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Sport The president of the French Hospital Federation: "We must put the human at the heart of the system"

01:59  24 may  2020
01:59  24 may  2020 Source:   lejdd.fr

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On the eve of a "Health Ségur", the head of the French Hospital Federation, Frédéric Valletoux , specifies the expectations of a world of health in crisis

Chaired by Frédéric Valletoux, the French Hospital Federation (FHF), with a thousand public hospitals and 3,800 medico-social establishments, will be associated with "Ségur of health "alongside representatives of hospitals, nursing homes and city medicine. These discussions announced by Olivier Véran open Monday for seven weeks. Objective: to respond to Emmanuel Macron's promise of a "massive investment and upgrading plan" for a hospital whose dysfunctions were cruelly felt with the Covid-19 crisis. In this perspective, Frédéric Valletoux proposes a "New Deal" for a fundamental reform of the health system.

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For twenty years, health reforms have been piling up without overcoming the problem. What do you expect from the opening consultation?

This is a historic opportunity! The government must learn from past mistakes. So far, reforms have had the art of avoiding the real issues. Funding, careers at the hospital, sharing of constraints between public and private, rationalization of expenses through the appropriateness of care or medical deserts. The worst would be a return to technocratic and economic management at the expense of the real needs of patients. And there is a major reform to be carried out for the elderly sector, with massive investment. The system must put people back at the heart of its operation.

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The Federation Council is formed of the heads of the regions.The legislative power is vested in the Federal Assembly.The executive power belongs to the Government.The judicial power is represented by the Constitutional Court, the Supreme Court and regional courts.

The dying hospital did miracles during the coronavirus crisis.

That's right. A dieter for ten years, victim of organized underfunding, the hospital has tackled the worst apnea crisis in its history. It only held thanks to the exceptional commitment of the professionals. But at what cost? The government must live up to what the hospitals have given. The real tribute to caregivers would be to not make fun of them with broken promises.

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The first medical desert in France is the hospital: nearly 30% of positions are not filled there

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Will the increase in earnings and careers announced be sufficient?

It's positive and it's emergency. Recognition must be given to nurses, nursing assistants, maintenance workers, by offering them more decent remuneration from the start of their careers. This must be commensurate with their social utility. The first medical desert in France is the hospital: nearly 30% of positions are not filled there. To encourage young people, the FHF offers a "shock of attractiveness". There is also a need to reduce the pay gaps between public and private, which weaken hospitals.

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The thinning ranks of doctors and nurses, particularly in Spain, are hampering the ability to fight the epidemic, straining hospitals and raising fears that health workers are spreading the coronavirus. At the smaller Igualada hospital in Catalonia, a third of the 1,000 hospital staff has been sent home.

Should we tackle the 35-hour taboo?

Five years ago, we already asked for a consensus conference on the organization of working time. It is necessary to be able to get out of the national shackles to introduce exceptions to the 35-hour week while respecting social dialogue.

What are the priorities of the "New Deal" you are proposing?

We need a complete overhaul of the health system, by tackling the bureaucracy that undermines it. We will not solve the emergency crisis without asking the question of the place of city medicine ... The priority is to reform management and governance, with a "simplification shock". Between the ministerial directorates, health insurance, national and regional agencies, the organization is illegible. It's Ubu King!

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It is necessary to be able to get out of the national shackles to introduce exceptions to the 35-hour working week while respecting social dialogue

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With the coronavirus, doctors have taken power in the hospital. A track to dig?

Caregivers must be given more care time. The administrative system, and in particular the steering by the regional health agencies [ARS], infantilizes the managers of the hospital. This normative inflation also weighs on city doctors.

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And he had witnessed the “personal courage not just of the doctors and nurses but of everyone: the cleaners, the cooks, the healthcare workers of every description “That is why we will defeat this coronavirus and defeat it together. We will win because our NHS is the beating heart of this country.

To "debureaucratiser", do you advocate local governance?

The coronavirus crisis revealed the powering up of the state apparatus, with a loss of energy. The ARS have sometimes shown operational failures. The idea is to move from a hypercentralized system to a system that trusts. The strategic State fixes national rules and health objectives by territory, evaluated a posteriori, but it leaves it up to the actors in the field - doctors, nurses, pharmacists, hospitals, elected officials ...

On funding, what solutions?

The subject is not the red cloth for activity pricing [T2A]. Certainly, there are malfunctions that need to be corrected. But our compass must be relevance: better finance the relevant acts and not the 30% of unnecessary acts. We must move from an accounting logic to a vision of public health; overhaul the obsolete construction of Ondam [national target for health insurance spending], the 200 billion euros spent on the health system; to finance the course of care, not the act; and, why not, create regional spending targets.

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The administrative machine stifled the initial ambitions of the My Health 2022 plan

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The recovery of a third of the hospital debt was to encourage investment, it did not work.

The original idea was distorted, and the central administration wanted to use it to fill deficits. Investment in hospitals, at 4 billion euros per year, has never been lower. Increasing it by 2 billion a year is imperative.

How to avoid such pitfalls at the end of the "Ségur"?

I hope that the President of the Republic will be more voluntary in the implementation of the reforms. None of those announced eighteen months ago in the My Health 2022 plan have been successful. The administrative machine stifled initial ambitions.

Are hospitals ready to face a second epidemic wave?

If it is large and close together, it will be difficult. My certainty: if we do not reform the health system, the next epidemic will overwhelm it.

Noël Le Graët, Jean-Michel Aulas and amateur football .
© Supplied by Sofoot It's Christmas before time. Since the announcement of the closure of Ligue 1 due to the coronavirus, not a day goes by without Jean-Michel Aulas criticizing this decision. An abnegation which slightly annoys Noël Le Graët who spoke at the microphone of the Canal Football Club : “We have known each other for so long, he sees me coming, I see him coming.

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