- The Observer,
- Sunday December 7, 2003
Trade unions representing the system's 750,000 staff have organised street demonstrations later this month, claiming a lack of government money could result in many of the 1,500 hospitals going bankrupt, despite a 5 per cent budget increase this year to about €50 billion (£35 billion).
'We believe the [conservative] government is encouraging a situation in which the public system is being run down so that the most lucrative business can be transferred to private clinics,' said a spokesman for the four unions involved. 'Public hospitals will end up as nothing more than hospices for the poor.'
A crisis has been evident since the deaths of 15,000 elderly people during the August heatwave. But this has been followed by a new scare in which Parisian and provincial hospitals have been overwhelmed by three winter epidemics: infant bronchitis, gastroenteritis and 'flu.
While tiny patients were kept waiting in corridors for hours and anxious parents advised to go to private clinics, doctors warned that the worst was yet to come.
Emmanuel Grimpel, head of emergencies at Paris's Armand-Trousseau hospital, said the 'flu epidemic had struck early and underlined a serious lack of medical staff and beds nationwide. He predicted that the crisis would last until mid-January.
Medical staff at his hospital spoke of inadequate equipment and poor morale. They quoted cases at other Paris hospitals where patients had been sent home early because of a lack of beds and nurses, and where waiting lists to see specialists were running into months.
Nurses smiled wryly when told of the high praise of British NHS patients sent to France. 'The wool has been pulled over your eyes,' a senior pediatric nurse said. 'France has one or two show hospitals, like anywhere in the world. Go and see the new Pompidou hospital in Paris - it looks like a Hollywood set. As for the rest... '
Alarm over staff shortages was first raised by 180 Paris consultants after the August heatwave. They said that even the number of interns had dropped by half. François Aubert, chairman of the public hospital co-ordination committee, said: 'If these weren't state-financed establishments, many would have the receivers in.'
A parliamentary report confirmed staggering staff shortages, which doctors blamed on underfunding and a reluctance by even senior staff to work 50 or 60 hours a week. Some provincial hospitals reported being up to 40 per cent short of specialists and other institutions had only been kept going by drawing on the presence of 8,000 foreign doctors.
Much of the problem stems from France's extravagant social security system, which has an accumulated shortfall of about €30 billion. Attempts have been made to fill what is called the trou - the hole - by restricting prescriptions, freezing refund levels and raising hospital accommodation fees, but the effect has been to create a two-tier health system.
Most French workers subscribe to a mutual fund to pay for cover not provided by the national health service or for the reimbursement of excess fees charged by GPs, who have been accused of massively over-prescribing patent medicines. Patients also exploit the right to visit as many specialists as they like without referral as long as they pay a supplement.
Families often contribute €50-€150 a month to mutual funds to ensure better refunds in private clinics, while poor families have to rely wholly on the public system.
Criticism has concentrated on Jean-François Mattei, the Health Minister, who was at the centre of accusations of mismanagement during the heatwave, when the health service failed to act to save thousands of lives. He escaped sacking after putting much of the blame on the 35-hour week introduced by the former Socialist government, claiming it had made continuous high-level care impossible. Hospital administrators have described the 35-week as 'trying to run the 100 metres with a cannonball attached to your leg'.
But administrators and unions both resent the minister's plans to encourage greater dependence on private clinics, which are usually run on American lines by consortiums of specialists.
His plans, known as 'Hôpital 2007', to overhaul the system over the next three years will be the target of the first in a series of protests on hospital funding starting on 16 December. Calls will be made for Mattei to be sacked. Bernadette Delorme of the Force Ouvrière union said his plans amounted to 'a powerful dose of free market priorities which put profitability before care'.
