Eye on France: The health service is sick

Trade unions in France have called on emergency medical staff to walk out on Tuesday in a last-ditch effort to secure better working conditions. The call comes after three months of strike action, despite some government concessions.On Sunday, over 150 accident and emergency departments were on strike according to the Inter-Urgences careworkers collective, which has called for Tuesday's strike action in tandem with hospital unions.The organisers have planned for a gathering Tuesday morning outside the French Finance Ministry, followed by a march to the Ministry of Health, where they hope to be received by Minister Agnès Buzyn.Hospital emergency room staff have been on strike in France for three months over poor working conditions.Last month the government unveiled a variety of measures in a bid to end the strikes.The Paris health center for instance, announced the creation of 230 jobs including in 25 of its emergency departments, while the regional health agency proposed a contract for "zero patients in hospital waiting rooms," with a "financial incentive" to encourage hospitals that put this measure in place.Dearth of doctors in summerThese measures are on top of the 70 million euros already unblocked last month by the government to appease health workers.From July, nurses and caregivers who agree to carry out medical tasks will be given a 100 euro bonus on top of their salaries.Authorities are also eager to boost recruitment over the summer to ensure there are no gaps in care when doctors and nurses go on holiday.This may be a challenge. According to the regional health agency's pre-summer survey, at least 1,000 "12 hour slots" are "not filled" by any doctor or nurse in July and August.

Health issues dominate this morning’s front pages. There are nearly 90 French hospitals without accident and emergency services today, because the staff are on strike in nationwide demonstrations timed to coincide with the review of the new health legislation by the French upper house, the Senate.

Left-leaning Libération looks at the crisis in French accident and emergency services, as hospital staff take to the streets again to complain about what they describe as a dangerous lack of money and personnel.

Clearly, last week’s conciliatory proposals by the health minister, Agnès Buzyn, have done nothing to convince the overworked doctors and nurses who man the nation’s A&E wings.

One trade union leader has described the minister’s promise to launch a “mission” to propose fundamental reform of the emergency services as “a huge joke,” adding that missions are a politician’s way of burying a problem.

Centrist Le Monde takes a different but no less thorny angle with a front-page headline warning that the social security deficit is growing again, and is likely to end this year in the red to the tune of somewhere between two billion and 4.4 billion euros.

This was to have been the year in which the social security budget finally broke even, after 18 consecutive years of debt. The prime minister had even gone as far as promising that the enormous money machine which pays health, pensions, family allowances and social welfare would actually be making a net contribution to the national coffers from next year onwards. That now looks extremely unlikely.

Right-wing Le Figaro blames the looming financial disaster on two things: the general economic slowdown means that less cash has been coming in, and the various emergency measures promised to the Yellow Vest protestors will result in an awful lot more going out.

It's all money, stupid!

The problem in the emergency services is obviously financial too. The closure of under-budgeted hospital units around Paris puts additional pressure on those which remain open; many A&E doctors are deserting the public service for better-paid jobs in private clinics; some hospitals complain that staff are being drained from other crucial services by the constant pressure exerted by the emergency rooms.

Tired staff, out-of-date equipment and the anger of exasperated patients are just some of the daily difficulties mentioned by a sector specialist interviewed by Le Figaro.

Describing the whole system as under intolerable strain, one senior consultant warns that, for example, a sudden severe heatwave in France could bring the entire edifice crashing down.

To put the debate into perspective, the annual number of visits to French hospital accident services has more than doubled over the past two decades, from 10 million in 1999 to 21 million now.

While staff numbers have increased over the same twenty years, they are far from having doubled, says Le Figaro, without giving precise figures.

There are certainly fewer hospital beds available, which puts an additional pressure on those treating accident victims, since no one wants to see unfortunates emerging from intensive care obliged to spend their first days of recovery on a stretcher in a hospital corridor.

Le Figaro points to one structural problem which seems to underlie, perhaps even undermine, the whole debate.

The operational margin for French public hospitals, in simple terms, that’s the turnover minus the running costs, is set at 5 percent. According to the social affairs inspector, that margin needs to be increased to 8 percent, otherwise work conditions in public hospital generally, and accident services especially, will continue to worsen.

It all sounds curable, but serious. Nothing that a huge dose of money wouldn’t put right in the long term. We should expect no miracles.