Hospital crisis in France: "The 35 hours is the tree that hides the forest"

Monday, May 25, Prime Minister Édouard Philippe kicked off a major consultation to reform the health system. With the Covid-19 crisis, which exposed the lack of hospital resources in a bleak light, the subject has become a priority. All the signals therefore appear to be green so that the salary increase demanded for so many years by the staff takes place. However, the head of government has made no concrete announcement, either on remuneration or the hospital budget, and discussions about working time cause concern.

"I said that constraints of all kinds had to be lifted. Working time must be looked at in the same way," Édouard Philippe announced on Monday.

"Work more to earn more? Out of the question. The main issue is increasing wages," immediately commented the Inter-Block Collective, which brings together professionals in the operating room, taking up the slogan dear to Nicolas Sarkozy.

➡️ Kick off of #SegurDeLaSante!

Work more to earn more ? Out of the question.
The main issue is increasing wages.
We will fight to defend the interests of #ibode and #ideenbloc méprisé.es@20Minutes @RTenfrancaishttps: //t.co/l0FTlzifaT

The 35 hours in the viewfinder ?

A few hours before Edouard Philippe's speech, former President François Hollande had sent a clear signal: "You imagine saying to staff who worked without counting their time, who worked overtime sometimes unpaid […] : 'You know, we must cut the 35 hours?' […] Please, let us keep what is perceived as a social asset ". Introduced by the Jospin government in the early 2000s for all businesses, the 35-hour reform is one of the most emblematic measures of the French left. And a totem pole to shoot for the right.

For Frédéric Valletoux, president of the Fédération hospitalière de France, this political battle proved counterproductive for the hospital: "In the early 2000s, the left wanted to apply strong reforms, quickly before the presidential election. "It is certainly a social asset, but which has been experienced as a shackles in the hospital, which brings together professions and fields with very different rhythms. We tried to get everyone into the same box, which has and continues to pose major organizational problems. " 

A million day debt

The publication of the 2002 35-hour decree gave rise to local discussions within hospitals to reorganize work. Hospital staff often work well in excess of seven hours a day. There remains the question of recovery time to reach the 35 regulatory hours.

"When we do on-call or on-call duty, this generates recoveries which are integrated directly into our planning", explains Éric, operating room nurse in Lannion, in Brittany, "suddenly, we have recovery time without accumulating too much RTT ". If Eric is satisfied with his situation today, he readily admits that the management of leave poses big problems in certain establishments: "When I worked in the Paris region, we accumulated many more days and it was sometimes complicated to take them" .

According to the National Union of Nursing Professionals (SNPI), the AP-HP owed its 72,000 agents 1.3 million days at the end of 2018. For Virginie, a night nurse in surgery at the AP-HP, this situation is linked to the psychological pressure that weighs on the nursing staff: "Next week, I posed for days. But I don't know if I'm going to be replaced and that worries me. We are replaced about once in two, so try to work out with colleagues, but you can never be quiet, it can be calm, but it can also be hell for the workforce "she laments. "Ideally, we have a nurse for 10 patients, but we, at night, we are often left with a nurse for 15 patients. We know that it is dangerous, vigilance is not the same, or we are opposed accounting arguments. Yet if something happens, we will be held accountable. "

Faced with the aging of the population and the increase in chronic diseases, the public hospital widens its deficit, estimated today at 30 billion euros. At the same time, its businesses have lost in attractiveness. According to a survey by the Fédération hospitalière de France, published in 2019, 97% of public health establishments are struggling to recruit nursing staff, especially nurses, which sometimes limits the possibilities of replacement.

More "agility" for the hospital ?

During his speech, Édouard Philippe stressed the importance of a "pragmatic" approach, saying that working time "is not a taboo". According to the Prime Minister, a "change in usage" could allow us to find more "agility". But for Thierry Amouroux, a nurse at the AP-HP and spokesperson for the SNPI, the question of working time is a false debate: "The 35 hours are a social asset which was accompanied by the creation of 4,000 jobs for hospitals. This is undeniable progress, but it is not enough. Today, the effort must focus on the lack of staff, beds and upgrading of jobs, "he said.

A point of view shared by Vanessa: "If we increase the 35-hour limit, that means working more without these overtime hours being paid. However, this is unfortunately already the case. If we stay longer for treating a patient or because a colleague is late we are told that it is our fault, that we are poorly organized. We cannot always take our days and when we are paid for them, they are poorly compensated Working time is not a taboo subject, we can discuss it, but it is the tree that hides the forest. "

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