MOnsieur the President of the Republic, the moral, organizational and budgetary state of the Assistance publique-Hôpitaux de Paris (AP-HP) is at its lowest. Staff are discouraged and many quit, including some of the best medical officials. Attractive, the CHU [centre hospitalier et universitaire] Ile-de-France has become repellent. It no longer fulfills its mission satisfactorily, despite the dedication and scientific quality of our hospital community.
In 2019, the “new AP-HP” was implemented. To cope with its poor budgetary results, the general management has introduced a new division of intermediate structures. The poles, renamed “medical-university departments” (DMU), went from 128 to 76, the hospital groups, renamed “university hospital groups” (GHU), from twelve to six. The creation of these ungovernable behemoths brought about the effects that the most lucid among us had foreseen: dysfunctions and additional disorder in an institution which already had many.
As expected, this reorganization, which only created unnecessary additional layers, did not improve the financial results. The optimistic budget forecasts made by the AP-HP headquarters did not materialize. The government was forced to replenish the funds of the CHU Ile-de-France, as it must do at the national level.
The second reform of the AP-HP management was to reduce the daily working time of healthcare teams, with the aim of reducing the number of working time reduction days (RTT) and saving staff. The consequence was to shorten the phases of transmission between the teams, to lose the feeling of belonging to a department and to deteriorate the working conditions.
An archaic recruitment policy aimed at delaying recruitment as much as possible, as well as increasingly difficult working conditions mean that hundreds of nursing positions are currently unfilled. As a result, beds are closed in an unprecedented proportion, up to almost 20%. Caregivers are increasingly forced to refuse medical and surgical care, some of which is urgent and vital.
Accounting obsession
The bureaucracy is constantly expanding. It is an old, systemic evil. It will not be fought by those who spread it. Multiplying a little more each year, the finicky, even absurd regulatory requirements, as well as the paradoxical injunctions trickle down from the ministries to the regional health agencies (ARS), then inundate every nook and cranny of the hospital. The “managers” present in all unnecessary layers multiply hassles, meetings, irrelevant reports, irrational procedures, abusive requests, committees and sub-committees on any subject.
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