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HEALTH

How can France increase hospital ICU capacity to 10,000 beds?

French health professionals have greeted with scepticism President Emmanuel Macron's pledge that ICU capacity in the country's hospitals would increase to 10,000 beds to cope with rising Covid-19 hospitalisations.

Published: 2 April 2021 16:36 CEST
How can France increase hospital ICU capacity to 10,000 beds?
Health personnel at the intensive care unit of the Andre-Gregoire Hospital in Seine-Saint-Denis, outside Paris, treat a Covid patient on April 1st. Seine-Saint-Denis is the area suffering the highest pressure from the epidemic on hospitals. Photo: BERTRAND GUAY / AFP

On Wednesday, Macron outlined plans for an “extraordinary mobilisation” of the health sector in the coming days. 

Since the start of the pandemic, the number of hospital intensive care beds has been brought up to 7,665 beds from its usual base of 5,000. Of those, 7,053 are now occupied – 5,109 by Covid patients, according to Covid Tracker.

Health Minister Olivier Véran said the number of patients in intensive care could peak at 10,000 at the end of April. In comparison, at the peak of the health crisis last spring, on April 8th, 7,148 people were being treated in intensive care units across France.

During the second wave, intensive care patients peaked at 4,919 on November 16th. 

Healthcare issues

Increasing the number of beds to cope with rising Covid infections comes at the expense of non-Covid patients who needed medical help, several senior doctors have said.

“Theoretically, it is feasible, but to achieve it concretely it would take at least three weeks or a month,” said Alain Ducardonnet, a doctor and health consultant for French TV channel BFM.

Bruno Mégarbane, head of the intensive care unit at Paris’s Lariboisière Hospital, told French news channel LCI: “It can be done by transforming recovery rooms, operating theatres, or other sectors of medicine into new, temporary intensive care beds.”

The issue is not finding the beds.

Mégarbane explained the cost to staffing: “Doctors, nurses and anaesthetists would need to be redirected from operating theatres to these new beds.” 

It is estimated that 40 percent of non-Covid related surgeries have already been postponed to allow treatment for the number of patients with the virus. The health minister said last week that the aim was to increase this number to 80 percent in the greater Paris region Île-de-France, where hospitals are struggling to cope.

REVEALED: Just how bad is the third Covid wave hitting France compared to previous spikes?

Thierry Amouroux, spokesperson for the National Union of Nursing Professionals and a nurse at Saint-Louis hospital in Paris, described the knock-on effect. 

“When you postpone 5 percent of the operations, it is only cosmetic surgery [that gets cancelled], but at 40 percent, it starts to get serious, and when the [regional health authority] posts a target of 80 percent deprogramming, it touches on oncology (cancer treatment),” he told French daily Le Parisien.

Staffing and training 

Mégarbane said that, as well as current staff, the health system in France would have to mobilise its healthcare reserve, a list of 26,000 retired doctors, military medics and students at the end of their studies to be able to care for the number of people requiring the level of treatment and monitoring involved in intensive care.

But, then there is a question of training. Intensive care is highly specialised.

“In normal times, we can take less trained people and supervise them. Here we cannot, everyone is at the limit of what they can do,” Nicolas Bruder, head of the intensive care unit at La Timone hospital in Marseille, told BFM TV.

“So we need fully-trained people from tomorrow and we do not have them.”

Jean-Daniel Lelièvre, head of infectious diseases at Mondor hospital in Créteil told Le Parisien: “It seems completely unrealistic. We have the equipment and the physical space in the hospitals, but what will be lacking is the staff. 

“The president seems to say that we will find reinforcements, but will he learn resuscitation himself in two weeks? It is not my habit to criticise, but you should not announce anything.

“Going to 10,000 beds is a third more than the peak of last year. We do not know how we did it [then] and today staff are exhausted, while patients with other diseases are in a much more serious state because of breaks in care.”

Others have been rather more direct. These medics at the CHU de Nancy demonstrated their professional opinion of Macron’s statement in a tweet:

“We obey our president:

 – we make the effort

 – we move the walls to accommodate 10,000 ICU beds”

 

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HEALTH

The French government scheme that helps cover the cost of therapy

The French government launched 'Mon Soutien Psy' in 2020, in an effort to help people afford psychological care. In June, the scheme will be expanded.

Published: 29 May 2024 15:03 CEST
The French government scheme that helps cover the cost of therapy

What is ‘Mon Soutien Psy’?

It is a scheme that allows anyone aged three and over who is suffering from anxiety, depression or mental distress to benefit from psychological support sessions, the cost of which is partially reimbursed by the state.

Currently, people can benefit from up to eight counselling sessions in a year with the assistance of Assurance Maladie, as long as the appointment is done with a psychologist registered to the scheme. 

Previously, it has been difficult for people to find an available psychologist due to high demand. However, with the changes coming into effect on June 15th (increasing the price per session and the number of sessions covered, as well as removing the requirement to visit a doctor for a referral beforehand), the government hopes it will be more accessible.

That being said, patients must use the psychologists who are registered with the scheme, and as a result, English-speakers may be limited.

READ MORE: Ask the expert: How to find an English-speaking therapist in France

Who can participate?

Anyone who is “anxious or depressed; feeling unwell; with a smoking, alcohol or cannabis problem; or struggling with an eating disorder” can participate.

It is not intended for patients in emergency situations – ie those risk of suicide or dealing serious psychiatric issues. They will be referred to a psychiatrist or specialised facility.

How does it work?

As things stand in May 2024, the patient must first visit a doctor. This normally would be your GP, but it can also be any other doctor ‘charged with your care’, including other local GPs, paediatricians, geriatricians, and more.

After evaluating you, the doctor can give you a referral (courrier d’adressage) to a psychologist. This step will change in June 2024, and patients will be able to consult registered psychologists directly.

You can find the list of participating psychologists (HERE) to make an appointment.

Your first session will be for evaluation purposes. The psychologist will then determine the number of follow-up sessions (up to seven, but soon to be increased to 11) based on your needs. 

How much is reimbursed?

As with other medical appointments in France, you pay the practitioner and later receive a reimbursement. 

The reimbursement rate is 60 percent, and the remaining 40 percent is either out-of-pocket or covered by your complementary healthcare plan (mutuelle).

The fist session costs €40, and the follow-up sessions currently cost €30. However, starting in June 2024, they will be increased to €50 in an attempt to attract more psychologists to participate in the scheme. They will remain reimbursed at the 60 percent rate.

READ MORE: Health insurance in France: What you need to know about a mutuelle

If you are in the following situations, then you do not have to pay anything up-front.

  • Beneficiaries of the Complémentaire santé solidaire scheme ;
  • Beneficiaries of state medical aid (AME);
  • People with disabilities or long-term illnesses (Affection de Longue Durée – ALD) 
  • Pregnant women (from the 6th month of pregnancy);
  • People under care in connection with an accident at work or occupational illness.
How can I get reimbursed?

In the coming years, the system will be incorporated into your Carte Vitale, so you will not need to mail in any reimbursement forms.

However, as things stand, you must request a feuille de soins at each session and mail it into Assurance Maladie to get your reimbursement. You would also send this to your mutuelle, depending on your situation.

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