On January 6, the President of the Republic presented a new health system reform plan. The challenge ? Reorganize, decompartmentalize and facilitate cooperation, he mentioned. A plan essentially centered on the hospital, which he wishes “on a human scale”. What are the chances of success of this new plan? How to get out of the current tensions? How to reform by involving all stakeholders?
These are the questions addressed on January 24, 2023 in Health Counterpoints, of which we are partners, in the presence of Charles Gueprattenew Director General of FEHAP, Vincent Roquedirector at the FHF, Christine SchiblerGeneral Delegate of the FHP and, finally, Remi Solomonpediatrician, president of the CME of the APHP and, for the past year, President of the Conference of Presidents of CHU.
For Charles Guépratte, it is difficult to say that the plan presented by Emmanuel Macron at the start of the year is “a complete revolution”. This being so, the “observations were once once more well established, with great lucidity, including on measures that were not completed in 2018”SO “yes, we have the feeling that a strong dynamic is being driven, that important subjects are taken into account”, he believes. Among them: the hospital funding and the end of T2A, long awaited. He also welcomes a budget and timeline “more than ambitious” with the reallocation of 80 billion euros by 1is June.
Christine Schibler welcomes the desire to “to see endure” the logic of agile cooperations born during the Covid crisis as well as the ” taken into account “, ” Finally “of “staff shortage” in the area.
The hope of an impulse for the next 6 months
“What We Can Expect”points out Vincent Roques, “it is that this speech sets a course, an impetus so that the next six months will finally be those of the transformations that we expect”. And to remember that we “talk today regarding the hospital crisis” more than “The challenge is indeed the crisis of the health system” : “one cannot think of the hospital crisis without also thinking of the first resort crisis…” This presupposes, among other things, strengthening the coordinated exercise.
The articulation of the ambitions of the President of the Republic with the CNR health still remains to be clarified, as well as the method of their implementation. “We hope for consultation with all the players and in particular the federations” of establishments, slips Charles Guépratte, which would be in the logic of things, supports Christine Schibler.
THE actors in the field are therefore expecting. “I had seen, with some pediatricians on December 23, the President of the Republic and I had told him that the caregivers felt abandoned. I told him, Mr. President, you must speak quickly and announce concrete measures. He spoke quickly. Concrete measures, we are waiting. It’s not a plan that is announced at the moment, it’s intentions, full of good intentions, it’s true. But when I discuss with the caregivers since the speech of the President of the Republic, I do not have the feeling that they are reassured for the moment “explains Remi Salomon.
The urgency is absolute
Looking forward to, “caregivers”, like doctors, “keep going”even if, “in the CHU for the moment, we are relatively preserved”, details the President of the Conference of Presidents of CHU. And to qualify very quickly: “I say for the moment, but there is still a drop in attractiveness” towards the “hospital and hospital-university careers”.
He did not, moreover, in the presidential speech, “not heard much regarding the CHU and when we say that training is a major issue, it’s a bit regrettable”. He also doesn’t have “heard of Ondam” : “we talked regarding the mode of financing, but not regarding the overall envelope”. And to drive the point home: if “a lot of money has been put on the table with Ségur, it’s true”, “It’s not enough for the moment”, “we know that today the account is not there”.
Vincent Roques confirms: “the budget of health establishments is voted each year by Parliament, on the proposal of the government”or “there is a huge gap” in between “the rates of change in the national health insurance expenditure target, the famous Ondam« et “the so-called natural evolution of expenditure”due to changes in wages, innovations, etc. “When we look at the differential between the two since 2005, there have been roughly 10 billion euros in savings on hospital Ondam, that is to say 10% of Ondam. »
Moreover, “At the level of the establishments, we have to do well with this budget which is voted by Parliament” or “The first item of expenditure is human resources” et, “between 2013 and 2018, employment in public hospitals increased by 0.1%”while “activity increased by 10%”, he notes, lamenting a “too restrictive accounting policy” et “considerable productivity efforts” asked of the teams.
The issue of attractiveness
And this plays on the attractiveness of positions, which remains a major problem, insist, unanimously, the four guests. In short, succeed in recruiting and retaining professionals. “To recruit professionals, they have to exist, which means, first of all, that we have to train more of them”explains Vincent Roques. “We consider that when we look at the needs of the health system in the public hospital, there are approximately 5% of nursing positions and 2.5% of nursing assistant positions vacant, which which makes regarding 20,000 professionals. » It is therefore necessary to strengthen the training capacities of IFSIs, IFASs, etc.
Today, “the beds are closed because we lack nurses”, for example, confirms Rémi Salomon. In fact, 16% of beds are closed at the APHP… “We also need to recruit 100,000 people in nursing homes”adds Vincent Roques.
More “It’s not just regarding training” caregivers and “bring to the hospital” : il “must keep them”, insists Remi Salomon. He recalls that “10 years ago, 80% of graduates went to the hospital today, it’s only 40%”. Besides, “20 to 30% of students drop out during their studies, so there is a problem…” At the IFSI in Nice, “we went up to 50%”deplores Charles Guépratte, who notes “departures during the first internship and departures throughout the course”.
Both the public and private sectors concerned
The reasons are multiple: difficult working conditions, insufficient remuneration although it has been increased with the Ségur… “we are just in the European average so it’s not so bad but it’s not so good”, observes Remi Salomon. Not to mention, in large cities, the problem of housing and transport.
And the private sector is no better off. For Christine Schibler, “ there is absolutely no reason to pit the public and private sectors once morest each other” since they both suffer from “same shortages, same difficulties”. It is “a very good thing that the president underlines this problem of attractiveness, of human resources,” but, now, concrete actions are long overdue. “For many years we have been pointing out the lack of attractiveness of the sector, of trained personnel, of people in schools, of funding, of the possibility of having bridges between professions and nothing is happening”.
And to cite an example: “the federations, all together, made a number of proposals, exactly a year ago, to the government” on “the multi-year training of paramedics” ; “We never even received an acknowledgment of receipt”. Moreover, “the private health and medico-social federations, plus the Red Cross, have made joint proposals within Opco Santé to review the 2018 law for the freedom to choose one’s professional future, which is not adapted to health and which needs to be reviewed. » Sent in September, they have, for the moment, remained a dead letter, regrets the general delegate of the FHP.
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