Alexandre Roux is Neurosurgeon and Doctor of Neuroscience in Paris. He teaches at the Faculty of Medicine and has a research activity at INSERM. He is a member of the Syndicat Jeune Médecin - Île de France.
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“
France has the best health system in the world
”. This sentence, which we are used to, is it still relevant today? Our Hospitals are aging badly. The equipment, essential for care, is deteriorating or even lacking in some departments. Nothing new you will tell us. But the Public Hospital has reached a level of suffering unmatched in history. To this gradual deterioration of working conditions is added a new (and brutal) fact, the flight of caregivers.
Nurses, orderlies, physiotherapists, speech therapists, stretcher bearers fled the Public Hospital in the space of a few months. Their reasons? Deplorable working conditions and a climate of daily tension. This, explained by a policy of budgetary restriction (8.7 billion euros in savings since 2010), an activity in permanent increase (+ 14% activity since 2010) and the COVID-19 crisis which has finished caregivers. Never seen ! Some leave the big cities for a better quality of life in rural areas, others, exasperated by the impoverishment of the Public Hospital, change their mode of practice, even their profession.
Caregivers were waiting for a structural reform of the Public Hospital: renovation of premises, purchase of equipment, reorganization of work, recruitment of nursing staff, etc.
Alexandre roux
A report from the COVID-19 Scientific Council submitted on October 5, 2021 reports a closure of 20% of hospital beds, due to the lack of nursing staff.
An unprecedented figure.
Our Minister of Health wanted to be reassuring by taking the example of the Blois Hospital Center where only 5 beds out of 230 are closed.
He would have to visit other Hospitals and he could then see a very different situation there (18 beds out of 45 closed in my assigned service, or 40%).
"Priority to the quality of care and the continuity of care" he tells us.
Soon that will no longer be possible.
The management of the health crisis due to COVID-19 and the multiple waves leading to saturation of Hospitals was made possible by the courage and sacrifice of caregivers who have suffered an unprecedented overload of work.
The latter accepting overtime - late paid - at the risk of putting their own health, as well as that of their loved one, in danger.
All this at what cost?
The French, in an effort of national solidarity, applauded, made donations, lent their homes or even supported hospital staff by delivering meals to the wards.
What about the government?
To read also "Let us finally hear the suffering of the staff of the public hospital"
Of course, he too had to deal with this crisis and it is too easy to give in to the sirens of criticism.
However, no “major” measures have been taken for the Public Hospital.
What about Segur?
Didn't the caregivers get what they wanted?
An essential effort, of course, but insufficient, because we have said the problem is not only pecuniary, far from it.
In short, a sword strike in the water.
Caregivers were waiting for a structural reform of the Public Hospital: renovation of premises, purchase of equipment, reorganization of work, recruitment of nursing staff, etc.
According to the Department of Research, Studies, Evaluation and Statistics (DREES) there were in France in 2016, in Public Health Establishments, 98,579 medical jobs against 96,191 administrative jobs. Such a disparity between the massive recruitment of administrative staff in recent years and the lack of nursing staff is astonishing.
The Public Hospital is still operating at full capacity despite everything, carried at arm's length by these deserving caregivers.
But until when ?
Deprogramming and delays in support, due to a lack of space in the appropriate services, have been increasing for several months.
The caregiver-patient relationship deteriorates as a result.
Some physicians spend more time administratively managing these postponements or reassuring patients, worried about such a delay, than providing excellent care.
How to make future doctors, nurses, nursing assistants, physiotherapists, speech therapists, stretcher bearers want to work at the Public Hospital under such conditions?
Alexandre roux
We are protesting against the “experts” in the Health System who tell us about the Hospital of tomorrow, digital, connected, subject to artificial intelligence… Have they already set foot in the Hospital? Have they ever treated a patient? Do they really know the state of our health system? The future of the Public Hospital must be anticipated and thought out, of course, but the urgency is to save it. There will be no Hospital of the future without a Hospital of the present.
Let us not forget and do not neglect one of the main functions of the Public Hospital, the training of caregivers.
How to make future doctors, nurses, nursing assistants, physiotherapists, speech therapists, stretcher bearers want to work at the Public Hospital under such conditions?
The President of the National Intersyndicale des Internes (ISNI) reports, with supporting scientific evidence, that 39% of Doctors in training (Interns) have depressive disorders and 20% have suicidal thoughts… In addition, although the profession of he nurse continues to attract vocations (when we look at the results of the platforms of choice for high school students), we find 17% drop out during training.
Unpublished.
Read also Bed closures in the hospital: "We are not on the edge of the precipice, we are in"
Finally, concerning the last - and not the least - function of the Public Hospital, scientific research, for 30 years we have observed a gradual drain of French brains towards more generous countries. Lack of funding and attractive salary. In his latest book,
Which Country Has The Best Health Care
? ("Which country has the best health system?"), Ezekiel J. Emanuel, American Oncologist notes that the French health system, although affordable for the population thanks to healthcare reimbursements, is in reality very little innovative.
The triple mission and responsibility of the Public Hospital (care, teaching, research) must be rethought and unreservedly supported by the political authorities.
Clear reforms with immediate effect must be considered, otherwise the health of the French will be endangered.
We look forward to the proposals that will be made.
Our future President will have the heavy responsibility of reviving the Public Hospital via courageous and ambitious measures because “if health has a cost, it is priceless”.
