The negotiations of Segur of the health end, marathon covidien, which involved hundreds of associations, conferences, institutes, councils, government departments and other bodies. We thought rebuilding a health system in disarray, it has in fact solved a social issue with the trade unions, which have monopolized the discussions. Close the ban, the mass pay is so-called. Return to the starting point with a few euros more for everyone. Could it be otherwise in the face of the emergency economic and social looming on the horizon ?
In the midst of a pandemic, the former Prime minister and the minister of Health have made the best of their ability with what they had available in an environment that is execrable. Those who have laid the first stone of a trial announced should look in the mirror. But after the applause vespéraux, the curtain falls. It was only logical to raise the income of carers amongst the lowest paid in Europe. But, apart from the money, what advances in the organization of the health system have been discussed ? No. A-t-we discussed the transformation of businesses, doctors first ? No ! Has anyone considered another form of responsibility based on trust more than on the compliance with the standard and regulation ? No more !
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Walking back, all !
Walking back, all ! The simplification in the decision-making, who are still talking about it ? It perpetuates the hierarchical levels, we pelotonne in his little cocoon in a world where the digital and robotics chamboulent the gives. The hospital remains a frozen in a pattern that date from the past century. However, without a profound transformation of our entire health system, new pandemic or not, we charge right into the wall of a disintegration of the totality of our health protection have become unmanageable by its heaviness, its slowness, and its irrelevance to the contemporary world. The decline of quality and increase in the cost intersect in the three years that come.
Charivari ambient
The charivari ambient was not used to flatten the old habits, or reverse the wrong priorities and flatten the hierarchies obsolete. As to Waterloo, it was waiting for Grouchy, it was Blucher who is one-pointed. Germany has given us a masterly lesson of organization of health care, and industrial policy in the commitment of federal and federal-State that we should meditate in order to draw three lessons :
1. The urgency to reverse the order medical by first pressing the nurses, the nurses, the midwives, physical therapists, pharmacists, and professionals from the medico-social, these poor parents too often forgotten. Return the hierarchical pyramid by first making a call to the field staff, competent and dedicated to ensure the prevention, care, first-line, rehabilitation and reintegration in the active life. The doctor will still be the one, or the one that will have the diagnostics of the most difficult to formulate and direct the treatment of the most complex that it will not necessarily himself, of professionals specialized glass, taking progressively the relay given the digital evolution of galloping medical technology. This transformation will result in the need to train nursing staff in sufficient numbers, those that are treated today as ” paramedical “, as if they were “on-side” of the great doctor, for the board to occupations in responsibility for graduate medical. Direct result : a complete redesign of the health studies that splash out in a curriculum is complex and too long. Are we going to finally understand that it is pointless and costly to call a professional bac +12 to carry out acts which can be perfectly executed by the actors bac + 3 to 5 ? Promote these men and women who see the same patient, know him in his environment and accompany him all the days is the first of the transformations to operate.
2. The urgency to play in the nearby health with the regions and the departments in involving elected officials. Jean Castex has understood this and he will do it, but the money has to follow without having to go up systematically in Bercy and the freedom of enterprise must be displayed on the pediment of the institutions. Regional investment funds are not up to the stakes. About 3 000 health expenditure per capita a year, inject-in-1 500 directly administered loco-regionally, and keep the national funding for the crises and the major causes. The regional agencies of health which are not adapted to this change will need to make their moult. Finish with technocracy far to invent governance to be trusted to the actors.
3. The urgent need to revise our methods and places of production of drugs and other medical devices, to be ready for the next wave of where it comes from. A european vision is needed to accelerate the research of new products, including antibiotics, and the manufacture as a whole and not country by country.
The new Prime minister must take the subject by jumping over all the obstacles of legislative, administrative, academic and corporatist who stand in the way of two feet, the emergence of the evidence. In six hundred days, no desert should not persist in a condition to bring all the actors in the same dynamic. The money is there : we are throwing away every year about thirty to forty billion acts of medical and nursing unnecessary, according to the OECD. Use this “money crazy” advisedly. Restructure the supply of hospital bloated between real public and private partners without multiplying the levels of decision-making. Evaluate as soon as the start the relevance and quality practices. Release the energy and let it bloom for local initiatives. Restructure the regional agencies of health on a more operational level. Décloisonnons the ministry of Health.
The real battle begins, not against an invisible enemy nano, but against ourselves and our damn propensity to always complicate what is simple to undertake. Good luck, Mr. Prime minister, courage the minister of Solidarity and of Health, the nation loves you.
Guy Vallancien is a member of the Academy of medicine and president of the Convention on Health Analysis and Management (Cham).
