five-years-later,-the-shock-of-covid-still-visible-on-the-french-health-system

Five years later, the shock of Covid still visible on the French health system

January 20, 2025

Activity not fully restored, difficulty in recruiting, financial debts: five years later, the shock of Covid-19 is still being felt in the French health system, deeply shaken despite the resistance it has shown.

In hospitals, while the pandemic filled the intensive care units, it also emptied the other departments, with a drop in hospital activity of 6.71% in 2020 in volume, which took a long time to catch up on.

While private clinics have returned to pre-Covid levels of activity in 2022, the situation has not been completely restored in public hospitals.

In 2023, the public hospital federation (FHF) still observes under-recourse to care in digestive surgery (-11%), cardiology (-13%), care related to the nervous system (-11%) and transplants (-7.5%) compared to the expected level.

A doctor with a Covid patient in the Lyon-Sud intensive care unit at the Pierre-Bénite hospital, September 8, 2021. (AFP - JEFF PACHOUD)
A doctor with a Covid patient in the Lyon-Sud intensive care unit at the Pierre-Bénite hospital, September 8, 2021. (AFP – JEFF PACHOUD)

"We closed operating theatres during Covid because there was no more activity (...) And when we resumed, which was gradual, we didn't reopen everything," explains Dr Marc Noizet, president of the emergency doctors' union Samu Urgences de France.

Behind this slow recovery lies an unprecedented human resources crisis.

– “Resignations” –

The pandemic "revealed" the lack of resources in hospitals and gave caregivers "hope for real change," recalls Thierry Amouroux, spokesperson for the SNPI (hospital nurses' union, CFE-CGC). "But when, during the deconfinement, the small managers returned to resume their savings plans where they had been before, it was terribly violent. There was a divorce with the white coats" and "resignations," he points out.

In 2022, the FHF counted nearly 6% of vacant nursing positions, or 15,000, an unprecedented number. The situation has eased somewhat since then, with the rate dropping to 3% in 2023.

But for Thierry Amouroux, these figures underestimate the reality. According to a calculation by the union based on the social reports of the establishments (including unreplaced sick leave, burn-out, etc.), 60,000 nursing positions remain vacant in public and private hospitals.

After the crisis, "pillars of service left, those who provided tutoring to young people... Because they lost hope," he sighs.

A caregiver takes care of a patient with Covid-19 in the intensive care unit of the Abymes hospital, on August 6, 2021 in Pointe-à-Pitre, Guadeloupe (AFP/Archives - Cedrick Isham CALVADOS)
A caregiver takes care of a patient with Covid-19 in the intensive care unit of the Abymes hospital, on August 6, 2021 in Pointe-à-Pitre, Guadeloupe (AFP/Archives – Cedrick Isham CALVADOS)

Financially, the hemorrhage of caregivers has forced the government to loosen the pay tap a little, to retain them. In 2020, the "Ségur de la santé" increased caregivers' salaries and planned investments in hospitals. An additional expense for Health Insurance, estimated at 13.2 billion euros in 2023, according to the Social Security Accounts Commission.

– “Sharing skills” –

But for many experts, these expenses are not financed, explaining a large part of the current deficit in health insurance.

"For the most part, these ongoing expenses have not been covered by the allocation of additional resources," soberly noted the annual report of the Social Security accounts committee in October.

The paramedical professions, led by pharmacists and nurses, regret that the promises of transformation and decompartmentalization of the health system made at the heart of the crisis, when all arms were requisitioned to screen, vaccinate and treat, have not all materialized.

Nurses, who were heavily involved and applauded every evening on the balconies like all caregivers during the lockdown, are still suffering four years later from a "lack of recognition", believes the president of the Order of Nurses, Sylvaine Mazière-Tauran.

Measures to give them more autonomy are being taken bit by bit (possibility of issuing death certificates, direct access to certain advanced practice nurses, etc.), but the overall reform of the nursing profession, promised by successive health ministers, is slow in coming.

For Gérard Raymond, president of the federation of patient associations France Assos Santé, the world of health has returned "too quickly to its old corporatism".

"At the time of Covid, nurses, doctors, pharmacists, physicians, knew how to collaborate, coordinate, set up remote consultations... They showed that it was possible. But today, the sharing of skills does not go far enough, not at all fast enough," he regrets.

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