A week after its salary announcements, the government unveiled on Tuesday a series of measures to "accelerate the transformation of the" healthcare system, including providing for 4,000 "on-demand" beds and a reduction in the share of pay-per-view pricing. activity, closing the "Ségur de la santé". "We acted quickly and hard because it was necessary (...). It is a question of putting back the human, but also of putting back means and meaning in our health system", pleaded the minister. of Health Olivier Véran, concluding this lively six-week consultation. We summarize the main advances resulting from this consultation.
On wages
8.2 billion euros have been released for the salaries of hospital staff, as part of memoranda of understanding to which a majority of unions have given the green light. This gesture will benefit a total of 1.8 million employees. Paramedical and non-medical personnel will benefit from most of this envelope: € 7.6 billion. This sum will be used to finance a general salary increase of 183 euros net, but also salary scale revisions. Doctors will have 450 million euros with, at the end of the day, an increase in the compensation paid to practitioners working exclusively at the public hospital. Internal and external staff will benefit from 200 million euros.
About working time
The principle of 35 hours per week is not called into question, but the rules will be relaxed, via "working time annualization devices" making it possible to adapt working time to needs. Within this framework, the establishments will be able to adjust the weekly working time, with a minimum of 32 hours and a maximum of 40 hours, if they respect the 1,607 annual hours. This measure, intended to limit the use of temporary workers, will have to be validated by "agreements" with the unions in the establishments concerned, then ratified by amendments to the employment contracts.
On the workforce
The agreement signed with the unions of the hospital public service provides for 15,000 recruitments to "support hospital employment", "fill vacant jobs" and "better ensure" "replacements". Of these 15,000 hires, funded from the 8.2 billion euros promised to hospital staff, half will correspond to job creation and the other to recruitments in positions hitherto unfilled. The "coverage of staffing needs" will be based on "impact studies" carried out "with representative organizations" in each establishment, and submitted to the regional health agencies (ARS), states the document.
On the beds
Some 50 million euros per year will be released to finance the opening or reopening of 4,000 beds "on demand" in hospitals. This will make it possible to "adapt to seasonal or epidemic overactivity", underlined the Minister of Health Olivier Véran. The lack of beds is regularly denounced by caregivers, exasperated by the many closures that have occurred in recent years: in the space of 20 years, 100,000 beds have been removed in the 3,042 French hospitals and clinics.
On investments
Six billion euros will be released over five years for investment in the health system. This money will be used to renew equipment, improve buildings, or even develop digital technology. In detail, 2.1 billion euros will be devoted to nursing homes and other medico-social establishments, 2.5 billion to "priority hospital projects" and 1.4 billion to "catching up with digital health". This investment plan comes in addition to the recovery of a third of the hospital debt, or 13 billion, announced in the fall as part of the "hospital plan" and endorsed by the recent bill on debt. social.
On financing
A mixed model of financing hospital activities will be tested in establishments that so wish, with a "population allocation", based on the health needs of the populations of the territory. The objective is to "accelerate the reduction of the share of T2A" (activity-based pricing) in the financing of hospitals, and "to take better account of the quality of care", according to the ministry. A mission to overhaul Ondam (national health insurance expenditure target) will also be launched, with the support of the High Council for the Future of Health Insurance, to "adapt it to a policy of long-term health ".
On governance
Greater room for maneuver and responsibilities will be granted to services within health establishments, which will also be able to adapt their internal organization "to their local context". The "Copermo", national committee responsible for validating hospital investments, much criticized by the Hospital Federation of France, will be replaced by a national council for investment in health, "carrying a new approach". Finally, the role of elected officials will be strengthened. The government plans in particular to develop the presence of the ARS at the departmental level, with boards of directors giving more space to local elected officials.