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Eye on France: The health service is sick

Not a good day to have an accident. Staff in 90 A&E units are on strike.
Not a good day to have an accident. Staff in 90 A&E units are on strike. Ryan McVay/Getty

Health issues dominate this morning’s front pages. There are nearly 90 French hospitals without accident and emergency services today, because the staff are on strike in nationwide demonstrations timed to coincide with the review of the new health legislation by the French upper house, the Senate.


Left-leaning Libération looks at the crisis in French accident and emergency services, as hospital staff take to the streets again to complain about what they describe as a dangerous lack of money and personnel.

Clearly, last week’s conciliatory proposals by the health minister, Agnès Buzyn, have done nothing to convince the overworked doctors and nurses who man the nation’s A&E wings.

One trade union leader has described the minister’s promise to launch a “mission” to propose fundamental reform of the emergency services as “a huge joke,” adding that missions are a politician’s way of burying a problem.

Centrist Le Monde takes a different but no less thorny angle with a front-page headline warning that the social security deficit is growing again, and is likely to end this year in the red to the tune of somewhere between two billion and 4.4 billion euros.

This was to have been the year in which the social security budget finally broke even, after 18 consecutive years of debt. The prime minister had even gone as far as promising that the enormous money machine which pays health, pensions, family allowances and social welfare would actually be making a net contribution to the national coffers from next year onwards. That now looks extremely unlikely.

Right-wing Le Figaro blames the looming financial disaster on two things: the general economic slowdown means that less cash has been coming in, and the various emergency measures promised to the Yellow Vest protestors will result in an awful lot more going out.

It's all money, stupid!

The problem in the emergency services is obviously financial too. The closure of under-budgeted hospital units around Paris puts additional pressure on those which remain open; many A&E doctors are deserting the public service for better-paid jobs in private clinics; some hospitals complain that staff are being drained from other crucial services by the constant pressure exerted by the emergency rooms.

Tired staff, out-of-date equipment and the anger of exasperated patients are just some of the daily difficulties mentioned by a sector specialist interviewed by Le Figaro.

Describing the whole system as under intolerable strain, one senior consultant warns that, for example, a sudden severe heatwave in France could bring the entire edifice crashing down.

To put the debate into perspective, the annual number of visits to French hospital accident services has more than doubled over the past two decades, from 10 million in 1999 to 21 million now.

While staff numbers have increased over the same twenty years, they are far from having doubled, says Le Figaro, without giving precise figures.

There are certainly fewer hospital beds available, which puts an additional pressure on those treating accident victims, since no one wants to see unfortunates emerging from intensive care obliged to spend their first days of recovery on a stretcher in a hospital corridor.

Le Figaro points to one structural problem which seems to underlie, perhaps even undermine, the whole debate.

The operational margin for French public hospitals, in simple terms, that’s the turnover minus the running costs, is set at 5 percent. According to the social affairs inspector, that margin needs to be increased to 8 percent, otherwise work conditions in public hospital generally, and accident services especially, will continue to worsen.

It all sounds curable, but serious. Nothing that a huge dose of money wouldn’t put right in the long term. We should expect no miracles.

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