Le Figaro Nantes
The dozen cranes steer the sky above the island of Nantes. In the City of the Dukes, the construction site of the future CHU is visible. It is even starting to come out of the ground. After the foundations, the first ground floors are being erected. A sign that the project is progressing at the planned pace. On this point, everything is fine for the time being. Regarding the financing of the operation, it is a different story according to the regional chamber of accounts. In a report submitted this Monday to the members of the supervisory board - who are due to meet on May 15 - and that Le Figaro was able to consult, the institution points to a new additional cost of this major project.
Originally estimated at 957 million euros, the bill has already climbed to 1.254 billion euros. And it wouldn't be over. Factor mentioned: inflation. "The CHU is facing a significant increase in work costs," notes the regional chamber of accounts. It estimates it "in the order of 55 million euros". This new additional cost, which "is, at the end of 2022, not financed" could have the consequence of making its financing "unsustainable" "by the CHU alone". Reasons given: the health institution's revenue forecasts are based on "objectives of activity and efficiency whose achievement is not guaranteed" while, at the same time, it could be faced with an increase in expenses following the "development of salary attractiveness schemes, to cope with recruitment difficulties".
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Rising construction costs: "a global reality"
An analysis that the management of the CHU of Nantes wishes to nuance. "It must be kept in mind that this simulation represents only 4.8% of the total cost of the operation," tempers Philippe El Saïr, the director of the establishment. Noting that the rise in construction indices is a "global reality", he downplays the analysis of the control institution: "In our markets, we have fifteen different construction indices. This diversity helps to mitigate the inflationary effect."
He also specifies that the CHU undertook in June 2020, a work of "renegotiation" with the companies involved: "This allowed us to land at prices that were those of the market, for hospital achievements, before the Covid crisis. We made sure we didn't overpay for the project."
Quality of life at work: "fewer weekends"
On the human resources part mentioned by the regional chamber of accounts, Philippe El Saïr acknowledges that the year 2022 has been very complicated because of the impact of the Omicron variant. For the future, he says he is confident: "As of September 2022, we have put in place an attractiveness and loyalty plan. It produces its results. We manage to recruit more staff than there are departures. On absenteeism, which was a major problem in 2022, the rate is decreasing and approaching that of 2019. It's encouraging."
Fewer staff?
This is one of the arguments put forward by opponents of the CHU construction project: the future site would lead to a reduction in staff. A "fear" to which Philippe El Saïr responds again: "During the laying of the first stone, the Prime Minister of the time (Jean Castex, Editor's note) assured that there would be no reduction in beds and staff."
Regarding the recruitment difficulties identified in the study, the health institution says it is vigilant and proactive. "We are thinking about less restrictive organizations for staff in order to make them work less on weekends," retorts Philippe El Saïr who also counts on the "attractiveness effect" of the future CHU generated among staff who will be able to "benefit from working conditions among the most modern".
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Deferred borrowings and debt: "€100 million of cash aside"
Regarding the financing of the project, the regional chamber of accounts stresses that the debt of the CHU "is another risk factor". In this, it points to two toxic loans that continue to burden the accounts while the riskiest "could have been secured in 2021". She also questions the management's strategy with regard to recourse to loans: "The CHU is delaying the mobilization of new loans and is now faced with strong uncertainty about the evolution of borrowing conditions in a context of rising rates."
On this subject, Philippe El Saïr defends the direction taken by the establishment he manages. "We are able to wait for the interest rate cut because we have €100 million of cash set aside. We don't have the knife at our throat and we can afford to wait for a more opportune moment to borrow," he said. As for the lots of the site that have not yet been awarded and could weigh on the final invoice according to the audit conducted, it would be "a wise decision" concerning "technological markets for which developments are very rapid." According to Philippe El Saïr, "the fact of having waited will allow to benefit from the latest advances".
Optional building: "We want to do it"
In the audit, it is mentioned that the construction of a building originally included in the project was put on hold in 2020 in order to save money because the companies' first offers proved too expensive. This was to include the school of midwives, the emergency care education centre, the ambulance training institute, a vaccination centre, occupational medicine, the research centre and the administration. What about three years later?
"This is a building we want to do because it is necessary. At this point, there is no timeline. It is still under discussion with the Regional Health Agency and the ministry. We have many arguments to demonstrate that this site is indispensable. We must succeed in establishing people somewhere, "answers Philippe El Saïr.
Mother and Child Hospital
On June 11, 2023, opponents of the project to build the future CHU on the Ile de Nantes are organizing a demonstration to "rebuild health, without breaking everything" in order to "save" the current site of the Hôtel-Dieu. In particular, they criticize the "demolition" of the Mother and Child Hospital, which was renovated a decade ago. "The project to convert the existing site by the Metropolis has not yet been stopped. This building will certainly be able to be converted. We were not going to leave this hospital alone in the middle of the city because it needs equipment, operating theatres, biology," replies Philippe El Saïr.
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Project management: "a legal disagreement"
In its study, the regional chamber of accounts also looks at the change in project management of the site that took place in April 2021 "due to a dispute relating to remuneration" with the first party engaged. If for the institution, the separation agreement was well negotiated and its timing opportune, it would pose a significant risk to the CHU: "The transaction was concluded at the price of a significant concession from the CHU, which waived the contractual guarantee of the first project management. The harmful consequences of errors that may have been made by the latter during the design and that would be revealed during the execution of the work must be assumed by the CHU. Given the scale and complexity of the Île de Nantes project, the CHU is thus exposed to a financial risk for the duration of the project."
A point of view that Philippe El Saïr does not share: "On this point, we have a legal disagreement. For the abandonment of the contractual guarantee, we relied on experts. In the event of recourse by a third party (a company for example), we may turn against the project manager as stipulated in case law of the Council of State. My second point is that we are keeping the ten-year guarantee. It may be used if the solidity of the structure is called into question or if its vocation is compromised. We consider with the agreement that the interests of the CHU are protected."