Health service shake up details

THE health service is set for a massive shake-up but no hospitals will close as a result, according to the government.

However Health Minister Roselyn Bachelot said the wide ranging reforms would see major changes for hospitals.

One of her staff said: “You can rifle through our drawers, even our safes and you will find no map of France with crosses through certain hospitals.”

The reforms bill, entitled Hôpital, patients, santé et territoire, has been approved by the cabinet and will be debated next year.

Under the bill, a manager will be appointed to run every hospital.

They will be in charge of the budget – a task currently overseen by the conseil d'administration. The conseil d'administration will then become the conseil de surveillance charged with overseeing the work of the manager.

The local mayor will no longer automatically sit on the conseil - as the health ministry wants to downplay the role of local politicians in the health service.

Doctors and MPs (many of whom are also local politicians) are likely to oppose this measure which could see them lose a substantial amount of their power.

The law will also create a new level of hospital organisation called communautés hospitalières de territoire.

These will rearrange the facilities of several hospitals to respond to the needs of the local population - with many becoming specialist facilities.

In principle the specialisations will be voluntary but the law allows the agence régionale - another new level of organisation – to push through the measures where necessary.

The agence régionale de santé (ARS) will oversee a large number of health services, currently run by several agencies. There will be one per region in France and will be headed by the region’s prefet.

They will regroup 8,000 staff currently working for bodies such as Ddass, Drass (which oversee the same areas on a departmental and regional basis), agences régionales de l'hospitalisation (ARH) and caisses d’assurance-maladie.
It will be able to organise conventions with private health groups to share facilities such as research labs, scanners and emergency wards. As well as hospitals and government functions, the ARS will also be in charge of retirement homes, town doctors and disease prevention projects.

While the ARS will not end the freedom for doctors to establish practices where they like, it will help certain doctors and specialists move to help the distribution of healthcare.

To counter a lack of doctors, hospitals and agencies will be allowed to take measures to ensure healthcare continues.

They will be able to offer new contracts to nurses which will allow them to do some jobs currently reserved for doctors.

Hospitals which find themselves with a shortage of medical staff will be able to offer “generous” recruitment bonuses on specific contracts, depending on the skill levels and fields needed.

While unions have criticised this proposals, the health ministry said that hospitals faced with such problems were employing foreign doctors from poorer countries to fill the gaps

Under the proposals, doctors will have to justify their reasons for refusing to see a patient with random tests carried out to check they were doing so.

They could also face fines if their fees beyond those of standard charges are deemed “beyond tact and measure”.

Medical professionals have described these last measures as outrageous.

Photo: Health Minister Roselyn Bachelot
besoin d'air