The dissolution of the National Assembly, caused by the defeat of the presidential camp in the European elections, initially stunned the whole of France. It now gives way to an unbridled legislative campaign which keeps the whole country in suspense with its incessant twists and turns. In the meantime, all current projects have been put on hold, including those in the health sector. Parliamentary work, National Council for the Refoundation of Mental Health (CNR), Pediatric Conference, birth plan, bills… All are, at best, suspended until the election, at worst, canceled and promised to be forgotten. We will have to wait until a new majority emerges, if it emerges, to see things more clearly.
The most emblematic example is surely the major societal reform of Emmanuel Macron’s second five-year term: the bill on the end of life. After debate for weeks by the deputies, he is finally buried, sacrificed on the altar of dissolution. Because the new elected officials of July 7 will not be those who are sitting today, and all of the work carried out on the text since April 22 will fall through the cracks. The only option: the new government will have to place the bill on the parliamentary agenda, which will in any case involve starting from scratch, or almost.
The necessary reform of the “stand-by” healthcare system
The fact is striking, but far from isolated. Above all, it hides a more global problem. Because the French health system has been facing, for years, a profound change which tends to transform hospitals into increasingly specialized technical platforms and to entrust prevention missions to community medicine. This requires a fundamental rethinking of the organization of access to care. If all the players in the world of health seem to agree to reform the system, the way remains to be imagined. “And there is an emergency,” warns Carine Milcent, health economist and CNRS researcher at the Paris Jourdan laboratory. Because the hospital is no longer able to carry out its missions and the practitioners no longer want to work there, as for community medicine – general practitioners, pharmacists, nurses, etc. – she feels that she is not sufficiently paid, especially as we want to entrust her with new missions. The first stage therefore involves discussions, some of which were carried out during different meetings, while others were to be held during the CNR mental health, scheduled for June 12 but ultimately canceled, or in parliamentary committees. “All these reflections were interrupted and postponed, at best. It’s catastrophic,” insists the researcher.
Illustration with one of the central debates: the delegation of medical acts. Which health professionals should take charge of the actions – and which ones – so far reserved for doctors? “Part of the answers were provided for in the current reforms, and some decrees were passed for midwives, such as the simplification of the practice of surgical abortions, and for nurses, with the possibility of signing death certificates or the possibility of carrying out new vaccines, extensions for pharmacists (prescription of antibiotics), or even ophthalmologists, physiotherapists and psychologists were in progress and have now been stopped,” adds the researcher.
The upheaval of the nursing profession will have to wait
The nurses, in fact, were impatiently awaiting details on the evolution of their profession, in particular the granting of new responsibilities. “The new bill (PPL), which was to be tabled this week and extremely significantly modify our profession, is canceled,” laments Sylvaine Mazière-Tauran, president of the National Order of Nurses. The regulatory work which was to accompany this proposal and which was to be translated into decrees of the Council of State and implementing orders is also obsolete. By domino effect, the suspension of this PPL calls into question the entire reform of the profession which has been expected for years. “It is a very big disappointment, especially since it was only the first step which was to open the debates on specialties (childcare workers, etc.), but also the training reform which was to be put in place in September 2025, continues the president of the Order We will have to wait for the future Assembly to know if the project is taken up as is, modified or abandoned.
The impact of the dissolution does not stop there, since even if the Valletoux law – which must respond to the emergencies of the moment, including the fight against medical deserts – has already been passed, all the implementing decrees which allow its implementation has not yet happened. “And in particular that on first prescription and direct access to nurses in advanced practice (IPA) without going through doctors, or on the creation of a role of referent nurse for patients suffering from a long-term condition , or the decree which aimed to authorize nurses to prescribe dressings without a doctor’s prescription”, adds Sylvaine Mazière-Tauran. The Order and the nursing unions are now trying to plead for the pending decrees to be signed urgently and for the orders to be published. Except that they are not the only ones and that there is already a traffic jam at the ministries.
Concerns about children’s mental health
Many specialists are also concerned about the fate reserved for children, particularly in the field of mental health. Since 2020, several reports and national organizations have warned of an increase in psychological suffering among children and adolescents. This is one of the reasons why the Pediatrics and Child Health Conference took place. “Already between the steering committee report written by the co-pilots and the ministerial announcements, very little has been retained, but in addition, the ministry had promised us that all unaddressed problems would be addressed during the CNR… which was canceled!”, deplores Christophe Libert, president of the Association of Infant and Juvenile Psychiatrists and co-pilot of the Pediatric Conference.
The doctor does not hide his “immense anger”. Especially since the request for a national strategy for child psychiatry dates back several years and meets a quasi-consensus, on the part of doctors as well as family associations, patients and even the Court of Auditors and the High family, childhood and age advice. “Everything was there so that we could finally tackle the problems head on and review the entire health system in a systemic way, but the project fell through and now depends on the elections,” adds -he. A tragedy, according to this expert, when mental health is one of the largest expenditure items and the majority of mental disorders take root during childhood, and must therefore be taken care of at that time.
French fertility postponed indefinitely
The major national plan for fertility, which had received a very broad consensus, will experience a fate that is barely more desirable, since the recommendations of the fertility report, commissioned by Emmanuel Macron, will only be partly preserved. “Despite the dissolution, the Ministry of Health should contact the High Authority of Health to accelerate the implementation of pre-gestational consultations which aim to identify risk factors 100 days before the birth of a child, such as the consumption of coffee, alcohol, tobacco, obesity, or even pollution in the workplace, the identification of endocrine disruptors including in makeup”, explains Professor Samir Hamamah, head of the reproductive biology department from Montpellier University Hospital, gynecologist and co-author of the report. The free “fertility check-up” consultation for young men and women should also be saved, although the age at which it is possible has yet to be defined.
For the rest, it’s unknown. The chapter on prevention, which aims to improve education and information at the individual and collective level and which provided for the establishment of a prevention day at school, is on hold. Just like the upgrading of the knowledge of health professionals, which should concern general practitioners, but also midwives and IPAs, in order to better identify and diagnose male infertility, which is still under-treated. The creation of a National Fertility Institute, which was to embody, prioritize, and supervise the proper performance of measures, has also been postponed.
“However, there is urgency here too: scientific studies show a significant drop in fertility, explains Samir Hamamah. In France, we went from 2.3 children per woman in 2010 to 1.68 today, while the population renewal threshold is 2.1″. According to this specialist, the problem is all the more serious as it concerns all countries in the world. “From 2060, the entire Earth will be, including in Africa – which is new – below the threshold of 2.1 children per woman. The world population is aging and the pronatalist policy must be rethought, which “has nothing to do with right and left, but concerns the future of our country.”
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