Hospitals: Elisabeth Borne formalizes emergencies in degraded mode

This bodes ill for the rest of his term. For one of her first decisions taken from Matignon, Elisabeth Borne announced this Friday that she was retaining « all the proposals » from the flash mission led by Dr François Braun. The president of Samu-Urgences de France had been mandated by Emmanuel Macron a month ago to find solutions to avoid the collapse of emergency services this summer. However, the 60-page document released Thursday presents a « toolbox » which is more like a box of bandages to be placed on the gaping wounds of emergency services.

The recommendations are all short-term and aim to “regulate admissions”by cutting off the flow of patients upstream via « a paramedic triage » at the entrance to the emergency room, or by a “systematic prior medical regulation”, via the Samu switchboard. To do this, the number of medical regulation assistants (ARM) would be « upgraded » in order to absorb the rise to be expected calls on the 15th.

In this system, only the “vital emergencies” would have access to services, which could even organize the shortage by partially suspending their activities at night by pooling « the means of several services on a single site ». This drastic reduction in users’ access to this basic care would be accompanied by a major information campaign whose slogan could be “before you go, call”.

No obligation for liberal doctors

Staff participating in this attrition of resources would be financially rewarded. Small for hospital staff, with a revaluation of night work and bridges on July 14 and August 15, as well as a bonus for psychiatric, pediatric and gynecological emergency teams. A little more for liberal doctors participating in the regulation (up to 100 euros gross per hour « tax-free ») and in consultation (with an increase of 15 euros per act requested by the Samu), city medicine does not not subject to an individual custody obligation.

The flash mission thus responds at least to the requests of “territorial regulation” and information and awareness of « the population on the proper use of hospital emergency services and on the use of unscheduled care » claimed a week ago by around twenty doctors’ unions who signed a forum (https://www.ufml-syndicat.org/les-medecins-tous-unis-pour-repondre-au-defi-de-la -crisis-of-the-health-system-communicate-joint-of-the-unions-27-June-2022/). But even one of its initiators, the president of the UFML union, finds only moderately his account. Jerome Marty, note “proposals that go in the right direction”but also regret “wishful thinking in the absence of effectors”or new reception capacities to meet the needs of patients.

« Questioning free access to care »

Appalled by the 41 recommendations, the CGT Santé denounces this report which “proposes to formalize all the operations in degraded mode which have multiplied in recent weeks in the emergency room: total or partial closures, filtering, instructions to patients not to come. For the first time, in an official document, the triage of patients is openly recommended (…). Service closure is presented as a new usual mode of operation for establishments. (…). The generalization of operation in degraded mode, without a doctor is also recommended. This involves, for example, replacing the SMUR emergency physicians with an ambulance nurse pair. » The union is all the more angry that « These measures endanger the population, the staff and lead to the questioning of free access to care and to further reductions in the capacity to care for the population ».

For the Association of Emergency Physicians of France, this report has only one objective: “Hide the real problem which is not an “influx” of emergency patients but the lack of beds for the 20% of patients who must be hospitalized. The difficulties and the workload in the departments are not linked to the patients who come on their two legs and who leave on their two legs, but rather to the most serious ones who wait for hours, sometimes days, on stretchers that a bed becomes free. We are paying for the policy of massive closure of beds which has resulted in the elimination of 100,000 beds in 25 years. (https://www.humanite.fr/societe/hopital/en-france-99-des-hopitaux-public…) »

For AMUF,“The most serious is the abandonment of the population to whom no one has asked their opinion. But she is legitimately angry. Not only does she have difficulty finding a treating doctor, but access to specialists is increasingly difficult and is generally conditional on the payment of significant excess fees and now the last services open 24 hours a day are closed. which still allowed them to be treated. To be clear, what is scandalous is that the search for so-called « solutions » has been entrusted to doctors and organizations very close to the government who are only there to validate a deterioration of public service under the guise of a » professional consensus”.

Stephane Guerard