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With the Covid-19 pandemic, the issue of health has become one of the main concerns of the French a few weeks before the presidential election.
The health system, more specifically, comes in second place (32%), behind purchasing power, according to a France Inter - Ipsos Sopra-Steria survey.
And this is apparent in the many proposals that Le Parisien has received as part of its "Lab".
One of them, sent by Anthony, suggests eliminating administrative positions at the hospital to replace them with hiring caregivers.
What are we talking about ?
Lack of staff, closed beds, carers on the verge of burnout… “The situation is complicated” at the hospital, acknowledged the Minister of Health Olivier Véran at the end of October 2021 in Liberation.
The positions are more and more neglected in favor of those of liberals or salaried employees in schools, or in companies.
A survey carried out by the president of the Scientific Council, Jean-François Delfraissy, concluded that one bed in five approximately would be closed today in the CHUs and CHR of France, for lack of arms.
The crisis comes from afar: the Covid-19 epidemic has only accentuated the malaise of a suffering profession, which has been warning for several years about its increasingly degraded working conditions.
And it is on the side of nurses that the situation is most critical: "3 to 5% of nursing positions and 1 to 2% of nursing assistant positions are vacant", recently indicated to the Parisian Amélie Roux, from the French Hospital Federation (FHF).
In addition, the OECD notes that nearly 34% of hospital jobs in France are neither medical nor paramedical.
In detail, according to the National Institute of Statistics and Economic Studies (Insee), these establishments have an average of 14% administrative staff, 10% technical staff and 9% service agents.
Is it doable?
Could replacing administrative positions by hiring caregivers help the hospital in crisis?
“It is not the number of administrative positions in the hospital that is the problem”, estimates Thierry Amouroux, of the national union of nursing professionals (SNPI), who recalls that most practitioners devote a significant part of their day to the tasks administrative, proof that these jobs are not oversized.
The problem, he says, “are the administrative positions in the structure that manages the hospital”.
And the nurse explained: "First we have a hospital with its management team, above, there is the GHT which brings together a certain number of hospitals and which also has its own management team, again above are the Regional Health Agencies and their thousands of agents, then, finally, the Ministry of Health with its 11,000 employees.
A real administrative mille-feuille!
»
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Frédéric Bizard, economist expert in social protection, agrees: “There is an over-administration of the system which does not necessarily come from the distribution between non-care professions and those of care, but from the 2009 reform which nationalized the governance of the system and concentrated the power in the hands of the administration", he analyzes.
“These senior civil servants have redefined the supply of care using Excel files, which has reduced the attractiveness of public hospitals.
“Nearly 30% of caregiver positions are vacant there, says the specialist.
“Today, we are in a logic of traceability, not quality, so the profession loses its meaning and caregivers leave the hospital”, deplores Thierry Amouroux who reports a dangerous “infernal circle” at work. “The more departures there are, the worse the working conditions are for those who stay.
And the worse the working conditions get, the more new beginnings you have.
»
What about abroad?
The share of non-caregivers in the hospital workforce is higher in France (33.6% in 2019) than in Germany (22%), Italy (25%) or Spain (23.5%).
In French hospitals, 405,600 people dedicate themselves to tasks other than medical, "i.e. 54% more than in Germany, whose population is nevertheless almost 25% higher than that of France", noted in April 2020 the liberal think tank Iref.
The proportion of non-medical personnel is, on the other hand, higher in Canada (33.8%), Belgium (35.6%) and the United States (46.3%).
But beware, this data does not only concern administrative staff, it also includes all technical positions in the hospital.
What are the candidates proposing?
The recruitment of staff and the revaluation of salaries are unanimous among presidential candidates.
Most of them also want to give more power to doctors in the management of hospitals and reduce the administrative burden.
The Regional Health Agencies, which were strongly criticized during the health crisis, are in the sights of several candidates: on the far right, Marine Le Pen (National Rally) and Éric Zemmour (Reconquête!) want to abolish them, just like , on the left, Anne Hidalgo (Socialist Party), who accuses them of having become “accounting agencies which are only there to contain health expenditure”.
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Another point of convergence between several candidates with very different ideas: the abolition of all or part of activity-based pricing (T2A) - which remunerates establishments according to the medical acts performed and not with a global envelope - at Yannick Jadot ( EELV), Marine Le Pen and Jean-Luc Mélenchon (LFI).
According to them, the T2A has created a “hospital-company”, to the detriment of the quality of care.
More cautious, Valérie Pécresse suggests modifying it “where necessary, in particular on intellectual acts”, while Anne Hidalgo wishes to replace it with a “State grant which takes into account local public health needs”.
“Candidates want to spend more because they have realized that health is an important subject, but no one has worked on the subject at its root.
It is the whole system that must be reformed, ”said Frédéric Bizard.
In summary
Removing administrative posts to replace them with hiring medical staff would not solve the crisis that has shaken the public hospital for several years.
As proof: the large number of unfilled nursing positions in these establishments, or the part of their working day dedicated to administrative tasks.
On the other hand, according to specialists, there is indeed an over-administration in the structure that manages the public hospital which has contributed to the deterioration of working conditions and thus reduced the attractiveness of these establishments.