“This summer, like every summer, professionals have responded. Hospitals have ensured continuity of care and permanent emergency care despite the difficulties,” Arnaud Robinet, President of the FHF, immediately emphasized on September 3, 2024, during the Federation’s back-to-school press conference. Thus, according to a flash survey conducted this summer by the FHF, 46% of the 260 responding establishments noted a stability in the emergency situation compared to the summer period of 2023 and 15% an improvement. And this despite an increase in activity for 48% of hospitals (45% noted stability). Nevertheless, the problems encountered by the establishments persist: difficulties in accessing medical beds downstream of the emergency department for 66% of them and a lack of medical staff for 62%. Respondents also highlight the closure of other emergency departments which contribute to increasing patient flows (42%). They also point out the lack of involvement of other players in the health system: 54% of private clinics and 35% of private doctors and territorial professional health communities (CPTS) do not contribute to regulating the situation in the event of summer tensions in an establishment. However, these figures mask territorial differences. For example, Martin Trelcat, general director of the hospital group in Le Havre (Seine-Maritime), noted that CPTS general practitioners had set up 250 unscheduled care consultation slots per day in order to relieve the emergency department. On the other hand, Professor Jean-Luc Jouve, president of the medical commission of the Assistance Publique – Hôpitaux de Marseille (Bouches-du-Rhône), noted that private clinics in the center of Marseille had closed this summer, leading patients to go to the emergency room at La Timone.
Persistent recruitment difficulties
So what are the solutions to deal with these recurring difficulties? 64% of hospitals that responded to the survey have resorted to overtime and 48% to temporary staff. 34% have also implemented prior regulation by 15 and 31% have redirected patients upon admission. “We estimate that 20 to 20% of people who go to the emergency room are city residents,” noted Zaynab Riet, general delegate of the FHF. However, each year, emergency rooms record 21.6 million visits, 80% of which are provided by public hospitals. “In 20 years, this represents a doubling while the population has only increased by 10%. And 37% of these visits result in hospitalization,” added Zaynab Riet.
Although this summer’s results are therefore mixed, the FHF sees some positive signals on the attractiveness of the public hospital sector. A second survey by the federation concerns the recruitment of hospital staff excluding doctors. 311 establishments responded and two thirds have recruitment difficulties concentrated in certain professions, while a quarter say that these difficulties remain generalized. But this varies greatly depending on the profession: more than half of the establishments have no difficulty in hiring payroll or purchasing managers and medical laboratory technicians (respectively 55% and 57%), but 44% have significant difficulties in recruiting nurses which lead to structural organizational changes within the team. However, the rate of vacancy positions continues to decrease, particularly for nurses with only 3% of vacancies in 2023 (compared to 5.7% in April 2022). Absenteeism is also down and has reached (all establishments combined) 9.5% (compared to 11.1% in 2022), the lowest level observed since Covid. Finally, half of the University Hospitals (CHU) note an increase in the recruitment of caregivers leaving school between summer 2022 and summer 2023.
Unfortunately, there are few improvements in the recruitment of doctors. The results of a third survey focusing solely on medical staff show that 98% of the 258 institutions responding report recruitment difficulties in at least one specialty. Among those most frequently cited (several choices were possible), geriatrics comes first, followed by emergency services, psychiatry, radiology, anesthesia, pediatrics and general medicine.
Finances still in the red
Added to this context is a sharply deteriorating financial situation. According to the FHF, the resources allocated to public hospitals are not commensurate with the costs it bears in fulfilling its missions. Worse still, the deficit of the establishments is expected to reach between €1.7 billion and €1.9 billion in 2023 and, if nothing is done, more than €2 billion in 2024. “This budgetary crisis constitutes a public health emergency,” Arnaud Robinet did not hesitate to declare. The Federation is therefore calling for an increase in the National Objective for Health Insurance Expenditure (Ondam) 2025 of around €6.3 billion for health establishments, i.e. + 6% compared to the initial Ondam 2024, in the event that it is not corrected in 2024 (the FHF is calling for an additional €2.4 billion for this year). For Arnaud Robinet, the urgent need is for France to “equip itself with a clear, assumed and multi-year strategy to improve access to care and prevention”.
Magali Clausener
