FRENCH workers are fighting attacks on their pensions and health service.
French trade union federation CGT has raised the alarm over hospital closures.
On Saturday March 5, the population of the town of Guingamp, in the Côtes-d’Armor, strongly mobilised against the plan to close the 24-hour surgery department and the maternity ward.
Concern is growing in this Breton living area which has just over 73,000 inhabitants.
Peripheral hospitals, several tens of kilometres away, will not be able to absorb the activity of the services which would be eliminated at Guingamp.
If, for patients and their families, travel times would be increased, an entire territory could suffer in terms of attractiveness.
While the Covid pandemic has highlighted the extreme fragility of our country’s health and social system, what is happening in Guingamp is symptomatic of the government’s desire to continue the damage to public services.
In the agglomeration, after the police station of the city which was closed, many sectors experienced a real haemorrhage of jobs: La Poste, Public Finances … And today, it is the turn of the public hospital.
The case of Guingamp is not isolated, the closures of beds, services or hospitals continue everywhere on the territory.
It is a real methodical destruction of the territorial network that has made our health system one of the best in the world.
To date, with just six beds per 1,000 inhabitants, France is only ninth among countries in the Organisation for Economic Cooperation and Development (OECD).
The public hospital is sick and nothing is being done to improve the situation.
Due to the financial strangulation, hospitals are turning into veritable centres of profitability.
As the budgets of the health and social action sectors are essentially devoted to the remuneration of personnel, the inevitable consequences of this financial constraint are thousands of job cuts.
This is reflected in a profound deterioration in working conditions, in the context of the current health crisis. Staff are resigning from the public hospital and the number of sick leaves is increasing.
Also, the rate of vacant positions in public hospitals and medico-social establishments is between 2% and 5%.
There is an urgent need to change the logic to guarantee access to the healthcare system for all.
The crisis has shown that we need a better equipped public service, with more personnel and material means, financed by social security which covers all the needs of the population.
For the CGT, the health system must guarantee to each individual, whatever their financial means, their place of residence and their origin, access to quality care.
This can only be done by reconnecting with the origins of Social Security and the republican principle of solidarity resulting from the programme of the National Council of Resistance (CNR) ‘to each according to his needs, each must contribute according to his means,’ which are the fundamental basis of Social Security.
It requires daily attention to defend it, expand it to cover new needs (ageing population, loss of autonomy, child protection, professional social security, etc.) and to enrich it by including all forms of prevention.
It will be necessary to put an end to the commodification of health, and even reverse its process.
Some numbers that make you dizzy.
In 2018, according to a study by the Research, Studies, Evaluation and Statistics Department (DREES, 2019), nearly 4,200 full hospitalisation beds were closed in French healthcare establishments.
Over the period 2013-2018, no less than 60 public hospitals went out of business, and nearly 20,000 beds were closed . In 2019, the number of public establishments fell by 3.7%.
In total, over the past twenty years, the closure of hospital beds has amounted to nearly 100,000.
At the same time, since 1980, there has been a shift in healthcare from the public sphere to the private sphere. This is also the time when the first large lucrative private groups of retirement homes and private clinics were created: Générale de Santé, ORPEA.
Meanwhile, In a joint letter sent to the government at the end of July, five trade union organisations including Force Ouvriere (FO) and two employers’ organisations expressed all their fears regarding government ‘reforms’.
This consists in entrusting the Urssaf (Organisations for the Collection of Social Security and Family Benefit Contributions) network with the collection of supplementary pension contributions, a task hitherto carried out by Agirc (General Association of Supplementary Pension Institutions for Managers) – Arrco (Association for the Supplementary Pension Scheme for Employees).
In June, the report of a senatorial mission assured that the transfer is unfeasible as it stands and also pointed to the risks in terms of feasibility.
Employers and unions are asking that this reform be subject ‘to at least’ a new report. For its part, FO challenged this transfer project, enacting a centralisation of the collection of contributions, as soon as it was committed via the social security financing bill for 2020.
‘It seems necessary to us that the government be able, at the very least, to postpone once again the date of entry into force of this reform,’ this is one of the demands in the joint letter sent on July 28 by employers’ organisations and trade unions to Gabriel Attal, minister delegate in charge of public accounts.
The seven authors of the letter (FO, CGT, CFDT, CFE-CGC, CFTC, Medef, CPME) ask the government to reconsider its decision to apply on 1 January next the reform consisting in transferring to the Urssaf network the recovery of supplementary pension contributions currently provided by Agirc-Arrco.
This reform, which FO opposed from its launch, is carried by the social security financing law for 2020 (article 18) which initially provided for this transfer to take place on January 1, 2022.
However, in June 2021, the government citing the context of the ‘health crisis’, decided – under pressure from the unions, including FO – to postpone this decried reform for a year, consequently to postpone its introduction until January 1st, 2023.
‘It is not possible to complete the transfer to the Urssaf at the end of January 1st, 2023.’
But, behind the question of the postponement of the date with highlighting a context of health crisis, hides above all, and very badly, the difficult technical development of this reform which, in the end, nobody seems to want!
The initiative of the joint employer-trade union letter sent to the government speaks volumes about the fears that the social partners have regarding the feasibility of the reform. And they are not alone, says Force Ourvriere.
Thus, at the end of June, the Senate, via the Social Affairs Committee, reported the conclusions of a check carried out as part of the Social Security Assessment and Control Mission (Mecss). The authors of this work expressed their fears and asked for the reform to be postponed until 2024.
‘Given the issue of securing the supplementary pension rights of the 20 million employees affiliated to Agirc-Arrco, it is not not possible to complete the transfer to the Urssaf on January 1, 2023,’ assured the two authors of the report.
‘The reliability capabilities of individual data from the nominative social declaration (DSN) of Urssaf have been developed too recently to allow the implementation of the transfer, which is only of residual interest in terms of simplifying the procedures for companies and savings in management,’ they still asserted.
Continue or abandon the project …
It is these two points, simplification and savings – which are otherwise called ‘efficiency gains’ – that the government put forward to argue the reform, also advocated by the Court of Auditors, also seeing it as a means of reducing expenditure public.
In the senatorial framework, last June, the rapporteurs of the Mecss mission asked for a ‘clarification of the distribution of responsibilities between Agirc-Arrco and the Urssaf and of the observation of the quality of the reliability mechanisms implemented by the Urssaf’.
The president of the Mecss indicates for his part: ‘a third party, which could be the Court of Auditors, will have to note the progress of the Urssaf in the matter before the decision to continue or to abandon the project is taken.’
And the report points out the risks conveyed by the use of the DSN (Declaration Social Nominative – a social data reporting standard), ‘a unified declaration which has replaced 45 declarative formalities,’ and on which the ‘automatic payment’ of supplementary pension benefits would be based.
Thus, it indicates, ‘the family branch currently assesses the error rate in the DSN flow feeding its databases at 2%, a significant proportion’.
Concretely, the report considers that not only is the transfer of contribution collection ‘not strategic’, but that the risks it poses ‘outweigh the potential benefit of an improvement in collection rates.’
