As the bronchiolitis epidemic in children reaches its highest level in ten years, the Minister of Health François Braun announced, Wednesday, November 9, the triggering of the Orsan plan, known as the “white plan” in all French hospitals. . Neuropediatrician at the Necker hospital, Mélodie Aubart, is part of the “collective of 7000 signatories for Pediatrics” having sent an open letter to President Macron in October, which has just published a statement. She explains the reasons for the collective’s opposition to this emergency plan – “an umpteenth bandage on a wooden leg”, according to her – which will have “serious consequences” on the state of the public hospital and on its patients.
L’Express: The Orsan plan is an emergency plan intended to help the public hospital to absorb exceptional health situations. Is that the case with this outbreak of bronchiolitis?
Melody Aubart: The bronchiolitis epidemic that we are observing is indeed greater than the previous ones: the peak is already greater than last year at the same period, and we know that the number of cases will continue to increase, until it reaches a proportion similar to the epidemic we experienced ten years ago. But the root of the problem is not there. The proof, the last epidemic of this size had not triggered the Orsan plan. Since Covid, this plan has been triggered at least once a year, which is completely abnormal and indicates a serious weakening of the public hospital.
What is the root of the problem?
On October 21, at the start of the bronchiolitis epidemic, our collective sent a letter to Emmanuel Macron, telling him of the poor state of French pediatric services. We then warned that we would not be able to absorb an epidemic of bronchiolitis this year, even if it had remained in “normal” proportions, while continuing to treat chronic diseases. And for good reason: usually, the epidemic season gives rise in pediatrics to an increase in the number of open beds, to reach 120% of reception capacity. However, for the past year, the pediatric departments of French public hospitals have been operating with 20% of beds closed, that is to say only 80% of beds open, for lack of staff and means. The government was therefore warned.
In these conditions, we have already had to postpone the care of children with chronic illnesses to accommodate those with acute illnesses, such as bronchiolitis. And this, from the start of the epidemic, and even though it did not yet exceed that of previous years. At the same time, we also had to transfer 38 children in intensive care because of bronchiolitis, to hospitals outside the Paris region, since the start of the epidemic in early October. This is more than in the whole of 2019. Transferring a two-month-old child to intensive care several hundred kilometers by ambulance is not trivial.
What will this white plan allow?
Concretely, this plan authorizes the administrations to change the destination of the beds: a surgical bed can become a reception bed for bronchiolitis, for example. Ditto for the allocation of personnel. It also makes it possible to cancel leave requests made by caregivers, and in extreme cases, to move staff from one region to another. This will once again be very hard to take for the healthcare teams, who have already been physically exhausted for three years, since overtime is used to make up for the lack of staff. They will have to intervene in areas that they do not know, which will exacerbate the feeling of doing their job badly, already created by the poor working conditions. This plan will effectively make it possible to accommodate more acute bronchiolitis in pediatric wards, but this will be done to the detriment of other patients for whom we will have even less room.
What are the consequences for patients?
The difficulty in coping with this outbreak of bronchiolitis is just the tip of the iceberg. Today, all patients are affected by the public hospital’s lack of resources. With the initiation of this plan, care as well as surgeries will be deprogrammed or postponed, as has already been the case many times since the Covid. Diabetic children, for example, who must be hospitalized when they are fitted with an insulin pump, will have to wait to receive this essential care for their life expectancy. The waiting period for pediatric spine surgeries, which has already reached 18 months, will be further extended. Patients with chronic diseases will once again become the adjustment variable and have to wait for essential care for their health, and that is unbearable.
Is this white plan useless?
This white plan is not useless, but it is not the right answer to the situation: it is yet another bandage on a wooden leg. A few days ago, the government announced 400 million euros in aid for services in difficulty. But it is still an emergency measure rather than a long-term measure, and we do not know how this money will be distributed. What is needed are concrete measures: structural investments, ratios on the number of children who can be cared for by a carer, for example. We need a commitment from the State on these issues. The government must also recognize its responsibility for the bankruptcy of the public hospital, which dates back well before Emmanuel Macron but which continues under his five-year term. This would relieve carers, who today live with the guilt of a job they cannot do well.
The small victory for us is that with the triggering of this emergency plan, the government admits half-heartedly that the public hospital and pediatrics are doing badly and do not have the capacity to absorb an epidemic which would normally be very well absorbed. But it’s a snowball, and this plan will have serious consequences for the hospital: as after the Covid, we can expect mass resignations when the emergency plan ends, since it prohibits any departure of caregivers until March. We keep repeating it, the caregivers are exhausted. To be able to treat others, you have to be treated well yourself, and it’s hard to hope that the young people we need today will be attracted to our profession under these conditions.