Macron govt faces tough talks on French hospital revamp in wake of Covid-19

French Health Minister Olivier Véran has set expectations high for his first meeting with medical personnel over the future of the French healthcare system.

“We’ll go fast, we’ll go strong,” he said on Wednesday as he outlined his plans for reform. The Covid-19 pandemic has exposed the weaknesses of France's cherished healthcare system, which has seen its capacities cut and the burden on staff increased over the last several years.

In late March, French President Emmanuel Macron promised a “massive” new investment plan for public hospitals, with an eye to improving pay and working conditions for staff as well as patient capacity. On Monday, the health ministry will hold its first meeting to discuss the reforms with 300 representatives of unions and advocacy groups representing medical personnel.

To grease the wheels, the government has picked an ally to oversee the negotiations: Nicole Notat, a former head of the moderate CFDT labour union and a supporter of Macron during his 2017 presidential campaign. Notat has promised to seek the widest possible consensus in negotiations and to refrain from expressing her own positions.

Not all parties have welcomed her pick, however.

“This choice is a negative signal,” wrote Dr. Jérôme Marty, head of the UFML doctors’ union, on Twitter. Marty highlights Notat’s support in 1995 for reforms to the Social Security system under then prime minister Alain Juppé. The government backed down on key provisions of the reforms after they provoked the largest strike movement in France since 1968. However, it passed measures seeking to reduce the overall deficits of the Social Security system, which also funds hospitals. Critics say the budget cuts took a heavy toll on hospitals.

The controversy over Notat adds to what are already likely to be tense negotiations between the government and medical personnel, whose grievances date back long before the current pandemic.

Salary hikes

The negotiations also come after the government’s promise of Covid-19 bonuses for health workers met with a tepid response. Véran has since told the French weekly Journal du Dimanche that he wants to increase salaries, a longstanding demand from health workers. President Macron for his part has promised to end the “pauperisation” of medical personnel.

Currently, salaries for French nurses start around €1,500 per month — among the lowest in the OECD, putting France 28^th out of 32 on this measure. In a recent poll commissioned by a private hospitals’ federation, 55% of respondents said they supported increasing health workers’ pay.

Véran has said he wants to increase salaries in hospitals and nursing homes to “at least the European average”. Unions, however, are worried that the pay hike will only apply to nurses.

In an interview with the Journal du Dimanche, Frédéric Valletoux, president of the French Hospital Federation (FHF), also urged the government to “reduce the gap in pay between the public and the private sector, which weakens [public] hospitals”.

Working hours

The government has also put working hours on the table, saying it wants to remove the “straightjacket that prevents those who would like to work more from doing so”. This, too, is a demand put forward by the FHF.

Since 2002, French health personnel have officially been limited to a regular 35-hour workweek — a rule that unions are adamant about protecting. They say that working hours are already much longer in practice, and that insufficient staffing prevents health workers from taking their mandated paid time off to make up for the overtime. According to the SNPI nurses’ union, the hospital system for the Paris region alone owes its staff 1 million days of paid time off.

Hospitals the ‘biggest medical desert in France’

Valletoux, of the FHF, notes that thirty percent of positions in French hospitals are not staffed.

“Hospitals are the biggest medical desert in France,” he says, adopting a phrase normally used to refer to rural areas where health workers are lacking. Macron’s government hopes that boosting pay and improving career paths will help attract more personnel.

“Thirty percent of new nursing graduates leave the profession within five years,” says Thierry Amouroux, spokesperson for the SNPI. The unions blames working conditions but also inadequate management of human resources.

Staffing shortages lead to bed closures. They also require hospitals to hire temporary workers, who are paid higher than their salaried counterparts.

Staffing shortages and saturation of activity have emerged in recent years years as the main challenges for the health system in France, leading some doctors to resign in protest. In December, one intensive care doctor told FRANCE 24 he had resigned because he no longer wanted to “walk on a tightrope without a safety net”.

Funding

Despite the 1995 reforms, French hospital debt today is close to €30 billion. Before Covid-19 hit, the government had agreed to pay off a third of this debt under the annual Social Security funding bill (PLFSS). On Wednesday, Véran offered to slightly increase that sum to €13 million over three years.

Meanwhile, no sum has yet been specified for the “massive” investment plan Macron promised in March.

A further area being considered for reform is the widely criticised model known as “activity-based payment”, implemented in 2003. Under this model, hospitals bill Social Security for each medical procedure, which is coded with a given fee. Critics say the model is dangerous because it incites hospitals to carry out more procedures than might be necessary or to prioritise the best-paid ones to help balance their books. Others argue that it pushes hospitals into a “race for profitability”.

In a manifesto published on May 13, a group of MPs, including former members of Macron’s party, proposed reducing the share of hospital funding dependent on this scheme.

Timeline

Véran said he wanted the hospital revamp plan to be included in the next Social Security budget in September. Trade unions have already called this timeline into question.

“If everything has to be completed by July 15, the room for manoeuvre for negotiations will be very limited,” a union official told AFP.

Healthcare unions and advocacy groups are planning national demonstrations on June 16.

“We will stick to our demands,” the Inter-Urgences collective warned on Twitter. 

This article has been translated from the original in French.