No day passes without an accident, a scandal, tainting the immense work of hospitals. In the past, you could die of otitis in an emergency department or cold in a palliative care service. All the media are awash with alarming reports about the state of our hospitals, desperate but also organized individual calls from those who run the hospital services. Probably justified, since one of them, recently appointed Minister of Health, confessed that she would probably have signed one of their protest calls, a few weeks before becoming a minister (Appeal of 1,000) ...
Yet most solutions are known. Often painful, and demanding a lot of courage, therefore unpopularity, on the part of the one who will make the decision; which, probably, prohibits their implementation.
New testimony of the incipient anger, but still contained, this open letter. She is sent to Martin Hirsch by a set of "bosses" of the hospitals *.
It remains open for signature by all concerned physicians who wish it and your comments are welcome.
It should be remembered that Martin Hirsch is a singular character who, until now, was particularly notable for his atypical, rather enthusiastic, route: after becoming known to the Emmaus presidency - a very high official had illustrated by refusing to Nicolas Sarkozy to become a minister to remain free, and agree to become "High Commissioner for Solidarities active against poverty", in return for the creation of the famous RSA, the Active Solidarity Income, then " High Commissioner for Youth "; we owe him the youth plan of 2019.
His appointment to the general direction of Assistance Publique - Hôpitaux de Paris, the APHP, was greeted with great hope by most signatories of today's open letter. It is the initiative of a group of doctors, brought together by Professor Grimaldi, a leading diabetes specialist, professor emeritus of hospitals, now known agitator of ideas and feared. Probably not enough! Though…
It is now necessary to wait for the reaction of the director, thinking that this mountaineer of talent, which has as climbing playground chamoniardes needles, is certainly not intoxicated by his high office, and will not remain without reacting.
Dear Martin Hirsch,
We are addressing not only the Director General of Assistance Publique - Hôpitaux de Paris, but the political personality known for his commitment to the poor and excluded, to you who know that the public service is the wealth of those who have none. Inequalities have become so great in our country that "we have never seen so much money rolling over for rent and luxury, and money refusing so much to work and poverty" (Charles Peguy) , so much money to roll for the profits of the CAC 40, and the money to refuse at this point to the hospitals and the EHPAD.
May the Director General of the APHP not forget the cause of the committed politician. The deficit of the APHP, like that of the majority of hospitals in France, is not due to the incompetence of the directors, to the irresponsibility of the doctors, to the laziness of the staff, to the abuses of the patients, all stuck on their "privileges". It is wanted and programmed by the public authorities which, with one hand, decreases from year to year the tariffs (T2A) and endowments (research, teaching, centers of reference, precariousness) while on the other, it accepts , when it does not decide itself, the increase in charges (prices of drugs and medical devices, cost of equipment, repayment of loans, public-private partnerships, inflation of administrative rules to which must be added the upgrades and maintenance of buildings, categorical revalorizations ... that the hospital must finance).
The proposed measures will not solve the structural problems but will pay a little more patients and professionals: increased billing of individual rooms, not replacement of holidays, fewer doctors and nurses ... and with that, hope increase activity. As for the quality of care, your priority, your "red thread" say in your book on the hospital, failing to improve it, it will be measured through the multiplication of indicators. And if one adopts with 15 years of delay on the English and the Americans, the "pay for performance" (P4P), at the time when its promoters note its inefficiency, one will have to learn to cure the indicators rather than the patients. We do not leave the dictatorship of the figure and the requirement of "always-plus".
Dear Martin Hirsch, we expect a strong word and a courageous decision from you. Should not you be the spokesperson for the APHP professional community rather than relaying the old corporate hospital policy that the minister promised the end?
Is not this an opportunity for you to propose to implement without waiting the application of the new announced policy and to train with you all the APHP?
Of the 200 million APHP deficit, more than 100 million are due to unrecovered bills, many of which are not recoverable. This part must be paid by the State, unless now, we want that the hospitals replace the vital card by the visa card. Should we stop treating the excluded?
You have the legitimacy to ask the question.
Political and managerial leaders today recognize what they denied yesterday, namely the inflationary nature and rigidity of T2A, a brake to the modernization of care and in particular to the outpatient medicine. The APHP must volunteer to set up, as of January 2019, the annual allocation, inclusive, modulated for the management of chronic diseases, first step for pooled allocations with the teams of city care. The follow-up of patients with chronic diseases would greatly benefit from the delegation of medical tasks to nurse clinicians.
This funding at the annual endowment would be an opportunity for the APHP and the medical schools to implement a proactive policy to promote the relevance of care, unlike the prescriptive logic inherent in any fee-for-service in town and at all-T2A at the hospital.
There is no major structural reform without investments not only in premises and technical equipment, but first in human resources. To organize a territorial health policy on the basis of the graduation of care and the elimination of duplicates, to group services and hospitals within modern structures, to develop the approval of emergencies and the approval of acute care, to help develop health centers and multi-professional first-line medical homes that work with hospitals, investment resources must be allocated and zero-rated loans authorized. We do it for the banks, why can not we do it for hospitals and for the health care facilities in the city? Is not it time for the directors of hospitals, EHPAD, health centers and for the leaders of the federation of health homes to ask this question?
Finally, Martin Hirsch, to make credible the new policy based on the application of fair care for the patient at the lowest cost to the community, it is up to you to make a courageous decision: the closure of the Hôtel-Dieu de Paris whose maintenance within the APHP is no longer justified. Beyond the symbol, this hospital is no more than a juxtaposition of activities easily located on other sites. Its non-closure is only an expensive political fiction. Certainly, the previous president had given you a mandate when you were appointed to head the APHP. But the APHP no longer has the means to ensure the survival of this building emptied of its patients while the Parisians attend the slow decay of this historical heritage. If the Hôtel-Dieu is to be reborn, it will be on a project outside the APHP. In the meantime, it is not up to APHP staff to pay the price for the political aboulie.
All this is an emergency for the financial health of our institution, but first of all for the health of the caregivers, a condition for the maintenance of a quality care offer for all. You are committed to improving the quality of life at work. The loss of meaning when the performance objectives go before the end of the care, the revision of the working conditions making more difficult or preventing teamwork, the lack of recognition of the efforts made, aggravate the suffering at work.
Dear Martin Hirsch, you will understand the hope that we put in your power of political intervention and you will excuse the freedom of our interpellation. Believe in our respectful feelings and dedication to public service hospital serving the public.
Jean-François Bergmann, Professor of Therapeutics, CHU Lariboisière
Jacques Boddaert, professor of geriatrics, CHU Pitié-Salpêtrière
Philippe Chanson, Professor of Endocrinology, Head of Department, CHU Bicêtre
André Grimaldi, Professor Emeritus of Diabetology, CHU Pitié-Salpêtrière
Philippe Grimbert, professor of nephrology, head of department, CHU Henri-Mondor
Etienne Larger, professor of endocrinology, CHU Cochin
Véronique Leblond, Professor of Hematology, Head of Pole, CHU Pitié-Salpêtrière
Catherine Lubetzki, Professor of Neurology, Head of Department, CHU Pitié-Salpêtrière
Ronan Roussel, professor of diabetology, CHU Bichat
Gabriel Steg, Professor of Cardiology, CHU Bichat
José Timsit, professor of endocrinology, CHU Cochin
Jean-Paul Vernant, Emeritus Professor of Hematology, CHU Pitié-Salpêtrière
Jacques Young, professor of endocrinology, CHU Bicêtre