Tribune. In March 2020, the French discovered with amazement an unprecedented health crisis. Confined to their homes, they applaud the hospital staff every evening. Our hospitals have coped with great inventiveness and dedication to the influx of hospitalizations and multiple shortages, starting with the lack of stocks of protective masks.
If the Ségur de la santé, in June 2020, concretized the “whatever it takes” promised by the President of the Republic at the end of this first wave, the expectations of hospital staff are still very high on several levels. The hospital system, subjected for more than fifteen years to the only imperatives of profitability and restructuring, is today at the end of its rope.
What observation in 2022? Just-in-time management of activities and resources at the cost of deteriorating working conditions; a logic of pooling resources and versatility dictated by imperatives of profitability to the detriment of the collective care; unattractive salaries for caregivers and doctors; a considerable reduction in bed capacity in 30 years (100,000 beds), the consequences of which can now be seen in terms of access to care for populations far from large urban centers or underprivileged.
Reinforce the means
The hospital workers are exhausted and disillusioned. A significant number of them resign for lack of prospects, young professionals abandon the public hospital which has become unattractive. The overhaul of our hospital system, so often mentioned in 2020, is only mentioned marginally in the presidential campaign. It is however essential.
We are calling for a real Marshall plan for the hospital with five main priorities:
– We must strengthen the resources of hospitals.
We are asking for a moratorium on bed closures from the start of the next five-year period so that consultation can be initiated at regional level to define, in a multi-annual perspective, bed needs based on demographic and epidemiological data, changes in care and the number of staff required. It is necessary to create fifty thousand nursing positions in establishments in tension between 2022 and 2023 and to initiate, as of now, the essential measures to revalorize the care professions.
– The method of allocating resources must be reformed and the expertise of the regional health agencies (ARS) must be strengthened.
Activity-based pricing (T2A) implemented since 2004 on the basis of standard costs is combined with a national hospital expenditure target set by the public authorities below the evolution of real costs. The adjustments necessary to fit within this envelope have only been obtained by pressure on the workforce, the stagnation of real wages and the intensification of work.
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