Stretchers in the corridors and crowded waiting rooms. Day and night, winter and summer. The crisis is deep, the symptom has become unbearable. "By the end of next year, we must have unclogged all our emergency services," the president ordered.

Easier said than done. Because the hospital does not suffer from mild congestion: 20.4 million emergency room visits in 2021, compared to just over 10 million in 1996. Inexorable rise only stopped by Covid. Barring a miracle cure, the pre-crisis record (22 million) will soon be broken.

The head of state did not specify how to reverse the trend, but "we need concrete results in the short term".

Those most affected find it hard to believe. "The goal is unattainable," said Marc Noizet, president of the Samu-Urgences union in France.

In the absence of being able to "inject caregivers" to quickly increase the number of hospital beds, it will require "profound changes" of organization that will be "complicated to lead", he explains.

"With the current method, it is a pious wish," said Agnès Ricard-Hibon, spokeswoman for the French Society of Emergency Medicine.

On the other hand, "by listening to the emergency doctors it is still possible", she adds, provided "to apply the solutions" already proposed in 2019 in the "pact of refoundation of emergencies".

This plan, announced at the time after months of strike, was not enough to appease the anger of caregivers ulcerated by their working conditions. Nor is the general increase in the "Ségur de la santé" - 10 billion euros per year - granted in the midst of the pandemic.

"Going even further"

Treating emergencies will require taking out the checkbook. "It's playable", but "we will need concrete measures and immediately", warns Jean-François Cibien, president of the union Action Praticiens Hôpital.

"Much has already been done in recent months," says the entourage of François Braun, recalling that the measures put in place as soon as he arrived in the summer of 2022 (access to emergencies filtered by the Samu, increase in night hours) "have allowed our hospitals to hold" until now.

Nevertheless, "we must go even further," acknowledges the Ministry of Health, which has just opened a series of consultations with hospital doctors, supposed to conclude before the summer on crucial subjects such as salaries, careers and "the permanence of care" - evenings and weekends.

The government is also counting on "access to care services", associating Samu and liberal doctors, tested for two years in twenty departments, and which must be generalized by the end of the year.

But at the same time, the executive has chosen to cap the prices of temporary medical work, leading to closures - total or partial - of small emergency services such as Feurs (Loire), Vittel (Vosges), Pontivy (Morbihan) or Manosque (Alpes-de-Haute-Provence).

And the situation of hospitals is in "clear deterioration" with an overall deficit "around one billion euros in 2022", according to the latest opinion of the alert committee on health spending.

It will therefore take "strong actions to restore all its attractiveness to the public hospital," said the president of the Hospital Federation of France (FHF), Arnaud Robinet, welcoming "the voluntarism displayed" by the head of state while pleading for "better solidarity" with private clinics and liberal doctors.

However, the latter have other concerns, starting with the "arbitration rules" which must set their new rates, after the failure of negotiations with the Health Insurance. Their unions are invited Monday to an "information meeting" on this subject, said the UFML, demanding "a shock of attractiveness and financial".

© 2023 AFP