Question 12077 — health establishments

Summary

Mr. Steevy Gustave draws the attention of the Minister of Health, Families, Autonomy and Disabled People to the situation at the Sud Essonne hospital center. On November 3, 2025, the Île-de-France regional chamber of accounts made public its report on the Sud Essonne hospital center (CHSE), covering the financial years 2018 to 2025. This report highlights serious weaknesses in the organization, activity and financial situation of the establishment, resulting from the merger in 2011 of the Dourdan and Étampes hospitals. However, it adopts an essentially accounting approach, guided by a logic of financial profitability, which tends to minimize the fundamental missions of the public hospital service in a semi-rural territory. From the first pages, the report nevertheless recognizes that the CHSE “plays a determining role in meeting the needs of health of the population” of Sud-Essonne, a basin of more than 185,000 inhabitants marked by a strong medical underdensity. He also underlines the central role played by the establishment during the health crisis, recalling that the CHSE was the only hospital vaccination center in the Essonne department during the covid-19 pandemic. These findings illustrate the specificity of a local hospital in a semi-rural area, whose missions cannot be evaluated solely against the performance criteria applicable to urban establishments and in particular Parisian establishments. The report also admits that the population of Sud-Essonne "has an increased need for local medical services", a requirement which was precisely the basis for the merger of the two hospitals in 2011. It was then noted that each of the two sites had to meet all of the needs of the population. local, which implied maintaining active beds in Dourdan as well as in Étampes. However, this orientation has gradually been called into question. Since 2019, the CHSE has experienced the closure of 20 medical beds on the Dourdan site, in a context of persistent shortage of medical and paramedical staff. The report establishes a direct link between these closures and the drop in activity observed between 2018 and 2023, both in medicine and in surgery and obstetrics. He notes in particular that the closure of the Dourdan maternity ward did not benefit the Étampes site: almost two thirds of Dourdan patients turned to the Arpajon and Rambouillet maternity wards, leading to an overall reduction in the obstetrical activity of the CHSE (pages 25 et seq.). The Chamber goes so far as to recognize that the drop in activity in obstetrics and surgery is directly linked at this closure. The report highlights the decline in CHSE activity observed between 2018 and 2023, linked to the closures of 20 medical beds and the cessation of full hospitalization surgery on the Dourdan site since 2018, in addition to the closure of Dourdan since 2018, in addition to the closure of the maternity ward in 2015. These elements confirm that the transfer of activities from one site to another does not correspond not to reality territorial: the living areas of Dourdan and Étampes are distinct, with different historical, geographical and social dynamics and their areas of attraction only marginally overlap. The closure of services in Dourdan thus constitutes a failure, both in terms of activity and financially, contributing to the weakening of the entire establishment. On a financial level, the report shows a particularly degraded situation, with a cumulative deficit of more than 30 million euros over the period 2018-2024. The establishment is now forced to resort to external resources and borrowing to ensure its investments, revealing a worrying loss of financial autonomy. However, despite the observation of the failure of policies of concentration of activities on a single site, the regional chamber of accounts recommends the continuation, or even amplification, of the dismantling of the active beds at Dourdan for the benefit of the Étampes site. Faced with this critical situation, which threatens access to local care for an already weakened population, he asks her what measures she is considering to guarantee sustainable, balanced operation adapted to the territorial realities of the Sud Essonne hospital center.

Machine translation from French. The official text remains authoritative.

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