Question 14092 — hospital public service

Summary

Ms. Julie Delpech draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the situation of directors of health, social and medico-social establishments (D3S) and to the widening statutory and compensation inequalities between this body and that of hospital directors (DH). The reform of the senior civil service initiated in 2023 led, from January 1, 2026, to a significant upgrading of the careers of hospital directors. This development, legitimate in view of the need to strengthen the attractiveness of hospital management, has however not been transposed to the body of D3S, whose responsibilities are nevertheless recognized as comparable by the National Management Center. The consequences of this unequal treatment are now documented by the CNG in its statistical reports annual reports on the body of D3S: the number of active staff continues to decrease from year to year, the share of D3S choosing to detach themselves to the body of DH is continually increasing and the number of D3S on availability follows a regular upward trajectory. The balance between the body's inputs and outputs is structurally negative. This silent hemorrhage permanently weakens the management of medico-social establishments, to the detriment of the most vulnerable populations they welcome. D3S also carry out particularly broad and demanding missions, often in small structures and in rural areas, with more limited resources than their hospital counterparts. The feeling of injustice is all the stronger as no precise timetable has been communicated to representatives of the profession despite repeated commitments from the Government on this subject. She therefore asks what measures the Government intends to take to guarantee progressive statutory and compensation equity between the bodies of DH and D3S and how will be ensured, in the meantime, the retention of experienced directors in medico-social establishments, particularly in the least attractive territories.

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