We do not yet know if Olivier Véran will remain Minister of Health, but whether it is him or another, his mission will not be easy.
The pandemic has highlighted the distress of hospital workers, but has also delayed certain reforms, in particular the law on dependency.
Beyond Covid-19, the agenda of the future Minister of Health is likely to be loaded.
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has planned for the long term to design its four major projects.
“Caregivers leave to do cabinetmaking, the public hospital has entered the same perverse dynamic as the hotel and restaurant industry, regrets Frédéric Pierru, sociologist and researcher at the CNRS.
Once you've broken it, it's very difficult to fix it.
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If the flash presidential campaign was poor in substantive debates, the distress of hospital workers, the lack of caregivers and abuse in certain nursing homes were still invited to the menu of the rare meetings.
So much so that beyond the management of Covid-19 - an epidemic that is certainly still present but which must not evade in-depth reforms -, the challenge that the next (or next) Minister of Health will have to take up is gigantic ad.
Save the public hospital
The list of emergency services, maternity wards or specialized services that are closing, everywhere in the territory, is growing.
And shows how much, after two years of health crisis, the sector suffers from a lack of arms.
A distress supposed to find answers in the big "conference of stakeholders" announced by Emmanuel Macron, but whose timetable remains to be specified.
For all observers, there is urgency and a few announcements will not be enough.
"There is a human resources issue concerning attractiveness, training, coordination with the city", underlines Daniel Benamouzig, sociologist and holder of the Health Chair at Sciences Po.
Will the next Minister of Health have carte blanche to raise salaries?
To impose quotas of caregivers per patient, a long-standing request from the Inter-Hospital Collective?
And to negotiate early retirement for certain difficult jobs?
Responding to Addiction Challenges
Much has been said, via the Orpea scandal, about the situation of seniors in nursing homes.
Where, as for the hospital, caregivers are lacking and suffering.
“The Orpea scandal shows that the administration no longer has the means to control the private sector, analyzes Frédéric Pierru.
The Regional Health Agencies (ARS) lost 10% of their jobs between 2010 and 2020. The health system is emerging from the decade of budgetary austerity 2010-2020.
We now have underfunded sectors facing an epidemic of chronic disease and aging.
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“But the issue is wider than nursing homes, home care must be addressed, underlines Daniel Benamouzig.
We have kept a model centered on nursing homes, but it is difficult to bring out a structuring of the offer between city, hospital and nursing homes to know where the people are, what their needs are, their means of transport… ”
To help with home care, Emmanuel Macron has provided new financial aid, Ma Prime Adapt', to finance adaptations to housing for aging.
Insufficient ?
“Ehpads must also be transformed so that they become places of life and that we can feel at home”, insists Pascal Champvert, president of the Association of Directors at the service of the Elderly (ADPA).
Who is waiting for “the old age law that Macron had promised… like Hollande and Sarkozy.
It would allow more time to be spent with the elderly.
There are not enough professionals and they go too fast.
However, for people who go slowly, it is an abuse.
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Still, it is not easy to attract young caregivers to nursing homes… “While waiting to train nurses, we can bring in shrinks, facilitators, home helpers, including professionals who have not yet been trained. , which we will train,” he suggests.
But for that, budgets are needed.
“We need to create 300,000 jobs in helping the elderly, not just for the toilet but to accompany these people to their friends, to cultural places.
And these are not relocatable jobs!
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Fight against medical deserts
The deficit of public services, in particular in health, was particularly raised by the notebooks of grievances, the "yellow vests"... and the voters of Marine Le Pen.
In his program, the re-elected president has planned to increase the number of medical assistants (2,500 medical assistant contracts in January 2022, far from the objective of 4,000), to delegate certain prescriptions and preventive acts to pharmacists and nurses.
Moreover, since April 24, nurses can administer all the vaccines provided from the age of 16 without prior medical prescription.
Sign that task delegation continues.
But we should go much further, according to our interlocutors.
"For the territories to become attractive again, we must think about housing, transport, a city favorable to health", lists Daniel Benamouzig.
“We should also reorganize city medicine, adds Frédéric Pierru, also a doctor of political science.
On the one hand, to be more restrictive on the installation of new doctors.
If we want to make the true ambulatory shift, we must ensure access to primary care throughout the territory.
Second challenge: put back on the table the supervision of excess fees for specialists.
The most modest go to the emergency room, which is becoming the general practitioner of the poor.
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Improving prevention
Emmanuel Macron had made prevention a priority during his first term.
The Covid-19 pandemic has since underlined the importance of the subject… and the French delay.
For this second term, he promised three complete and free health checks at key ages: 25, 45 and 60 years old.
“We must be wary of organized screenings, it can generate overdiagnosis, criticizes Frédéric Pierru.
It is an individualistic, medicalized and poor vision of prevention.
“He believes that it would be more effective to put resources in the centers of Maternal and Child Protection (PMI), school medicine, that of work…
“Making effective prevention would mean taking an interest in diet, stress, alcohol, etc.,” adds Daniel Benamouzig.
However, we know that this president is not very conducive to opposing the alcohol or pesticide lobbies.
Health, and in particular public health, like the ecological transition, is a long-term task.
It's not easy to prove yourself in five years.
“The great drama of the Ministers of Health is that if you take your function seriously, you are condemned to make people unhappy, admits Frédéric Pierru.
If you try to be proactive, the lobbies will get angry.
If you invest in the hospital, the European Commission will be unhappy with your spending.
You'll take the hits right away...while the beneficial effects will show when you're gone.
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