Arms, budgets, sorting: the “flash mission” on unscheduled care presented this Thursday, June 30 to Prime Minister Elisabeth Borne its 41 proposals to overcome a “high risk” summer in emergency services, due to staff shortages, according to the draft report obtained by AFP. This mission, commissioned at the end of May 2022 by Emmanuel Macron to limit the damage to emergencies, was entrusted to the president of the Samu-Urgences de France association, François Braun. It had identified in mid-May at least 120 services forced to limit their activity or preparing to do so.
The prescription of Dr François Braun is therefore now in the hands of the head of government. Dr François Braun presented this 60-page document during a “working meeting” in Matignon, in the presence of the suspended Minister of Health Brigitte Bourguignon, Health Insurance and the federation of patient associations France Assos Health.
The head of government must now arbitrate among these 41 recommendations supposed to “facilitate the management of this high-risk summer period”, which does not spare the large university hospitals such as Bordeaux, Toulouse and Grenoble. An indefinite “symbolic” strike started on Tuesday June 28 among caregivers at the Bordeaux University Hospital, one of the largest in France, to demand hiring and salary increases.
“Before you go, call”
To save what can be saved, while 22 million emergency visits were recorded in 2021, the “flash mission” recommends “regulating admissions”, either with “paramedical triage at the entrance” to emergencies, or by “systematic prior medical regulation” by the Samu telephone switchboard. The report even suggests limiting access in places to only “vital emergencies”, in particular at night, this “partial suspension of activity” which should make it possible to “pool the means of several services on a single site”.
The embolization of the urgencies is due to the numerous entries but also to the difficulty to leave there. The objective is therefore to facilitate the discharge of patients. For it, as revealed Le Figaro, the report recommends the compulsory establishment of “bed managers” (persons in charge of finding available beds) in all establishments having an emergency service and an organization of bed management at the scale of the territory under the responsibility of the Regional Health Agency (ARS). It also recommends improving the use of home hospitalization (HAD). A major information campaign on the mode “before you travel, call” is desired in parallel, as well as an “upgrading of the workforce” of medical regulation assistants (ARM) to absorb the increase to be expected in calls to 15.
As reported Le Figaro, the document also recommends creating in the city, whether in a practice or a nursing home, a complete and attractive alternative. For this, it is necessary to optimize medical time and increase the capacity to respond to the demand for unscheduled care in the city. This presupposes facilitating the activity of retired doctors or the accumulation of incumbent/replacement activity.
Other budgetary efforts are requested to better pay independent doctors in 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). Ditto 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. So many tracks accompanied by “impact indicators”, in order to decide at the start of the school year “on the continuation or abandonment of these measures”.
As mentioned Le Figaroit is indeed an in-depth overhaul that Dr François Braun is asking for, setting up a balanced collaboration between the city and the hospital. “Our health system must change paradigm, be dedicated to meeting health needs and nor to the organization of a competitive, costly and unsuitable care offer”, he concludes.