A MASSIVE restructuring plan for French healthcare will be discussed by the cabinet today.
“No hospitals will close,” said Health Minister Roselyn Bachelot.
“You can rifle through our drawers, even our safes and you will find no map of France with crosses through certain hospitals,” added one of her staff.
Entitled Hôpital, patients, santé et territoire the legislation will include measures to reorganise the health service – including a manager appointed to run each hospital.
The hospital manager will be in charge of the budget – a task currently overseen by the conseil d'administration.
A spokesman for the health ministry said: “At public hospitals, everyone has the power to oppose but no one has the power to decide.”
Under the changes the conseil d'administration will 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 wishes 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.
While the health minister has promised that no hospitals will close, some will become specialised in different fields.
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. Unions and socialists have denounced the move as a “privatisation” of healthcare.
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.
Intern positions will be opened up in every speciality and every university to help even the spread of students across the country.
Currently 80% of medical students work in the same area where they studied.
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.
Among the 33 articles, smaller measure will also include a ban on selling alcohol to under 18s and the sale of cigarette sweets.
The legislation will be examined by parliament at the beginning of 2009 under a procédure d’urgence which will limit the number of readings to one for the National Assembly and one for the Senate.
