Patients’ group outlines solutions to A&E crisis at French hospitals

A shortage of doctors in private practice is a key cause of the hospital problem, says Claude Rambaud, vice-president of patients’ group France Assos Santé.

People struggle to find key services such as a GP “and the hospital is the only option left”.

Read more: How to get a weekend or out-of-hours doctor’s appointment in France

Any action is 15 years too late

She said it dates back a long time: “First, to the creation [in the 1970s] of the numerus clausus [a limit on numbers of medical student places – it was abolished in 2021], and from the end of the requirement for doctors to organise out-of-hours care [in 2002].

We already knew that, compared to doctors retiring, we weren’t training enough. We weren’t prepared.

“Today’s crisis has been amplified by the current [Covid] context and the tough working conditions in Urgences, but we can blame the last 15 years of government and health ministers for having left things to get as bad as they are today.”

Poor care was just accepted

She added: “For some time, we’ve had patients waiting on trolleys in A&E corridors so it’s pitiful nothing has been done.

“I recall a case going back 10 years of a patient who was suffering stroke paralysis and was on a trolley and it ended up much worse.

“When we started seeing that, it was just accepted – how is it possible? Fifteen years ago we had time for massive reforms.”

Patients and staff transfers impact care

Of the 127 hospitals facing “great difficulty”, she said many were small hospitals but might not have been at fault.

“I’m in Haute-Loire, where the Urgences at Brioude’s little hospital works well, but now a linked larger hospital has asked it to send emergency staff.

“They’re not OK with that. Little hospitals may be local people’s only source of healthcare, especially after 18:00.”

There are also rising cases of patients being moved to a different establishment, meaning care is disrupted. “I’ve not heard of deaths resulting but it could happen.”

Political courage to reinstate out-of-hours GPs

As for solutions, she said: “We need first to re-establish out-of-hours care in private practice. It will need political courage but we have to do it. It was a catastrophe to stop it.

“But if we do, we will have to pay doctors properly for working at night when the rest of us are in bed or at the weekend.

“We need more health professionals who can be trained quickly, such as so-called ‘nurses in advanced practices’ [trained to do certain specialised tasks, to take pressure off doctors], and nurse-anesthetists, who can take charge of emergency service patients, carry out shock treatment, etc.

“We can reinforce the Samu and Smur teams, and we must develop telemedicine, particularly via pharmacists.”

She added: “I think the government is now taking this very seriously but you can’t just create doctor posts instantly.”

Returning retired doctors not up-to-date

Regarding the new proposals, she said there are already many doctors who have been coming out of retirement to work again, as “many take their vocation very seriously and want to do what they can to help”, though sometimes she said they lacked training in the latest advances.

“But it’s going to be more and more necessary. It’s really a kind of general rallying call.

“We are in a difficult situation and anyone who is competent and who has the will to help is welcome.”

Unvaccinated nurses must not be reinstated

The fact that non-Covid-vaccinated staff were laid off had also had an impact, with “hundreds” of nurses affected, but Ms Rambaud said France Assos Santé believed they should have got vaccinated unless there was a medical reason against it.

“Covid is starting to pick up again and it’s certainly not the time to catch it in hospital because your nurse isn’t vaccinated.”

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