Hospital: why many emergency services are forced to close – France

  • 1 Which establishments are experiencing difficulties in France?

  • Almost all. And as always, it is the emergencies that are the first affected. According to the Samu-Urgences collective, 112 services [sur les 690 que compte la France] would be affected by temporary, partial or total closures.

    This is how, in the Alpes-de-Haute-Provence, the emergency room of the Manosque hospital will be completely closed for five nights next week; in Draguignan (Var), vital emergencies are only open on Friday and Saturday evenings; in Bagnères-de-Bigorre (Hautes-Pyrénées), they have been closed at night since September…

    But the tensions are spreading to other services: in Indre-et-Loire, the Chinon maternity hospital is also closed until further notice. “Beds are closed in more than three quarters of establishments, including medico-social, and many blocks are idling,” adds Frédéric Valletoux, president of the Fédération hospitalière de France.

    More worrying, the big university hospitals are also starting to lower the curtain. Since Wednesday, it has become impossible for Bordeaux residents to go to the city’s public hospital, between 8 p.m. and 8 a.m., except with the prior agreement of the Samu. And in Paris, a specialized service at the Saint-Louis hospital (AP-HP) risks closing at night, from June 1.

  • 2 What is the situation in Brittany?

  • Breton hospitals are also struggling. In Ille-et-Vilaine, the emergency services of the Redon-Carentoir Hospital Center have been closed at night for a week. In Saint-Brieuc, the White Plan is still active at the Yves-Le Foll hospital center. Ditto in Vannes and Loudéac. At the latter, the management of the CHCB even closed the third floor of the establishment, i.e. 30 beds removed.

    In Brest, a patient who came to the Cavale Blanche said he had to wait nine and a half hours to see a doctor, the emergency room being overwhelmed. The Sud Santé union ensures that the establishment would be on the verge of triggering the White Plan. At the Rennes University Hospital, a caregiver was physically assaulted by a patient on Monday. That day, the service had recorded a record number of admissions in 24 hours. And, in Carhaix, the hospital almost temporarily lost its continuing care service.

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  • 3 How can these closures be explained?

  • At the root of all evil: the lack of human resources. According to the National Union of Professional Nurses, there are 60,000 vacancies for nurses. On the emergency physician side, there would be a need for 25% additional staff to run the machine correctly, according to the Amuf.

    If there are so many people missing, it is no longer just because of staff infected with covid-19 or suspended because they have not been vaccinated. Overtime, duty every weekend… The health crisis has accelerated the deterioration of working conditions and the departure of caregivers, without them being replaced.

    “More and more people want to leave,” notes Yves Morice, elected South at the Rennes University Hospital. “Colleagues are fed up with no longer having a private life” and being “constantly reminded of their rest time”. Some “are in great psychological difficulty, we see them cry. On the verge of burnout, sick leave becomes legion. “We are supposed to have a night team of 12 nurses, but today they are only two,” explains Jordan Le Solliec, nurse at Saint-Louis hospital (Paris).

    The activation, on multiple occasions, of the White Plans may also have accentuated the “fed up” effect of the personnel. This device makes it possible, among other things, to postpone the leave or RTT of caregivers. “But making us come back to plug the holes when we are already exhausted is the snake biting its tail,” laments a psychiatric nurse in Midi Libre. And when a service closes, for lack of staff, it shifts its load to the other establishments, which are already under pressure.

    Nor is the profession any longer a dream. Many students do not finish their course, frightened by the reality of the field during their internship. The significant use of temporary workers has “destroyed the work collective” and pressure from the hierarchy, “linked to current hospital policy” (ambulatory shift, fee-for-service, etc.), has increased, notes sociologist Marc Loriol.

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  • 4 What are the authorities’ responses?

  • According to Olivier Véran, the lack of carers does not stem from “not a problem of salaries” but “of organization”. “There are positions, there are budgets, money, salaries which have been increased to recruit enough”, affirmed, on May 12, the Minister of Health (since resigned), on RMC. “I think it’s more of a problem of organization, bureaucracy, administrative burden” and “fatigue”, two years after the start of the covid-19 epidemic in France.

    But, on the salary side, the Ségur de la Santé is already showing its limits: the allowance for nurses working at night is 1.07 euros per hour, within the limit of 9 am. However, “our nurses are on call for 12 hours and we know that night work has an impact on health”, recalls in 20Minutes Jehane Fadlallah, doctor in Saint-Louis (Paris).

    Emmanuel Macron promised a “stakeholder conference” to find solutions. But no date has been set yet. To this vagueness is added the expectation of the new government, which does not allow the sector to be given an interlocutor at the highest level of the State.

  • 5 Why are caregivers ringing the alarm bells for this summer?

  • The prospect of summer holidays worries caregivers, because the situation could worsen with “the massive influx of tourists in seaside areas where hospitals no longer work”. “It’s going to be atrocious, unheard of,” warns Patrick Pelloux, president of the Association of Emergency Physicians of France, in Ouest-France.

    Especially since hospitals will not be able to count, this year, on as many replacements as usual. “Almost none of our third-year nursing students want to work right out of school this summer,” said the director of IFPS Lorient, Véronique Lescop, in early May. After two trying years of covid, “they want to take a break and take a vacation before starting the gear”.

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    The student caregivers will not be able to be mobilized either, because “their year has been extended by a month and ends for the first time, at the end of July”, indicated Françoise Huet, director of the IFPS of Saint-Brieuc. However, it is on these students that the hospital structures relied until now.

    In Saint-Brieuc, the hospital offers a bonus of 350 euros to caregivers who will shift their holidays to stay working this summer. A sham according to the unions. “The agents concerned will have already worked at least the entire school year. More in the summer, there are risks of stoppages, even errors. »

    Guards at the hospital: should liberal doctors be forced?

    Against the lack of personnel in hospitals, Frédéric Valletoux, the president of the French Hospital Federation, called on the government to decide “as a matter of urgency” to restore “the obligation of care for [médecins] liberals” from which “no one should be able to escape, except exemptions because of his state of health or his age ».

    Compelling liberal doctors to come as reinforcements and perform on-call duty to relieve hospitals: a proposal that is not new and which is still controversial among liberal doctors, who oppose any coercion.

    “We would like to point out that the average working time of liberal doctors easily exceeds 50 hours per week and that nearly 9 out of 10 consultations are provided by a liberal doctor”, declare the seven representative unions of the sector in a press release.

    According to them, making on-call duty would scare away new practitioners, which would create new problems in community medicine. “Liberal doctors cannot be held accountable, responsible and reduced tomorrow to simple auxiliaries, to save a public hospital out of breath”.