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One in five French A&E units face cuts or closure due to lack of staff

One issue is the shortage of private-practice doctors meaning people turn to the 'Urgences' for non-A&E work

“If people have no doctors, they go to the Urgences for any old thing” says APVF health spokesman Pic: NeydtStock / Shutterstock

Critical staff shortages have left more than one in five hospital A&E units in France in “great difficulty” with many forced to cut opening times or stop services altogether.

Unions and other groups fear this will get worse over the summer due to the influx of tourists along with staff holidays.

France ‘cannot run an A&E service properly’

The problem, first seen in smaller rural towns, has spread to several cities and many A&E units are no longer 24/7 services. 

The Samu-Urgences de France union said 127 out of 620 A&E units are struggling.

Association des Médecins Urgentistes de France spokesman Christophe Prudhomme highlighted Bordeaux: “The biggest hospital’s A&E unit is closed at night. People have to call the Samu and answer questions to see if their case is serious enough to go to A&E.

“We’re supposed to be one of the top 10 world powers, but we can’t run an A&E service properly. It’s a catastrophe.”

Government responded to strikes

The problem is widespread. The Association des Petites Villes de France (APVF) said smaller hospitals with restricted services include Sarlat, Dordogne; Guingamp, Côtes d’Armor; Jonzac, Charente-Maritime; and Sainte-Foy-la-Grande, Gironde. 

In Chinon, Indre-et-Loire, the hospital has suspended all activity, and Draguignan, Var, is shut at night.

Unions took industrial action in May and the government responded with proposals to let student nurses start work before receiving their diplomas, to encourage retired workers to return and to pay overtime at double pay. 

Read more: French hospital workers strike over ‘disastrous’ staff shortages

Read more: France announces ‘first measures’ to tackle hospital staff shortages

Another report is expected by July 1 but Dr Prudhomme said: “We’ve had dozens of reports in recent years.

‘French nurses salary worse than Mexico’

“It’s getting worse because state hospitals were already in difficulty before Covid, which involved a major mobilisation of personnel.

“After the first wave, we asked to keep the extra intensive care beds that had been opened, but they were closed again. 

“So we found ourselves in a crisis again in the second and third waves – and that has left its effects.”

He added: “The government supposedly took measures but it’s limited to a salary bonus of €180/month which not everyone got, and if you look at a French nurse’s salary, it’s worse than in Mexico. It’s not attractive. 

“We also have students dropping out of courses, and resignations from personnel who see no hope of improvement to their working conditions.

‘Patients die on stretchers’

“In my hospital, APHP in Paris, there are 1,500 vacant nursing posts – we have closed 20% due to lack of personnel.”

The A&E situation is made “catastrophic” by a lack of beds in the rest of the hospital, so people stay longer in A&E. 

“That means too much work for A&E staff, dealing with patients on stretchers – some of whom die on the stretcher due to lack of supervision. 

“The staff just can’t cope with working in these conditions anymore.

Population quadruples in holiday hotspots

“It will get worse this summer because the government isn’t taking account of how serious it is.” 

He said summer poses particular problems. “Patients increase, but staff do not. There are regions like the Mediterranean or Atlantic coasts where in some places the population quadruples. 

“When hospitals don’t have enough staff under ordinary conditions, they obviously won’t cope.”

Dr Prudhomme said they told the government in May “there will be deaths. It is clear that the situation is explosive”.

Massive training and recruitment drive needed

He said the most urgent solution was to ask doctors to organise out-of-hours care so only the most serious cases have to be dealt with by A&E.

“We also have to reopen beds and hire more staff, but this summer, like during the Covid crisis, we’ll have to put off some operations to the autumn so we can help the patients who arrive at A&E. 

“And we must plan for a massive training and recruitment campaign if we don’t want the winter and next summer to be worse.”

The problem is widespread, hitting many hospitals, in particular in the west and south west and in the Paris area. 

Samu-Urgences de France compiled a map, which you can see here.

A&E units react in different ways, from short closures to setting off plans blancs – a set of pre-laid emergency plans that see crisis units managing actions such as recalling staff on leave, delaying ‘non-urgent’ operations or redirecting patients to other units. 

Lack of general doctors pushes people to A&E

APVF health spokesman Xavier Nicolas is mayor of Senonches in Centre-Val de Loire and said he had been highlighting the need for action for 10-15 years. 

“However, people only start talking about a problem when they are confronted with it. There has been a clear lack of anticipation.

“The fundamental problem is the shortage of private-practice doctors so the Urgences pick up an enormous amount of non-A&E work. If people have no doctors, they go to the Urgences for any old thing.”

Mr Nicolas said this was not only in areas with poor medical coverage, the ‘medical deserts’. 

“In the evening or at the weekend, there are no doctors anymore. An out-of-hours service used to be obligatory but is now optional and doctors no longer do it. 

“It’s still obligatory for pharmacies but there’s nothing for doctors.”

Out of hours doctors work in ‘profitable’ towns

Some towns do have maison médicale de garde services but he said this was voluntary “in towns where it’s fairly profitable. In general, there is no out-of-hours service anymore so people go to the A&E”.

Asked about temporary closures, he said: “They’re overwhelmed. Everyone has to be ready to work but there are high levels of people off sick – some are still catching Covid, or other illnesses, some feel tired from work pressures – so they shut because there aren’t enough people to cope. 

“The same can happen in some other public services but when it’s the A&E lives can be at stake. 

Three-pronged solution 

“The first solution is to make GP out-of-hours service obligatory. 

“The second is to ensure doctors are better spread across France by saying they can’t opt to practise in an area with more than one doctor per 1,000 residents. 

“There’s no point going to Nice, Cannes or Mont­pellier, where there are too many – you should go 20-30km away, where there is room.

“The third is to let other health professionals deal with minor complaints. Pharmacists are now allowed to treat certain problems, such as ENT illnesses or cystitis so we must make more use of that.”

Mr Nicolas said his suggestions would resolve 75% of problems but tests of other ideas showed little effect, such as paying €19.60 to use A&E if not hospitalised.

Manage holidays and sickness better

Loss of unvaccinated staff had a “small impact” however he said “there were fairly few, maybe 3-4%. But when there’s a lack of staff that still has an effect.

“I’m not aware of cases of people who have died, but it could happen.”

Mr Nicolas called for a better eye on staff holiday and sickness levels. 

“Where there are too many off work, we must ask if there is a problem with human resources management and what the reason is – overwork, poor management… Some establishments work better than others.

“Staffing levels are only barely adequate, so once people are off work, things come to a halt.”

Minister not responsible for today’s problems

However, Mr Nicolas had sympathy for the new health minister Brigitte Bour­guignon, who lost her seat in the June elections and will be replaced in the coming days. He said she “picked up a situation that has been developing for 30, maybe 40, years.” 

Each government has looked at healthcare only through the lens of money, with reducing expense as the only goal, he added. 

“The minister today isn’t responsible for the drop in the number of doctors, for closed beds… They won’t be able to perform miracles. 

“It will take 10 years to resolve. They want to enable student nurses to start work sooner. It’s good, but it won’t revolutionise anything.

“In the meantime, it will get worse as long as we don’t have enough professionals.”

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