Healthcare staff in France say they fear their hospitals will struggle to find enough staff this summer and may have to close beds, due to a new law that caps salaries for locum staff.
The Rist law (loi Rist), which came into force at the start of April, caps salaries of locum staff at €1,390 gross per 24-hour shift.
It is intended to help hospitals manage locum staff pay, at a time when budgets are already stretched. It also aims to prevent locum staff from being paid far higher wages than permanent staff for the same hours.
Arnaud Robinet, president of the Fédération hospitalière de France, told FranceInfo that locum staff can cost public hospitals up to €2billion per year.
‘Teams are suffering’
But some say that imposing this limit has destabilised hospitals, at a time when they are already suffering from staff shortages following the Covid-19 crisis. This is because hospitals rely on locum staff to keep services open at all times.
Some hospitals - namely medium-sized, more rural establishments - rely on them more than others.
Hospitals in the greater Cognac area, for example, have 50 locum staff and 67 permanent members. In contrast, the CHU in Rennes uses only 0.6% of locum staff.
Jérôme Goeminne, president of the public health management union le Syndicat des manageurs publics de santé (SMPS), said: “Management teams are suffering, at the same time as medical teams and healthcare workers.”
He said that 20% of hospitals have already had to close beds or services as a result of the shortages, including maternity units in Sedan (Ardennes), Sarlat (Dordogne), and Guingamp (Côtes-d'Armor).
Similarly, locum doctor union le Syndicat national des médecins remplaçants des hôpitaux (SNMRH) said that 389 establishments have already had to close services, out of just over 1,300 across France.
Locum to permanent
Mr Goeminne said the hospitals in his group (eight establishments from Meuse to Haute-Marne) are seeking to solve the problem by trying to convince as many locum staff as possible to become permanent team members.
However, this takes time and resources, due to long interview and recruitment processes. Spending time on the recruitment of many staff members also means that other tasks, such as staff training, team organisation, and risk assessments, must be temporarily put aside.
And still, he said: “Like every year, we’ll be forced to close beds.”
His colleague Julien Bilhaut said that he will need to close 40 beds this summer, to ensure patient safety.
He said: “I don’t want to do a bodge job. I prefer to cut back and put a cap on it, for staff safety and to reassure them, because it’s a very anxiety-inducing time.”
President of the SNMRH, Eric Reboli, said that some services will definitely struggle this summer. He said: “It will not go well in some establishments.
“For example, in Bastia (Corsica), what are they going to do during the holidays? Declare a ‘white plan’ to requisition staff and stop everyone from going on holiday? Staff won’t like that.”
One medical business director, Julie Courpron at the CHU in Rennes, said that she would "safeguard the July and August holidays" of her teams, “but that it will be very difficult”.
She said: "We know that there will be many holes in our schedules. We are trying to share resources as much as possible, to ensure that all activities are maintained. We managed to get through April, but will we get through the summer? No one can say. There is already uncertainty about May and June.”
Similarly, the Laval hospital (Mayenne) is among those to have already announced that it will be forced to close beds in its emergency department for at least 10 nights in May, with only the most severe cases admitted from 18:30 to 08:30 throughout the month.
‘Less negative than feared’
Despite the tensions, however, some hospitals have found that the law has not brought the negative impact they feared.
Pierre Pinzelli, director of hospitals in Avignon and Cavaillon, said: “When they announced the bill, we had fears and questions. [But it came into force and] we have had no instances of staff stopping work, or changing their healthcare offer.”
He said that he has engaged in “dialogue with each doctor”, and offered them ‘motif 2’ contracts under the new law. These enable the salary cap to be raised to €1,700 for a 24-hour shift, with the approval of the Agence régionale de santé (ARS).
He said the law has affected how many locum staff work at the hospital. He said: “The ratios are changing. Before April, we had 65% locum staff in the emergency department and around 50% in other services. Now, this is the opposite. We have 15-25% locums in some services.”
France’s health minister François Braun has played down the issue. He told FranceInter: “There are tensions, but they existed already before the application of this law.”