“We need a battle plan for health”

Baptism of fire for Arnaud Robinet. Ten days after his election as head of the French Hospital Federation (FHF), the new spokesperson for the 4,800 French public hospitals and nursing homes will participate in the major conference on the healthcare system wanted by Emmanuel Macron, launched tomorrow in Le Mans , in the Sarthe. In his wallet, a series of proposals that he will submit to the Minister of Health, François Braun, on the occasion of the opening of the Health component of the National Council for Refoundation (CNR). At 47, this hospital practitioner specializing in pharmacology is far from being a novice, since he already chaired the hospital lobby for the Grand Est Region. The man is also a seasoned politician. Mayor of Reims since 2014, deputy for Marne from 2008 to 2017, the elected official recently left Les Républicains to join the ranks of Horizons, the party of Edouard Philippe, whose candidacy for the 2027 presidential election he supports. For his first interview as president of the FHF, the successor of Frédéric Valletoux warns about the state of the finances of public hospitals and calls for “reinventing the healthcare system”.

What do you expect from the National Refoundation Council which opens tomorrow?
While funding is a vital issue for all public health establishments, this will not be enough to solve the organizational problems of our healthcare system. We ask the government that this debate lead to strong, unprecedented and rapid decisions, to tackle the real problems head-on. We do not need yet another diagnosis: our health system is sick, we know its ills. We must reinvent it and set up a battle plan for health. For our part, we have carried out consultations upstream in all the territories, with our regional federations. We will provide the CNR with responsible solutions, from the field, which take into account the differences in access to care according to the health establishments. We will submit these proposals to the Minister of Health tomorrow. We do not want to be excessively hospital-centric. Organizing the sharing of the permanence of care is a major issue that deserves consultation with all the players, the private sector as well as city medicine.

Read also – Frédéric Valletoux on private nursing homes: “The public authorities do not have enough means of control”

How to respond to the challenge of access to care, while the territorial divide is widening?
We identify three priorities. First of all, human resources: we must assess and adapt our training capacities so that they best correspond to needs; review the place and role of the various health professionals; better share the drudgery of the guards and increase salaries. Second axis, the territories. The public hospital must be protected within the territorial organization, we cannot ask everything! It is therefore necessary to renew a dialogue with city medicine, the private sector and the unions of liberal doctors.
Should we question the freedom of installation of general practitioners to fill the medical deserts?
The question to be asked is: how to ensure that the population has access to care, by reducing the inequalities between the growing territories. Removing the freedom of installation is a sea snake that parliamentarians regularly propose for electoral reasons. On the one hand, it has not brought the expected effects at all where it has been implemented, such as in Germany. On the other hand, brandishing this idea at the moment when one claims to establish a dialogue seems dangerous to me! Above all, we risk robbing the doctors. We think that there are intermediate positions to be found at the territorial level, by articulating city medicine, clinics, hospitals. What is certain is that everyone has to accept compromises, to move the lines. People want results.

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All actors must take their responsibilities

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Are you in line with François Braun, who claims to want to “start from the field”?
Yes, it has to be custom made. The Covid-19 crisis has shown how the territories, each with their specificities, have taken care of patients thanks to tremendous cooperation between city medicine, public and private. Today, in some departments, the situation is very worrying in terms of access to care and continuity of care. Nearly 11% of French people have no attending physician. And depending on the territory, the ratio of specialists can vary from 1 to 6 per 100,000 inhabitants! But all actors must take their responsibilities. The public hospital, which provided more than 80% of the reception of Covid patients during the pandemic, at the cost of massive deprogramming and severe staff fatigue, also has problems with human resources and vacancies. adults: this is the case for 6% of nursing positions and 30% of hospital practitioner positions. Finally, our third priority is efficiency. The situation of public finances promises to be difficult in the months to come and our proposals will take this into account. In cities as in health establishments, we must adapt our methods of financing and secure them in order to make better use of public money.

Read also – Hospital crisis: these solutions to deal with the lack of personnel

Does the social security financing bill (PLFSS), which increases the hospital budget by 1.8 billion euros for 2023, go far enough?
We recognize the historic effort made with this increase in the ONDAM [objectif national de dépenses pour l’assurance maladie] hospital. But health establishments and nursing homes are worried about the prospect of inflation which could reach 6% and the costs of which do not seem to be fully compensated at this stage. This increase will weigh on current expenditure but could also jeopardize projects and investments already underway. In addition, public sector activity remains lower than before the Covid-19 epidemic. This non-recovery is explained by human resource tensions but also by the over-mobilization of the public during the pandemic. This destabilized the activity. However, the hospital financing guarantee system, which the government had put in place at the start of the crisis, will expire on December 31. The FHF asks that a transitional mechanism be put in place for two years, to protect the establishments most in difficulty. We also hope that all of the revaluation measures – increase in the index point, overtime, on-call duty, etc. – implemented following the “flash” mission on emergencies led by François Braun be taken care of by the State. .
What are your objectives for this three-year term at the head of the FHF?
I subscribe to the continuity of my predecessor, Frédéric Valletoux. I first want to federate the entire public health ecosystem and beyond, to establish a dialogue with the federations, the unions of liberal doctors and paramedics. I want to encourage concrete action to accelerate the transformation of our health system and guarantee its survival. In a pivotal period for the health and autonomy sector – for which we are calling for a law on old age programming – the FHF must play a watchdog role.