Hospitals warn France's healthcare system is at breaking point
French hospitals are warning that emergency rooms will close this summer due to staff shortages. A&Es that were full during Covid are now facing staff burnout, puting a strain on emergency services that some say are bearing the brunt of a more general disintegration of the French healthcare system.
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“We can no longer care for people the way we should. We can’t talk to them on a human level. We can no longer respond to their basic needs,” said Lucie, a nurse at the public hospital in Dreux, about 100 kilometres west of Paris.
Interacting with patients is even more important today, she says, because Covid restrictions mean that family visits are limited.
But she has so many patients to care for that she has no time to stop and check in on them and offer even very basic care.
“We don’t have time, either to give them something to drink, or help them contact their families. Or sometimes even to take them to the toilet. So we are no longer meeting people’s basic, almost vital needs.
"Personally, I am not doing well at all. I love my job, but I didn’t go into it to be inhumane. Some patients have told us: These conditions are making you inhumane. And it’s true.”
Voices from the front lines of France’s public healthcare system, in the Spotlight on France podcast:
Budget cuts over years
French public hospitals are reeling from massive staffing shortfalls – a problem that predates Covid, which added a strain on resources – as subsequent governments look to cut public spending by cutting into healthcare.
The French government spent 167 billion euros reimbursing healthcare costs in 2020, and healthcare represented 11.2 percent of France’s GDP in 2019 – higher than the EU average.
Accessible, good healthcare is a key part of France’s social structure, which people are willing to pay for through high taxes and social charges, as long as they get good healthcare in return.
But the care has been changing. The Covid pandemic put a strain on staff – some of whom were not allowed to work without a vaccine pass – which means remaining healthcare workers have been asked to do more with less.
Hospital workers staged a national strike at the start of June to draw attention on the problem.
“When we say we are fed up and we need more personnel, it’s not that we are lazy and want to twiddle our thumbs,” said Marie Rouseau, a midwife at the public hospital in Aubagne, a suburb of Marseille, in southern France.
“We know our jobs, we are health professionals and when we say there are not enough of us, there are not enough.”
Summer A&E closures
Hospitals have warned that staff shortages mean they will have to limit services or shut down this summer.
The French emergency services association SudF estimated in mid May that 120 emergency rooms are facing difficulties – a few have closed their doors altogether, and more than half have closed partially, at night or on weekends.
This has affected small structures, and even larger hospitals, like Bordeaux, which recently started turning away some patients at night.
But emergency services are just part of the problem. Anne Marie Lesage, the secretary general of the CGT union in the hospital in Arles, in the south of France, says many other services have been affected.
“We closed a whole geriatric service. Our maternity is struggling because there’s a shortage of gynecologists. We lost bed in psychiatry. We have 32 nursing vacancies,” she said.
Medical deserts
Hospital bed closures are due partly to consolidation, as small hospitals and clinics close and move services to larger ones in big cities.
This leaves behind what are called ‘medical deserts’, often in rural areas, where people are forced to travel far to get the care they need.
Emergency services are seeing the impact, as people turn up at A&E, even for non-emergencies, if they cannot find a doctor nearby.
Thierry Buquet, a CGT union delegate at the Dreux hospital, who works as a hospital porter, says the number of emergency arrivals has been on the increase, but the means have not kept up.
“When I worked in emergency services before, we did not see stretchers in the hallways” he said.
“We had enough beds to admit people into the hospital. They did not get stuck in the emergency room.”
"Public hospitals will no longer, in the future, fill in for the weaknesses of the entire healthcare system,” Frédéric Valletoux, president of the French hospital federation, said in a statement released at the end of May warning that 80 percent of hospitals are having trouble keeping beds open, either generally or in specific services.
Difficult recruitment
One solution to staff shortages is to recruit more, but healthcare work has become less and less attractive, with long hours and stagnating wages due to budget cuts.
Anne Marie Lesage, the union representative in Arles, says nurses are being asked to work 12-hour shifts this summer, night and day.
“They work 60-hour weeks, and are on the verge of burning out,” she said.
“They try to resign. Management refuses. It’s a catastrophe. People are quitting, as they have nothing to lose, and nurses can always find work elsewhere.”
This feeds a vicious cycle, with healthcare professionals quitting, leaving even more work for those who stay.
Patients are left with fewer options for treatment.
“Users are very worried because they sense the problems” said Michèle Leflon, president of the national coordination of committees to protect local hospitals and maternities.
“It’s more and more difficult to access care, whether it is urgent care or not. For pediatric psychiatry it’s catastrophic - there are year-long waits. It’s appalling.”
Overhauling the system?
The government has commissioned a report on the state of the public healthcare system, which is due to be presented on 1 July.
There is also a plan to pass a new law to reform the system, following on measures introduced in 2020 to address the strain caused by Covid.
Healthcare workers want significant wage increases, as well as a reorganisation of non-emergency care, to relieve the burden on A&Es.
In the meantime, ahead of what looks like being a complicated summer, the Health Minister reactivated Covid-era measures. They include doubling overtime pay for healthcare workers in July and August, allowing nursing students to start working before they receive their degrees, and retirees to go back to work.
Patrick Pelloux, the president of the association of emergency doctors, says there is a fundamental problem of inequality in French healthcare, which needs to be addressed if the system is to survive.
The wage difference between public and private healthcare workers has become too large, and “there’s an incredible social spiral – a form of social dumping between the wages for a doctor working for a private temping agency and one working in a public hospital.”
Pelloux, one of the first doctors to warn of the gravity of the 2003 heatwave that resulted in close to 15,000 deaths, said that the current system “means the summer is going to be dreadful.
"And if ever there is a heatwave, let’s not even imagine the disaster it will be.”
Reporting by Valérie Cohen, Aram Mbengue, Yoram Melloul.
Listen to a version of this story in the Spotlight on France podcast, episode 76.
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