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00:00Now, it's been four years since the French government launched a plan to revitalize the
00:04health care sector.
00:06Some changes include things like more pay have been made, but as our Jolano de Souza
00:10reports now, France's public health sector is still far from being in good shape itself.
00:18This was the height of the COVID-19 pandemic in France.
00:22Each night at 8pm, lockdown residents across the country applauded health care workers.
00:28After years of austerity cuts, the sector had been buckling under the weight of the
00:31coronavirus pandemic.
00:34A shortage of surgical masks, gloves and personal protective equipment highlighted the bleak
00:38state of French health care.
00:40It was a grim reality which forced the government to act.
00:44We need to and want to go quickly.
00:47Looking at all the shortfalls, the calendar is tight.
00:50French health care workers were fetted on the national stage in 2020 and were honored
00:55during the 14th of July celebrations.
00:58But after months of grueling work during the first COVID wave, medical staff wanted the
01:03applause to cease and the government's action to start.
01:11After holding consultations with professionals in the sector, the government announced an
01:15overhaul to public health care.
01:18Among the pledges made was a 19 billion euro investment which included taking on 13 billion
01:23euros in debt from public health institutions, the hiring of 15,000 personnel, as well as
01:28the allocation of 8.2 billion euros to boost pay.
01:32There are demands which exist and are legitimate which we need to listen to.
01:38While the Macron government continues to meet hospital staff to learn how conditions can
01:42be improved, nurses and health care workers faced with an increasing workload and low
01:47pay continue to leave the sector en masse.
01:52Today we're asking ourselves questions if it's worth sacrificing our personal lives
01:56for this job which we all love.
01:59But can we in a few years continue to do this beautiful job?
02:02We don't know.
02:03Despite this shared sentiment, the government insists public health remains indispensable.
02:09Our hospitals and our health workers are a national treasure.
02:13While doctors in French public hospitals admit there has been a slight improvement to working
02:17conditions and pay, they say the government's goal of making the sector desirable in the
02:22face of competition from private institutions remains overambitious and is unlikely to happen
02:28overnight.
02:29Now, France 24 did attempt to reach out to the health ministry here in France to find
02:35out how much money had been poured into public health as well as to gauge how many new recruits
02:40have been hired.
02:41We have not received a response at the time that that report went to air.
02:44Well, we're going to talk more about the health care here in France now with Dr. Philippe
02:49Amouel, who's a public health professor at the University Hospital in the northern French
02:53town of Lille.
02:54Philippe, thank you so much for taking the time to speak to us.
02:58Four years ago tomorrow, May 3rd, that marks the end of the lockdown in France.
03:02Now, before we talk about the health care situation today, what are your memories of
03:06that time?
03:07Oh, that was one of my best time at the hospital, I must say, because everybody was working
03:13together.
03:14The hospitals listened to what the physician says because we don't know how to do anything.
03:21And it was a great time.
03:23And we saw that all this could give a momentum that could allow new organizations of the
03:32health care system in France.
03:34We had some projects, some elements, but really not enough.
03:40So here we are four years later.
03:41I mean, you're talking about that momentum.
03:44Did these promises for reform actually come to fruition?
03:47Are things better today?
03:50Oh, not so much.
03:52Unfortunately, we had some progressions, especially with what happened during the COVID and the
03:58lockdown.
03:59But as you saw, probably in France, we had five Ministry of Health during that time,
04:06during the last six years, which is not enough to build up a new politics in health care.
04:11So we have three major problems.
04:14One major problem is the availability of human resources to take in charge the health care
04:20system.
04:21So that's the first.
04:23What are the other two?
04:25The other two is the organization of the public hospital.
04:29Some of the hospitals are very old.
04:33People have a differential in salaries, which is very large with the private sector.
04:38They are working hours and hours, especially our residents.
04:44And we heard the resident presenting there.
04:46And they are just questioning their motivations to go forward as a medical professional.
04:53And that's a big risk.
04:55The third one is the state of mind of the populations.
04:59I'm not sure that the French population is really aware that we are going through this
05:05crisis.
05:06I can just imagine that they just have to take their phones, call their GPs and come
05:10to the hospitals.
05:11It's not anymore possible because of the lack availability of human resources for the health
05:17care system.
05:18OK, there's a lot to unpack there.
05:20Let's start with the money.
05:21I mean, money is always a bit of a taboo subject, particularly in France.
05:24But just to give our viewers an idea, one kidney specialist we spoke to in the public
05:28sector says he makes about 4000 euros a month, but that in the private sector in France,
05:34he would make five times that much, perhaps 20000.
05:37I mean, I hate to be crass, but but given those numbers, why would anyone stay in the
05:42public sector?
05:43I stay in the public sector for other reasons, because for the interest of the works, because
05:48you have some quality of works, you see different things to do this to have these high salaries.
05:55It's more, how would I say, rentability?
05:59You need to have written an investment very quickly for the clinics and you never precisely
06:06do what you need and what the patients exactly need.
06:09So that's a limitation.
06:11And that's one of the motivations.
06:12The second motivation is to teach.
06:14You need to have education of these physicians.
06:18And it's only in the public sector.
06:20Of course, some private sectors are participating on the practical positions, but all the theoretical
06:26elements and the research are done on the public side.
06:30So these are the different motivations, not only the money.
06:34Then let's talk a bit more about the resources, the human resources, like you said.
06:37I mean, we know that there are these what they call in French, deserts, medical deserts.
06:42And one part of this health care puzzle is is how hard it is to become a doctor in France.
06:47There are certain quotas for the number of medical students who can even become doctors.
06:52What's been done to increase those numbers, to get those doctors in place?
06:57Just to give you an idea, in the early 70s, France produced about 12,000 to 13,000 new
07:06physicians each year.
07:09At the end of the last century, it was only 3,500 each year.
07:15Now, with the new government, the last government, sorry, we are back to the 12,000 to 13,000
07:24new physicians.
07:25But to have the physicians, you need about 15 years to have a physician which is really
07:32operational.
07:33So actually, the lack of human resources is linked to 10 or 15 years ago, where we reduce
07:40the government, reduce significantly the number of physicians.
07:44And now we have, let's say, a hole that will last about five or 10 years, where it will
07:51be very difficult to have new physicians.
07:53Philippe, we only just have a few minutes left.
07:56Just for you, what is really the key issue, the thing that the government still needs
08:00to fix to get the health care system in France back on track?
08:05I think you need to discuss more continuously with the physicians, with the nurses, with
08:11all the staff involved in health care.
08:14That's very important.
08:15They will not find solutions immediately.
08:19We need to work together.
08:21We need also to work and educate better the populations, especially for all the question
08:25of the emergency, which is now the limitation in the system, actually, and then to build
08:30up a new health care system.
08:32I think we'll not find any satisfying solutions with one or three measures or even new billions
08:39of euros, because it's a whole system we have to rebuild now.
08:44And unfortunately, with the Ministry of Health lasting about one and a half years, it's very
08:50difficult to build up such a system like that.
08:52Right.
08:53So you think we just need to have a stronger health ministry, perhaps, and then things
08:56might get back on track?
08:58Yeah, not necessarily stronger, but that the government is giving more time to develop
09:05its hypothesis and its models.
09:07All right, Philippe.
09:08Thank you so much for taking the time to speak to us, Dr. Philippe Amouya, speaking
09:11to me from Lille in northern France.
09:13Thank you.