“President’s Lab”: what if we replace administrative positions in the hospital with hiring nurses?

In the context of the Covid-19 pandemic, the issue of health has become one of the main concerns of the French in the weeks leading up to the presidential election. The healthcare system in particular ranks second (32%) after purchasing power, according to a study by France Inter – Ipsos Sopra-Steria. And this can be seen from the numerous offers that Le Parisien received as part of its “Laboratory”. One of them, sent by Anthony, proposes to abolish administrative positions in the hospital and replace them with the hiring of nurses.

What are we talking about ?

Shortage of staff, closed beds, burnout nurses… “The situation is difficult” at the hospital, Health Minister Olivier Véran acknowledged at the end of October 2021 in Liberation. Positions more and more give way to liberals or employees in schools or companies. A survey conducted by the president of the Scientific Council, Jean-Francois Delfraissy, showed that today one in five beds in CHU and CHR hospitals in France will be closed due to lack of weapons.

The crisis comes from afar: the Covid-19 epidemic has only exacerbated the malaise of a long-suffering profession that has been warning of worsening working conditions for several years. And it is on the side of nurses that the situation is most critical: “between 3 and 5% of nursing positions and between 1 and 2% of nursing assistant positions are vacant,” Parisian Amélie Roux of the French Hospital Federation (FHF) recently pointed out.

In addition, the OECD notes that nearly 34% of hospital jobs in France are neither medical nor paramedical. Specifically, according to the National Institute for Statistics and Economic Research (Insee), these institutions average 14% administrative staff, 10% technical staff, and 9% maintenance staff.

Is it doable?

Can replacing administrative positions with hiring nurses help a hospital in crisis? “The problem is not the number of administrative positions in the hospital,” says Thierry Amour of the National Union of Nurses (SNPI), who recalls that most medical practitioners devote a significant portion of their day to administrative tasks, proof that these jobs are not oversized.

The problem, according to him, “is in administrative positions in the structure that manages the hospital.” And the nurse explained: “First, we have a hospital with its own management team, above there is GHT, which brings together a certain number of hospitals and which also has its own management team, again above the regional health agencies and their thousands of agents, then finally Ministry of Health with its 11,000 employees. A real administrative millefeuille! »

Frédéric Bizard, social protection economist, agrees: “There is an over-administration of the system, which is not necessarily due to the distribution between non-care and nursing professions, but due to the 2009 reform that nationalized system management. system and concentrated power in the hands of the administration,” he analyzes. “These senior government officials have redefined the medical care offering with Excel files, which has reduced the attractiveness of public hospitals. “Almost 30% of the places of educators are vacant there,” says the specialist.

“Today, we live in the logic of traceability, not quality, so the profession is losing its importance, and caregivers are leaving hospitals,” laments Thierry Amour, who reports a dangerous “hell circle” at work. “The more deviations, the worse.” working conditions for those who remain. And the worse the working conditions become, the more new beginnings you have. »

And abroad?

The share of non-carers in hospital staff is higher in France (33.6% in 2019) than in Germany (22%), Italy (25%) or Spain (23.5%). In French hospitals, 405,600 people devote themselves to non-medical tasks, “i.e. 54% more than in Germany, whose population, however, is almost 25% more than in France,” noted the liberal think tank Iref in April 2020. On the other hand, the share of non-medical personnel is higher in Canada (33.8%), Belgium (35.6%) and the USA (46.3%). But be careful, this data does not only apply to administrative staff, but to all technical positions in the hospital.

What are the candidates offering?

Presidential candidates are unanimous on hiring and reevaluating wages. Most of them also want to give doctors more power to manage hospitals and reduce the administrative burden.

The regional health agencies, which have come under fire during the health crisis, are on the radar of several candidates: far-right Marine Le Pen (National Rally) and Eric Zemmour (Reclaim!) leftists, Anne Hidalgo (Socialist Party), who accuses them in that they have become “accounting agencies that exist only to contain health care costs.”

Another point of convergence between several candidates with very different ideas: the abolition of all or part of activity-based pricing (T2A), which rewards institutions according to medical actions performed rather than a global envelope, in Yannick Jadot (EELV), Marine Le Pen and Jean-Luc Mélenchon (LFI). According to them, T2A created a “hospital-company” at the expense of the quality of service. More cautiously, Valerie Pekress proposes to change it “if necessary, in particular in relation to intellectual activity”, while Anne Hidalgo wants to replace it with “a government grant that takes into account the needs of local public health.”

“Candidates want to spend more because they have realized that health is an important topic, but no one has worked on this topic in the bud. This is the whole system that needs to be reformed,” Frederic Bizar said.

Eventually

Removing administrative posts and replacing them with hired medical personnel would not solve the crisis that has been shaking the public hospital for several years now. As evidence: a large number of unoccupied positions of nurses in these institutions or part of their working day devoted to administrative tasks. On the other hand, according to experts, there is indeed excessive administration in the structure that manages the state hospital, which contributed to the deterioration of working conditions and thus reduced the attractiveness of these institutions.