Contribution

Mr. Minister of Health and Prevention,

Mr. Minister of Solidarity, Autonomy and the Disabled,

Madam Minister for Territorial Organization and Health Professions,

Your appointments have been widely praised, in light of your career paths, skills and commitments. In the coming weeks and months, you will be implementing reforms to the healthcare system, autonomy and inclusion.

The healthcare system, a source of pride for our country at the start of this century, is suffering despite having proved its resilience during the pandemic. In the eyes of many of our fellow citizens, it is deficient. Two issues stand out:

Medical deserts, a somewhat catch-all term that reflects a real difficulty in accessing medical expertise, which can lead to shortcomings in care;

The pressure on public hospitals, but also on all other establishments, is currently reflected in a lack of attractiveness and a shortage of skills.

Despite the Cassandras and the "Yaka" (translate: always more means), the remedies are known. In particular, they were set out by the President of the Republic himself in his speech of September 24, 2018, entitled "Ma Santé 2022" (My Health 2022). As a reminder, let's mention in no particular order the priority given to prevention, the evolution of professions and the transversality of care, the taking into account of patients' expertise, the primacy given to innovation and research. And yet, little real progress has been made, with Covid acting as a gas pedal of the issues, despite the financial outpouring from Ségur.

A fussy Jacobinism

If this is due to the powerful resistance to change of corporatism, the invasive standardization and bureaucratization, the sterile statutory competition between the public, private and not-for-profit sectors, there is one obvious fact that you, the Ministers of Health and Solidarity, must grasp: your ministry, your departments, are not capable of carrying out a real and effective reform.

Spearheading a fussy Jacobinism, the opposite of the agile regulator it should be, the Ministry has not been seriously reformed for nearly thirty years. Made up of departments like silos, the central administration is weak in inter-ministerial arbitration, competes with a plethora of Authorities, Commissions and Agencies that it does not regulate, and proves to be castrating vis-à-vis the ARSs, which are in turn suffering from bureaucratic contagion.

An in-depth reform of "Ségur" is essential.

Three months to review the organization

This should be the priority mission of your closest collaborators, the cabinet directors, and the new secretary general you have just appointed; supported by a small group of experts, devoid of potential personal interests and above all representative of the entire system, with the exception of the administration itself or the inspection bodies: institutional and liberal players in the field, industrialists, establishments, patients, territories, start-ups, to whom you will entrust a simple roadmap: to propose in three months an organization for an efficient, fluid and agile ministry.

This will not be a sufficient condition for successfully transforming our healthcare and medicosocial system, but it is at least a necessary one!

Didier Bazocchi (Vice-Chairman, think tank CRAPS), Sophie Beaupere (General Delegate, Unicancer), Nejma Chami (Heand of global medical affairs Grünenthal groupe), Philippe Denormandie (orthopedic surgeon, CNSA board member), Olivier Mariotte (Chairman, Nile), Vincent Olivier (President of the Recto Verso agency), Jean-Paul Ortiz (former President of the CSMF), Benoît Péricard (former Director of ARH Pays-de-Loire and CHU de Nancy), Isabelle Riom (medical intern at AP-HP, President of SRP-IMG), Guy Vallancien (Urologist, member of the Académie de médecine).