Caregivers and patients mobilized to save “access to care for everyone, everywhere”
Caregivers and patients are not left without reaction to the last three decades of deconstruction of the public health service: “ There is a whole series of refusals, a whole interesting effervescence », notes the economist Bernard Friot.
A national network of “effervescence” locale
The subject of the public hospital concerns us all, yet the subject struggles to mobilize at the national level. This “effervescence” is especially palpable at the local level. « We dream of a national movement but with the current political climate, it is not simple. People do not believe in a global market, but rather in a local solution for their establishment »explains Michèle Leflon, president of the National Coordination of Defense Committees for local hospitals and maternity wards (CNCDHMP). This structure, which advances with the ambition to defend “ access to care for everyone, everywhere », was created in 2004, precisely to transform local struggles into a national movement: “ The objective was to bring together local committees that existed for a network which brings together around 70 committees. » This figure demonstrates – if necessary – the scale of the hospital crisis.
The Coordination lists on a map the establishments affected by service closures. 916 points were thus distributed throughout France, as of April 15: « This map is impressive, because it shows that services are impacted everywhere in France. And again, we cannot appreciate the departure of fragmented activities towards the private sector. For example, the Charleville-Mézières hospital no longer installs pacemakers. You have to go private, to Reims, 90 kilometers away. It is a representation of profitable acts monopolized by the private sector. »
Services saved by mobilization
Despite the mobilizations, the closures continue: “ It’s dramatic. » But these defeats must not overshadow the victories. In Marmande (Lot-et-Garonne), the announcement in 2021 of the closure of emergencies led to strong mobilizations: “ As a result, they continue to work. » Faced with strong opposition, “ the Vierzon maternity hospital is still not closed “. At the beginning of March, in Remiremont, a town of 7,700 inhabitants in the Vosges, more than 1,000 people took to the streets to defend their public hospital. « The fight is important because the ARS services do not want to make waves and sometimes back down »confides Michèle Leflon.
The president of the Coordination does not believe in a major reform which would deal a fatal blow to the hospital: “ All the levers for destroying the hospital system are already in place. The government understood that health was one of the priorities of the French. He nibbles little by little. » Mobilization is all the more difficult.
A complaint for culpable deficiency, “ to make the State face its responsibilities »
The CNCDHMP has joined forces with the Inter-Hospital Collective (CIH), in particular, to file a complaint for culpable failure by the State, the judgment of which is expected on May 23: “ We hope that the State will be condemned, as it was for the climate, to make the government face its responsibilities. »
Anne Gervais, practitioner at Louis Mourier and Bichat hospitals, co-founding member of the CIH, is in the same direction: “ We want us to examine the responsibility of the State, for it to make noise and for the State to be condemned so that we stop accepting the intolerable. What has been cut is unbearable for caregivers and intolerable for patients. »
Michèle Leflon, an anesthetist until 2012, experienced the disintegration of the healthcare system from the inside: “ It was gradual. But the main deterioration of the hospital system was the application of the Bachelot law or HPST law (“Hospital, patients, health and territories”), from 2010, with respect for the Ondam (National health expenditure objective). health insurance), the generalization of T2A (activity-based pricing), etc. We then moved from human management to strictly financial management of the hospital. » Solutions exist, however: « For doctors, income should be equalized between public and private and between specialties. We are also calling for a national strategy for the establishment of health centers, in order to avoid overbidding by different municipalities in installation aid. » We come back to this idea of care based on one’s needs and not on one’s means.
A democratic debate to relaunch
Marmande, Vierzon, Remiremont… Michèle Leflon is waiting for a political translation of these different movements. « It is not because the deputies come to the demonstrations that they will vote correctly to defend the hospital »she notes. A parliamentary commission of inquiry into the public hospital was launched in mid-April. After the failure of a request from the left, in the fall, she was led by Christophe Naegelen, co-president of the Liot group – Liberties, independents, overseas and territories, centrist group. The latter is president of the France-Qatar friendship group and signatory of a forum to denounce calls for a boycott of the World Cup in the emirate in 2022. He will perhaps be more open about hospital reform… in any case, Michèle Leflon prefers to keep the positive: « Any democratic debate can lead to something positive. We must move away from health decisions taken through 49.3. »
A law for more staff in the Assembly during the summer
It is in this direction that the CIH works behind the scenes. « We have four major demands: internal democracy, analysis of needs to estimate resources (and not the other way around), more beds and increased numbers. » The collective tries to pass these requests one by one: “ We met and insisted with the deputies and it bore fruit. On February 1, 2023, the Senate voted on the bill from Bernard Jomier (Member of the Socialist, Ecologist and Republican group), relating to the establishment of a minimum number of caregivers per hospitalized patient. », indicates Anne Gervais. The law was tabled in the National Assembly on March 19 by Sabrina Sebaihi, deputy of the Ecologist group. Anne Gervais hopes to move to the National Assembly in June or July. The opportunity to stop the dismantling of the public hospital. And even create new stitches? “ The idea is rather to tie knots to prevent the thread from being pulled… This is proof that all is not lost. »
Clement Goutelle
Illustration: Rémy Cattelain
Published in The Breach No. 8 (May-July 2024)
