Ségur ends: 7.5 billion euros… but a lot of criticism

This time, it's over. Finally, for the moment. The Ségur de la santé is coming to an end this Friday. Indeed, on the night of Wednesday to Thursday, the unions and the ministry reached an agreement at 1 am, after a nine-hour marathon negotiation. The final version of this protocol was received by the unions this Thursday afternoon. Proposal that they are supposed to study and vote at their base, if there is agreement, which is not won. All before Monday evening. Eve of the intervention of Emmanuel Macron, who should this July 14 make announcements for the hospital. While many congratulate themselves on having obtained a substantial amount for paramedics, others warn that this advance may be insufficient.

Too limited envelope

The draft agreement proposes a significant amount: 7.5 billion euros. "I am delighted with this unprecedented effort for the hospital in terms of financial volume", welcomed Frédéric Valletoux, president of the Fédération hospitalière de France. An envelope which should finance a salary increase of 180 euros net monthly for the paramedical professions (nurses, nursing assistants, etc.), but also for non-medical personnel (technicians, stretcher bearers, etc.) from public hospitals and nursing homes.

#FO #APHM #SEGUR pic.twitter.com/6E1wopDDwg

A breakthrough, welcomed by some unions ... but with a bitter taste. For months, the latter had been demanding an additional 300 euros net monthly. Because the health professions are far below the OECD average and this is a catch-up of years without increase, argue these caregivers. "Of course, this protocol is not perfect," acknowledged Didier Birig, secretary general of FO-Santé with AFP. But we were at the end of what we could do. And 7.5 billion euros is not a small sum: we don't leave with a few hundred million euros ”.

Others do not hide their disappointment.

🚨 "Ségur de la santé". Towards a salary increase of 200 euros for hospital carers
👉 the CIH requests 300 € net / month !!! https://t.co/bhTCj5Y4Xj

“It is quite far from what we were asking for, namely a strong attractiveness plan, says Olivier Milleron, cardiologist in Bichat and member of the Inter-hospital Collective (CIH). Second problem: this salary adjustment will take place in two stages: first 90 euros in September, but which will only be paid in January retroactively (i.e. 450 euros) and a second of 90 euros in March 2021. A gradual increase, which postpones long-awaited well-being to 2021… And annoys Patrick Bourdillon, federal secretary CGT health: “Olivier Véran had promised a revaluation for July 1, then for September and finally it will only be affected in January. I hope that the second wave will not have killed everyone by then! "

Health segur failed. The proposals are insufficient or even desperate .... #whichcoute and #lemonde according to were political utopias. Hope there are no other waves of #coronavirus

The losers and the winners

In its press release, Force Ouvrière ensures that the government only wanted to benefit from this boost to part of the healthcare teams. But they have obtained that this revaluation also affects the administrative, workers and technical staff. And the written project raised a doubt: the agents of the social sector will not be concerned. For Patrick Bourdillon, it is unfortunate to exclude "part of psychiatry, social assistance for children, centers for the care of disabled people, or 35,000 employees. "

If an outcome seems to be emerging for medical and paramedical staff, things seem to be compromised for hospital doctors. In fact, no draft agreement has been presented at this stage, discussions held on Wednesday with the unions of hospital practitioners having been blocked for lack of progress on the envelope promised by the government. Last week, Olivier Véran proposed 600 million euros for their salaries, including 400 million for doctors and 200 for interns and students. The doctors did not hide their disappointment. And warn that many practitioners risk going private ...

# Ségur # Hôpital

After the very tense negotiation of this night with hospital practitioners, very dissatisfied press release ... https://t.co/jQaqYixjnA pic.twitter.com/mrwEy5TR36

Precisely, what makes some union members really angry is that, from the start, this envelope includes the private sector. They estimated that private paramedics would earn about 1.6 billion. An envelope that could finance an increase in compensation of around 160 to 170 euros net. Meetings must be held with the unions in the establishments concerned to determine the terms. "The government has included and refuses to kidnap the employees of the private profit, storm Patrick Bourdillon. The public hospital was to be the target of this plan, ultimately, the private sector, which can afford its shareholders, will benefit from the contributions of citizens. "

Workforce

Prime Minister Jean Castex intervened by surprise in these meetings on Tuesday and insisted "so that employment issues are also included in the negotiations". It's done. Indeed, the agreement provides for 15,000 additional positions. An advance welcomed by the unions, who nevertheless regret that these staff are funded from the 7.5 billion euros proposed by Matignon. This necessarily leads to a reduction in the amount available for salary increases. But if we look more closely, it is actually 7,500 job creations and 7,500 staff recruitments on positions that were not previously filled. Which seems problematic. “Today at Bichat hospital, there are 100 vacant nursing positions, budgeted but nobody wants to come and work here, insists Olivier Milleron. The problem is not to create positions, but to attract people ... "Second reservation, on the part of the cardiologist:" it seems difficult to be satisfied with a figure, what matters is the ratio between caregivers and patients depending on the hospital. Not all have the same nursing needs. Today, the ratios are the same everywhere. We ask for a discussion with the teams of each hospital to match the means and the workload. "

Shadow areas

Unions and collectives do not hide their vigilance in the face of large, non-detailed announcements. "During the negotiations, we had the opportunity to compete to have a clear direction: how much for the additional staff? For private profit? Resumes Patrick Bourdillon. They refuse to answer us. And the final document still doesn't go into details, much to the latter's regret.

Another question: this envelope of 7.5 billion each year is added to the national target for health insurance expenditure (Ondam), which is decided by the Social Security financing bill (PLFSS), discussed in this moment and voted in the fall. "Upgrading wages is essential, but we must increase the finances of the public hospital in a sustainable manner," says Olivier Milleron. So get out of everything T2A (activity pricing), which does not allow you to adapt care to needs, and a planed Ondam every year. If we increase wages without increasing the method of financing, are we likely to be told that we have to increase activity to finance this? "

Don't forget the other topics

"The salary increase is the most visible aspect of this Ségur, but it cannot be limited to that, warns Patrick Chamboredon, president of the Order of nurses, who did not participate in the negotiations. The expectations are broader of all the actors. There were four pillars, the only one that had to result in an agreement, this is it, but the others have yet to be worked on. »Indeed, there is a lot to do on the front of hospital governance, the simplification of the organization, collaboration between carers ... Besides, a citizen consortium organized from May 15 to June 24 on the hospital of tomorrow by the Economic, Social and Environmental Council has brought out several consensuses, in particular on the governance and administrative management of hospitals (better involving nursing staff in decisions and preserving them from administrative tasks) ”, details a press release that the Cese published this Thursday.

There remains a blind spot: the freezing of bed closures, the third request from the Inter-emergency and inter-hospital Collectives with salaries and staff, on which there is no precise statement. "Olivier Véran said that the major restructuring projects were stopped during Ségur", continues the cardiologist. But what about after?

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