For the past three months, emergency departments across France have been hit by industrial action. Doctors, nurses and other healthcare professionals working on the frontline of healthcare have walked out over concerns about patient safety and their working environments. The stereotype that the French enjoy striking has come into its own recently, especially under the Macron presidency which has seen walk outs across the education, transport and health sectors.
Yet the protest outside of the French Ministry of Social Affairs and Health earlier this month saw a group of healthcare professionals injecting themselves with insulin, before being forcibly removed by riot police. It seems clear that tensions on both sides remain high, and begs the question if the voices of healthcare professionals are being heard at all.
The number of people attending an emergency department in France is growing year after year. According to French news organisation, LCI, the number of people attended emergency departments in France has doubled in the past 20 years, with 21.4 million attendances in 2017. An ageing population with more complex health needs, coupled with 6.8% fewer family doctors in the community since 2010, seem to be driving the spike in A&E attendances. Alongside the growth of patients, staffing in these clinical areas is falling. In fact, according to doctors and nursing striking, staffing has reached unsafe levels for the current demand, with patient safety being put on the line. The closure of beds across several hospitals across the country means that pressure on emergency departments has never been higher. As such, doctors and nurses have taken the decision to strike.
French healthcare professionals are not alone in Europe when it comes to industrial action. Last year, German doctors walked out over long, unsafe working hours, and salaries that did not reflect their roles and responsibilities. Catalan doctors, too, walked out in 2018. The junior doctor strikes in the United Kingdom in 2016 also highlighted similar concerns from medical staff about a proposed contract that would see them working more hours for less money.
Interestingly, the British Health Secretary at the time, Jeremy Hunt, is now in the running as one of the two potential candidates for Prime Minister. His relationship with junior doctors and NHS staff was tarnished during the strikes, with some doctors taking to social media to criticise his inability to listen to the concerns from those working on the frontline. Should Hunt win the leadership race, it will be interesting to see how he will seek to repair his ruptured relationship with NHS staff, and if he will attempt to build bridges with the wider public health sector.
Irrespective of borders, there is a moral and ethical debate surrounding medical staff going on strike. On the one hand, it could be argued that those striking are simply adding to the current strain being faced by the healthcare sector. If they are striking about poor staffing levels and A&E departments that cannot cope with demand, walking out will serve to put further pressure on the services. However, I would argue that medical staff only go on strike if they feet it absolutely necessary to do so, and if they feel that their actions would have a long-term benefit to the public they serve.
No one would become a healthcare professional to harm patients. I believe the fact that so many have chosen to go on strike - resulting in potentially patients being harmed - suggests they felt that all other options had been exhausted. As a group of professionals, it could be argued that healthcare workers are relatively powerless when it comes to fighting for safer working conditions. They are simply unable to strike for lengthy periods of time, because lives would be put at risk, going against their vocational commitment to helping others. The government knows this, which might be the reason why systemic issues around unsafe staffing levels and poorly resources clinical settings have been allowed to carry on for so long.
But are these strikes also a symptom of wider social issues in France? The Gilets Jaunes (“Yellow Vests”) movement continues to make global headlines, emphasising the current friction between government policies and French citizens. Whilst there have been some changes to policymaking, it seems evident that there are still problems that need addressing.
A growing divide between the highest and lowest socio-economic groups in France is often cited in relation to these demonstrations. People from lower socio-economic groups are at greater risk of developing poor physical and mental health conditions. Despite this group of society being most in need of these healthcare services, they are not always able to access it, and, given that the lights of an Emergency Department stay on 24 hours per day, it is sometimes the only place left for people to turn to in their time of need.
Obstacles to accessing medical services across various socio-economics groups has been at the forefront of public health research for decades; there is nothing ground-breaking about these observations. Yet, I think the current situation in Emergency Departments in France is another reminder of the intersection between social inequalities and the provision of healthcare services. This in turn results in a growing number of doctors and nurses suffering from burnout, long-term sickness - or leaving the profession altogether. The recent suicides of healthcare workers in France is a prime example of how poor working conditions can affect those in the trenches. By not addressing the causes of healthcare inequality, coupled with poor resourcing of the country’s healthcare system, the French government is allowing a further deterioration of social equalities and the country’s healthcare services.
Whilst the strikes by doctors and nurses working across France might seem like something that centres purely on the healthcare system, it is clear to me that these industrial actions are a symptom of a much wider societal problem in the country. The poor resourcing of hospitals, unsafe staffing levels and the closing down of hospital beds has resulted in a growing pressure on those at the coalface. These professionals, however, have very little agency to sound the alarm of what is happening behind the doors of their hospitals, due to the ethical implications of walking out. Moreover, social inequalities in France, it could be argued, are also partly driving demand on emergency services.
In order to treat this malaise in the French healthcare system, the government must act on the wider social issues that the country is facing. These widespread strikes by health workers are a warning sign of issues that extend beyond the hospital gates, but with a government that does not always seem prepared to listen, they serve very little use at all.
Hadley Stewart is a London-based writer, broadcaster and medical journalist
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