PARIS (Reuters) – The struggles of France’s health system will probably get worse before things improve, President Emmanuel Macron acknowledged on Friday, as he pledged to improve working conditions and hire more medical assistants for administrative tasks.

France, like many other European countries, is facing a shortage of healthcare staff, particularly in rural areas, with many hospitals overstretched, the population ageing, high number of doctors and nurses retiring and the system snarled in red tape.

“We’re facing a situation that could well get worse,” Macron said, citing the need to train up a new generation of medical staff in a New Year address to health workers, who have staged a strikes in recent weeks to demand better working conditions.

In the meantime, he said, the government would step up the recruitment of medical assistants, freeing up health workers to treat patients rather than do administrative tasks.

Promising a change in how hospitals work by June, Macron also said his government would take steps to increase cooperation between different parts of the health system, and improve oversight of working hours.

He said paying more money alone was not sufficient to make the profession more attractive, also saying his government would largely do away with the fee-for-service financing of hospitals.

Critics say that system has pushed hospitals into a downward spiral of pursuing a high volume of lucrative care while cutting costs and care in other areas.

“The fee-for-service principle has led to a lot of dysfunction”, Macron said, speaking at the Centre Hospitalier Sud Francilien (CHSF) in Corbeil-Essonnes in suburban Paris.

The COVID-19 pandemic weighed on already stretched medical resources.

Many hospitals have this winter had to call off planned surgeries or shut down emergency services at night, as a simultaneous spike of bronchiolitis and flu cases has added to COVID-related hospitalisations in some areas.

(Reporting by Dominique Vidalon, Tassilo Hummel and Jean-Stephane Brosse; Editing by Ingrid Melander and John Stonestreet)