© Chloe Sharrock
In the intensive care unit of the Avicenne hospital in Bobigny on January 25.
During the pandemic, the pressure on intensive care beds played a major role in the government’s choice to confine the population. Now aware of the possible consequences of a lack of reception capacity in these sensitive services, the Minister of Health, Olivier Véran, unveiled on Thursday a series of measures intended to “strengthen the sector” in anticipation future health crises. Some announcements “the campaign” for Professor Djillali Annane, head of the intensive care unit at Raymond-Poincaré hospital in Garches (Hauts-de-Seine) and president of the union of intensive care physicians.
You have been campaigning for several months for a strengthening of the reception capacities of patients in intensive care. The government’s desire to create 1,000 additional critical care beds by 2025 meet your expectations?
It’s a great campaign ad. But that’s just a showcase. When we open the door, we realize that behind, we are quite far from what the actors in the field were asking for, namely finding sufficient resuscitation care capacity to avoid saturation. Remember that in April 2020, peak of the first Covid wave, we were forced to transfer patients to the regions and abroad. For good reason, we had fallen to 5,080 intensive care beds, compared to just over 6,000 ten years earlier…
This will not be the case ?
No. During the pandemic, due to a lack of places in intensive care, temporary units were created to monitor serious Covid patients, using continuous care and intensive care beds, which are technically less demanding. From the summer of 2020, a new terminology appears in political language: the government no longer speaks of resuscitation beds but of critical care beds, which makes it possible to encompass resuscitation, continuing care and care beds. intensive. Even today, Véran plays on this semantic shift since of the 1,000 bed creations announced, only 500 are truly intensive care beds.
And the other 500 beds?
The other 500 are post-resuscitation beds: these are beds created experimentally a few years ago in so-called “post-resuscitation rehabilitation care”, with neurological orientation for injured brains, cranial traumas, strokes or to help wean off respiratory assistance for patients coming out of intensive care. The idea was to streamline the downstream resuscitation to free the beds faster. But there are no more than a dozen structures of this type today in France. And as these are experimental devices, we will have to get out of experimentation!
For you, is the glass only half full?
Yes. What we demanded is that we reopen the 1,000 intensive care beds closed since 2009 for budgetary reasons. It’s doable. The rooms exist. It is enough to reassign personnel to the resuscitation so that these beds can be reopened. This is also what the General Inspectorate of Social Affairs recommends in a report: return to an intensive care capacity of 6,000 beds.
Does the increase in the nurse/patient ratio announced by Olivier Véran bode well for an improvement in working conditions?
Not in intensive care. Véran promises to return to one nurse for four intensive care unit beds within five years. This obviously does not concern resuscitation, otherwise it would be a regression: since the decree of April 2002, the ratio of nursing staff there is one nurse for 2.5 patients and one nursing assistant for 4 patients. Above all, this means that, contrary to our expectations, we will not approach the ratio in force in intensive care with our Belgian, Swiss, English or German friends, which is one nurse for 1 or 2 patients. We were not listened to.
All the same, government announcements bode rather for progress…
They still need to materialize. However, the timing of the announcements sows doubt. In reality, they were expected in July, they were postponed to September and then to December. We can’t help but think that if the government is unveiling its roadmap today, it’s because we’re in the campaign and that doesn’t involve much. Whatever the result of the presidential election, the future government can question everything. This announced roadmap is politics. It is of the same ilk as the announcement of the discount at the pump of 15 centimes per liter…
Do you think the announced roadmap is credible?
No. In my opinion, it is untenable, unrealistic. Caregivers continue to leave the public hospital. The results of the survey we carried out in intensive care units in December show that we have fewer beds today than in February 2020: around 8% of beds are closed because staff have left. This affects doctors, nurses, caregivers and even administrative staff. This movement does not date from today but it has worsened. The Ségur de la santé, hastily closed, made it possible to raise salaries a little and renovate a few buildings, but it did not deal with the basic problem. The software has not changed: today, we work in the hospital to ensure figures, to produce care, not to meet the needs of society. As long as we do not redefine the role of the hospital in society, that we do not rebuild a vision for the hospital, we will not be able to retain or attract caregivers.
Are we once more at risk of saturation of intensive care beds in the event of a new Covid wave?
The reality is that we had a lot of luck with the omicron wave. If omicron had been as virulent as delta, it would have been an absolute disaster: the hospital would not have held out, I’m certain. The hospital is less strong today than it was in February 2020. The exhaustion of caregivers is seen on a daily basis. This translates into prolonged sick leave, burn-out, a terrible quality of life at work, with people in permanent tension, stressed, who have become hypersensitive. Today, we do not see what are the credible reinforcing elements.
