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Tuesday, 30 July, 2002, 14:18 GMT 15:18 UK
France's ailing health system
Scene at Paris hospital
The wards are full but the patients keep coming

Only two years ago, France's health system was deemed by the World Health Organisation the best in the world.

But now, as one doctor put it, the country's health system seems to be heading the same way as the national football team - towards disaster.

Normally, hospitals - either public or private - close on average 15% of their beds in July-August. This year, the figure is around 25%-35%

Dr Francois Aubart
Chronic staff shortages, worse in the summer when doctors and nurses take their holidays, have been compounded this year by the application of the 35-hour working week in hospitals.

Dr Francois Aubart, head of orthopaedic surgery at a hospital in a northern Paris suburb and president of health workers' union CMH, told BBC News Online that a number of large hospitals in Paris and its region were affected.

One major hospital in Versailles, for example, is only functioning at 60% of its capacity, he says.

Dr Laurent Casenove (left) and hospital worker Alex Talbot
Hospital staff are struggling to keep up with demand
Dr Patrick Pelloux, a consultant at Saint Antoine Hospital in Paris, says the current crisis is part of a wider one where it is increasingly common to see patients transferred long distances to be treated.

"No-one is surprised any longer to see patients sent from Nice to be treated in Marseille or even from Dunkirk [northern France] to Bordeaux [south-west]," he says.

This is the same system which last year began taking in patients from Britain, where waiting lists are much longer than in France.

"It is appalling, The hospital [system] has not evolved in the same way society has. There is a grave crisis," Dr Pelloux told BBC News Online.


Saint Antoine Hospital is one of the oldest in Paris and its A&E department is stretched to the limit.

Staff see an average of 150 patients a day.

But patients often end up having to spend the night in the A&E department through lack of beds in other wards. The backlog has not been cleared when the next day's patients start arriving.

Christine Sorensen
Trying to juggle rotas is part of the nursing role
Dr Laurent Casenove, one of the department's consultants, says the summer holiday has always been a problem, but this year is made worse by the 35-hour week. He has worked 80 hours this week.

One of the managing nurses, Christine Sorensen, whose job it is to ensure there is the minimum of staff required, says it is only possible to re-arrange rotas or hire extra nurses up to a point.

But when the money or extra staff run out, those on duty have to bear the brunt. The A&E department is not allowed, like other wards, to close.

It is easier to close a bed than hire more staff

Dr Laurent Casenove

On the day BBC News Online visited, the department's main communal room was full and some patients were left in the corridors - scenes not unknown in Britain.

One patient had spent four days on a stretcher.

"This patient happens to be homeless, and is too much to handle for other social services, but has no place here," Dr Casenove explains.

"I am here to cure people, not to make phone calls," he says as he struggles to find beds in other wards for his patients.

The hospital's neurology ward is closed, as is most of the cancer ward. "It's not a good time to be ill," he says.

And when there really is no space left, extra patients are sent off to private hospitals - a practice Dr Casenove says is more and more common and ends up costing taxpayers more.

Strike in the air

The system is the best in the world, he explains, because most costs are covered by social security and is available to all.

French hospitals are efficient and well-equipped, waiting lists are short, and general and specialist doctors are in plentiful supply.

Injured chef
The hospital remains the first port of call for many patients
But more jobs need to be filled, while salaries and work conditions need to be made more attractive, Dr Casenove and Pelloux agree.

But the underlying difficulty, they say, is the need for more flexibility of the system and on management's part.

"There is a shortage of beds, but especially a lack of reform of institutions with a hierarchical system dating back to the Napoleonic era," Dr Pelloux says.

If that does not happen, Dr Casenove foresees more strikes in the future - in the same vein as last winter.

The Health Minister, Jean-Francois Mattei, has pledged to plough some 700m euros into the system to alleviate the staff shortfall in the short and medium term.

French Prime Minister Jean-Pierre Raffarin, who recently announced his government was working on a reform plan called Hospital 2007, seems to have his work cut out.

See also:

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