage the single and entire Ehpad. We will gain in readability, in complementarity and in efficiency, for a better service rendered to our populations.

To read also: "Ségur de la santé: the hour of truth for the future of the public hospital"

In his address on April 13, the President of the Republic called on each and every one of us to reinvent ourselves. We will be there, with pragmatism. In terms of health, the budgetary aspect will be essential. But this should not obscure the essential adaptation of our health system so that it meets the expectations of our fellow citizens as closely as possible. To forget proximity health would be to miss the point.