FILE. At the emergency room of the Alès hospital: “We are understaffed and working overtime”

Pressure on emergency rooms increases, year after year: 2024 should reach a new record, with 52,000 visits. ABET20240920J Midi Libre – ALEXIS BETHUNE

What does the health world expect from the new government?? With a deficit of 2 billion euros announced for the end of 2024, the public hospital is in difficulty. Lack of doctors, influx of patients who do not require immediate care, assaults… the emergency rooms of the Alès hospital are facing problems that successive ministers are struggling with.

A salad quickly swallowed, a brownie devoured during the lunch break taken well after the hour, his eye fixed on the phone that could interrupt the interview at any moment, Dr. Thomas Tatulli, 42, gets to the point, in a time that he knows is limited, in the apparent calm of the emergency room rest area of ​​the Alès hospital.

The new minister, still unofficial, this Friday, September 20, when the name of Geneviève Darrieussecq is actively circulating a few hours before her appointment, does not elicit any comment. “It won't change anything, politics, the Ministry of Health will come up against the cogs of a big machine, we have to deal with other ways of thinking”, suggests in a lapidary sentence the doctor, who arrived at the emergency room in Alès in 2012.

Emergency rooms, medical deserts, nursing homes… five projects under the microscope

"Health will be my priority": by making his first official visit to Necker hospital on September 7, Prime Minister Minister echoed the expectations of the population, health is still among the main concerns of the French.

Three weeks later, urgent files are piling up on the desk of Geneviève Darrieussecq, Emmanuel Macron's sixth Minister of Health (and access to care) in two years, who has already warned: “I will not perform miracles”. Structural reforms, acute problems of financing and resources, societal developments… the stakes are numerous.

The overhaul of the status of the independent nurse, which was to be studied last June at the National Assembly, is one of the victims of the dissolution, like the new paradigm, to be defined, of palliative care.

The question of the public hospital, which will end the year with an unprecedented deficit of 2 billion euros, is the eternal headache of any government.

Access to care, a “major focus” of the new minister's policy, is a challenge, given that one in ten French people does not have a primary care physician, according to a Senate report published in 2022.

And what remedy to ensure the proper functioning of nursing homes ? The system is also running out of steam, with 85% of public establishments currently in deficit, according to the FHF, the French Hospital Federation.

There are so many other projects… the recent strike of medical biology laboratories reminds us of this, as does the standoff with private clinics, which suspended their strike at the last minute on June 3, mental health, propelled to the “major national cause 2025”, the debates around state medical aid… are other stigmata of a deep malaise.

Midi Libre went to meet the actors, on the ground: in the emergency room of the Alès hospital, at the Les Caselles nursing home in Bozouls, in Aveyron, with Laurence Soulas, a private nurse in the Hérault hinterland, Laura Sendrous, a social worker in the palliative care team of the Grand Narbonne private hospital, in La Bastide Puylaurent, where a doctor and a nurse come once a month to meet the Lozériens without doctors.

Thomas Tatulli does not see how here, and it would be the same in a neighboring hospital, and even a university hospital, the situation would improve with a wave of a magic wand.

Dr. Thomas Tatulli, 42, arrived at the emergency department of Alès hospital in 2012: “Politicians won't change anything.” Midi Libre – S.G.

Long waits, lack of resources, difficult working conditions… the observation is known, and “magic money doesn't exist”, recalls Pascal Westrelin, assistant to a new director of the establishment, Christian Cataldo, both are required to have a right of reserve. Between two doors, Pascal Westrelin, evokes the upcoming restructuring of this emergency service where “Working conditions are not ideal”, despite the deficit at the Alès hospital, a situation that two out of three establishments are currently experiencing.

“I don't expect anything from people, it's the system that will give us financial resources”, the deputy director says, in the office of Sarah Moreniaux, a health manager in the emergency room.

“Everyone has worked long hours additional"

Those of Alès live with a deficit of half the doctors needed : "We need 24 emergency doctors, we are 12", and maybe 11, with an upcoming retirement. We must add "four general practitioners" ready to strengthen the team, explains Dr. Tatulli. For 48,000 people seen in the emergency room, to which must be added 16,000 via the Smur, but with the growth in activity, this will be a total of 52,000 at the end of 2024, +10% in one year.

But the summer was not so bad, or rather “better than last year”, while a survey by Samu-Urgences de France reports that 61% of emergency doctors report of a “degraded operation”. “The system is understaffed and working overtime. Everyone has worked overtime”, says the emergency doctor, who is doing the math: “For me, it's 400 to 450 hours a year, including 80 to 100 in the summer”.

Cost, budget, territorial inequalities… we know the findings on access to care, what answers will the new government provide ? Midi Libre – SOPHIE WAUQUIER

“For a whitlow, a sore throat, an ear infection, lice in the hair…"

It remains to deal with the aggressions, the evolution of the exercise, and we will not talk about salaries, “We earn a good living”, admits the doctor : “When I started, I did my job, emergency. During my last shift from 11 p.m. to 2 a.m., I had 40 admissions, five of which deserved to be in the emergency room. Today, 40% of the people admitted here are not emergency cases". A “societal problem" which brings people "with a whitlow, an ear infection, tonsillitis, lice in their hair"… and which also has to do with the fact "that it takes a month to get an appointment with your GP, eight months with a gastroenterologist", "that there aren't enough beds downstream".

"Last week, a patient pulled out a knife", the emergency doctor said again. The soothing messages and threats of sanctions displayed in the reception room are not always enough to defuse tensions, even if an "unlimited waiting time" is sometimes announced.

So, Thomas Tatulli would like "the private sector to participate fully in an emergency service", and for "general practitioners to resume 24-hour care, knowing that they are also understaffed, there are between 10,000 and 16,000 patients without a treating physician in the Ales basin.

If the Ségur de la santé has increased salaries, if night hours have just been revalued, the doctor is more critical of other recent measures, the creation of SAS, healthcare access services supposed to relieve pressure on emergency rooms, “a great idea on paper”, or the Rist law which accentuates the difficulties of teams by capping temporary rates.

“It is a health crisis that has made it possible to advance battles"

Sarah Moreniaux, the executive of health (in two words: who organizes the service), and Thomas Laroudie, nurse, often make the same observation: “Lack of general practitioners”, evolution of society, “lack of beds”…In France, 20% of hospital beds were lost in 20 years, between 2000 and 2020, according to very official data from Drees (Directorate of Research, Studies, Evaluation and Statistics), and the figures have been falling further since then: – 1.4% in 2021, – 1.8% in 2022.

But “we're not here by chance, I wouldn't work anywhere else for anything in the world, the work is very interesting, from childbirth in Smur to the end of life”, adds Thomas Laroudie, who arrived in the emergency room in the middle of the Covid crisis, four years ago.

What do they expect from Geneviève Darrieussecq ? “Pfff… always good words", Thomas Laroudie breathes. "There will be no immediate impact, politics is long term, I wouldn't like to be Minister of Health", adds Sarah Moreniaux, who points out that it is a health crisis, Covid, which "has allowed us to advance the battles and put us back at the heart of the negotiations".

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