Closure of beds, lack of staff… For several weeks, even several months, hospital services have been facing strong tensions. To the point that emergency centers must now close at night or reduce their activity because caregivers are unable to receive patients for lack of means, deplores Patrick Pelloux, president of the Association of Emergency Hospital Physicians of France. Update on this crisis situation, linked only in part to the Covid-19 health crisis which has hit the hospital sector for two years.

What is the situation ?

“Many hospitals have one or more restricted or closed services”, acknowledged last Thursday Olivier Véran, the Minister of Health. Asked, his services were not able to give us figures. Latest example to date: the Bordeaux University Hospital (Gironde) has announced that it will no longer receive adult emergency patients at the Pellegrin hospital in the evening. Every night since Wednesday, from 8 p.m. to 8 a.m., they have been closed, except for those who have been directed beforehand by the 15th. human resources since the summer of 2021: many resignations, renewed contracts, departures…”

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In Laval (Mayenne), the lack of doctors forced the establishment to screen patients for eight nights during the month of May. According to Maxime Lebigot, nurse at the hospital center and deputy secretary Force Ouvrière, 91 positions are vacant out of the 2,257 jobs in the establishment, due to “resignations, requests for availability or work stoppages”.

What does the government say?

Olivier Véran believes that this tension in the hospital is not linked to a “salary problem”, but to a lack of “organization”: “There are positions, there are budgets, there are the money, there are salaries which have been increased to recruit these caregivers, ”assured the Minister of Health. For him, the crisis is mainly linked to “a problem of organization, bureaucracy, administrative burden”, to “a problem of fatigue” and a “very significant overload” of work linked to these last two years of pandemic.

The minister also points to a reinforcement of medical deserts caused by the numerus clausus. Abolished in 2020, this quota of students admitted to the second year of medicine reduced the number of private practitioners and led to “a greater postponement” of patients on emergencies.

What are the caregivers saying?

“The current difficulties are witness to all the dysfunctions encountered in the health sector for years”, denounces Rémi Salomon, president of the Conference of Establishment Medical Commissions (CME) of CHU. He lists: lack of staff, difficulties for patients to find an appointment with a city doctor, lack of beds in “downstream structures”, in “follow-up care” establishments. “We have stretcher beds in the corridors in which patients can spend more than 24 hours in unworthy conditions”, he illustrates, before lamenting: “The caregiver has the feeling of being mistreated. »

For nurse Maxime Lebigot, president of the Association of Citizens Against Medical Deserts, “the emergency crisis” is the “consequence of the exhaustion of caregivers over the past twenty years”. But “the coup de grace was the Covid” and the epidemic waves in the hospital.

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“The whole emergency system is derailed” and “the worst is unfortunately not behind but in front of us…”, also alerts the SUD-Santé-Sociaux union of the Bordeaux University Hospital. We are even running to “catastrophe”, protests the emergency physician Patrick Pelloux. “The situation is appalling. The state is going illegal. By law, every citizen must be within 30 minutes of an emergency service. When people have cardiac arrests, there will be legal proceedings,” he warns.

What solutions?

We must first, according to Rémi Salomon, “do everything to retain” caregivers “who throw in the towel because dedication has its limits”. For this carer, who recognizes the achievements, even insufficient according to him, of Ségur de la Santé, the solution lies in particular in better remuneration of staff at night, weekends and public holidays. It is also necessary to reintegrate into the medical teams the personnel ousted because not vaccinated, considers Patrick Pelloux.

Rémi Salomon finally recommends “better coordination between the hospital and the city medicine”. For the time being, he believes, “these are two worlds that turn their backs” when we should “coordinate all the caregivers of a territory”.