Illustration of a demonstration by caregivers a few days before the end of the “Ségur de la Santé”.
-
Louise Meresse / SIPA
In mid-July, the Ségur de la Santé agreements provided for an additional 8.8 billion euros for a salary increase and 15,000 hires.
Several measures aim to provoke an “attractiveness shock” to prevent doctors, nurses and nursing assistants from leaving the public hospital for the private sector or for other activities.
But while hospitals need more support than ever to face the second wave of Covid, the Inter-Hospitals Collective ensures that the flight of caregivers continues and that working conditions are still degraded in French hospitals.
We knew the anger was strong and old.
In some of the French caregivers, it has not fallen back.
While France is facing a second wave of the Covid-19 epidemic, some caregivers are sounding the alarm: the public hospital no longer has the means to fulfill its mission.
Particularly due to massive departures of caregivers.
However, the Segur agreements, which provide for an additional 8.8 billion euros per year and 15,000 recruitments, promised a "shock of attractiveness".
Hiring plans
After two decades of savings, the purse strings seem to have loosened.
According to the Ministry of Health, "the 15,000 positions promised, whether it is the opening of positions or vacancies to be filled, are in progress, but it takes time."
At the same time, the Assistance Publique des Hôpitaux de Paris (AP-HP), 39 hospitals in the Ile-de-France region, is launching a seduction operation to deal with the second wave: 500 nursing or nursing assistant positions are opened with working conditions improved (installation bonus, nursery places, etc.).
At the Assistance Publique des Hôpitaux de Marseille, we are also looking for 200 nurses.
Caregivers leave the public hospital
The problem is that the public hospital is struggling to recruit.
And that the departures continue.
In any case, this is the alert from the Inter-Urgences Collective (CIH), which organized a press conference on Tuesday and provides for a mobilization on October 15.
If some caregivers leave the ship, is it because of the Covid-19 that got the better of their dedication?
Or a disgust at a Segur who has not kept his promises?
Hard to say.
Thomas Laurent, a nurse for sixteen years at the Lyon hospital, hangs up his white coat, exhausted by dysfunctions.
Lack of training, sheets, overtime that is impossible to recover, additional tasks such as preparing medicines or cleaning ... "This way of working in a public hospital, I experienced it as a loss of meaning" , explains the one who threw in the towel last month.
Illustration of a nurse at the Pellegrin hospital in Bordeaux.
- UGO AMEZ / SIPA
"The Ségur has not made it possible to strengthen the staff, neither medical, nor paramedical, nor medico-technical", slice Anne Gervais, hepato-gastro at Bichat hospital and member of the CIH, who participated in the discussions of the Ségur de la Santé.
Two months later, it is therefore the cold shower.
"We have the impression that there is a leak of medical and paramedical personnel and that it is accelerating," adds Olivier Milleron, cardiologist at Bichat hospital and member of the CIH.
Even if the committee says it is unable to quantify these departures.
Which can be resignations, departures to the private sector, retraining ... "Hospital management does not brag about these departures ... far from it", quips Jean-Luc Jouve, head of the orthopedic surgery department of the hospital de la Timone, in Marseille.
These doctors warn about communicated figures that may hide a more complex reality.
“At APHP, 192 nurses were recruited recently.
Unfortunately, there were 192 departures, details Olivier Milleron.
We find ourselves in the same situation: 100 missing nurses.
At the Bichat hospital, a cutting-edge service against the Covid, we had to close six beds last week for a lack of nurses.
The lack of staff seems so glaring that the AP-HP plans to abolish the All Saints' leave for caregivers.
An amazing way to re-mobilize.
" It's humiliating !
annoys Olivier Milleron.
There has never been a need for this for caregivers to mobilize, come back on weekends to treat patients!
"
SOS
Disgusted by the technostructure, the young #healthcare workers leave the #hospital: 34,000 vacant #nurse positions
In reaction, the APHP decides to "squeeze the lemon" of the caregivers who remain
1) passage in 10 or 12 hours / day
and at 48
hours
per week
Fatigue, beware of errors in care pic.twitter.com/WTCfX3hPAR
- SNPI nursing union (@infirmierSNPI) October 3, 2020
Insufficient salary increase?
However, the Segur agreements provide for a salary increase already underway, in order to improve the attractiveness of these careers.
In September, paramedics and technical staff from public and private hospitals received an additional 90 euros net.
From March 2021, their payslip will still show an additional 93 euros.
But for the collective, this improvement was only a "catch-up".
For doctors, the calculation is more complicated.
Some low salaries (100,000 doctors) have been upgraded.
And the exclusive public service allowance went from 493 euros gross / month, or 704 (depending on seniority), to 1,010.
To encourage doctors to choose a public hospital.
On the side of the Ministry of Health and Solidarity, we ask for a little patience.
“The situation has been deteriorating for twenty years, we admit.
The decisions taken during the Segur are going in the right direction.
To say that the government is not going fast enough is not to see that we are working hard on recruitments, games on the salary scales, upgrading of paramedics and doctors.
"Without denying the current challenge:" In a climate where you have a pandemic that particularly mobilizes caregivers, we can understand a certain fed up, "we admit to the ministry.
Other topics put aside?
What worries the collective is that the other substantive subjects, addressed during the Ségur, have been forgotten: working conditions, equipment shortages, the reorganization of services, listening to users ... This However, consultation had to focus on three pillars, in addition to upgrading: "define a new investment and financing policy in the service of healthcare, simplify the organizations and the daily lives of the teams and unite the healthcare players in the regions at user service.
After a committee meeting, there is radio silence.
“If this work of global reflection is underway, it is without the actors in the field!
alarmed Anne Gervais.
The Notat report was pretty good.
Ministerial measures were precise on salaries, vague on the rest.
But these kind words don't lead to action.
"
And this when there is an emergency.
To redefine, for example, the number of professionals per patient.
“The staff ratios imposed by the National Performance Support Agency do not correspond to the workloads: when in California, the ratios are 1 nurse for 4 to 6 beds, it is 1 for 14 in France, she continues.
Even better paid, what paramedic can accept such a workload with no prospect of improvement?
"
A matter of training
Another question, training.
“All hospital structures are unfortunately ready to hire to recruit intensive care nurses, which requires training!” Insists Jean-Luc Jouve.
It is difficult to recruit, which is problematic not only for the Covid, but for the epidemics to come.
The tank is empty.
"At the Ministry of Health, it is replied that training was not forgotten in the plan:" we have opened 2,000 additional places for nursing students from the start of the 2020 school year. "
Third question raised by the collective: the hospital budget, defined by what is called the national objective of health insurance expenditure (Ondam).
The Social Security financing bill (PLFSS), however, provides for a much higher Ondam for 2021: with an increase in expenditure of + 7.6% (against + 2.45% in the LFSS 2019).
Particularly because of the epidemic (15 billion for masks, tests, vaccine, etc.) and for Ségur (8.8 billion).
Insufficient for the CIH.
“We need an Ondam which is set by an independent commission, which must start from the needs of the field and not from Bercy, tance Olivier Milleron.
And get out of the notion that the hospital costs too much.
During the Covid crisis, we heard President Macron say "whatever the cost".
All that was quickly forgotten… ”
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