The groaning from the naked elderly woman in the bed next to me was coming in
rasping bursts. I was unable to move and in agonising pain but she was
clearly dying. The one doctor in the admissions ward of the hospital had
been called out to assist an ambulance crew with an emergency some distance
away and nobody else came to tend to her for a very long time.
Was this Bangladesh, Albania or even Luton?
No, it was France, a country we are told has a well-funded, state-of-the-art
health service.
But while it has skilfully marketed healthcare tourism to Brits seeking
cheaper and quicker access to hip replacements, cataract surgery and even
heart bypasses, the luxury treatment packages conceal a very different
reality for the run-of-the-mill medical emergency like me.
Hospitals are being shut to save money; bed numbers are being cut in those
that remain; waiting for treatment is common, even when you have a booked
appointment; and given the famous French “pudeur”, there is an extraordinary
lack of concern for patients’ privacy and dignity.
I was rushed into hospital in the middle of the night with a suspected
life-threatening blood clot in my right leg. I was warned that it could move
to my lungs at any moment, cutting off the supply of oxygenated blood within
seconds, causing rapid death.
The pain was excruciating – as if car battery acid were being infused into my
veins. The leg was paralysed, and the merest touch caused me to scream with
pain.
The ambulance arrived at my remote home with impressive speed, however, and
quickly rattled off on the 12-mile journey to hospital. While I swore at
every rut and turn, the ambulanceman chatted as if we were on a church
outing. Was there a rural ambulance service in England, he asked. I told him
there was, but that the French health service was generally considered
superior.
It is not. I have spent more than a decade covering health issues for this
newspaper. I have been in hundreds of hospitals around the world, and
interviewed numerous enthusiastic British patients tucking into red wine and
steak and chips as they recover from planned surgery in splendid privacy at
immaculate French hospitals.
But when I was taken into the state-run hospital at Vire in the western
Normandy département of Calvados, not far from Mont St Michel, two weeks
ago, I did not realise that there was no vacancy among the 630 beds shared
between the town’s private and public hospitals. Although I was being
treated, I nevertheless lay stuck to a narrow plastic trolley for some 17
hours as the sun blazed down outside, and the temperature climbed above 30C.
I put on a brave face as my family came to visit and quickly left, aware they
were in the way and invading the privacy of other stricken patients. I
learnt a great deal about the medical history and personal circumstances of
three patients who shared my narrow space during my hours on the trolley. I
also got an opportunity for close monitoring of their bedpan use, vomit and
other bodily effusions.
The sparrow-like naked woman was the last of them. As we lay alone together,
she wondered if they had forgotten us and apologetically begged me to help
her. I explained I couldn’t move but shouted for a nurse, realising she was
dying. The room was suddenly full of people. As they fought to save her she
not only lost control of all bodily functions, but was reduced to helpless
panic as she struggled vainly for breath. I should not have been there.
In a surreal moment, a healthcare assistant slid through the melee to admonish
me for refusing the offer of an evening meal. I persuaded staff to wheel me
into the cool peace of the corridor only by pointing out they would have
more space to treat my roommate. Minutes later the stench from the room
followed me out, as a binful of soiled bedding was unceremoniously dumped
next to my head.
I was finally wheeled off to the cardiology unit, where all patients have
private rooms. A week of intensive treatment, infusions, blood-thinning
drugs and tests followed. The treatment was fine, but all the nurses spoke
of the relentless pressure on beds.
French doctors have been denied the 35-hour working week offered to other
public sector workers. Hospital administrators told me that most of them do
48-50 hours – for about half the average £110,000 paid to their NHS
counterparts.
I was told that patients sometimes complained about the lack of privacy, but
with little effect. One nurse said that after the director of the hospital
was treated in a six-bed unit and had to perform his ablutions while the
other patients looked on, opaque screens were introduced between the beds,
but only in that unit.
“I’ve seen on television those curtains you have round beds in English
hospitals,” she said. “I don’t think it occurs to the managers here, and if
people complain about the lack of privacy for patients not in rooms by
themselves, the first objection is that doing anything will cost more money.”
I was discharged and sent for more investigations in other centres and
clinics. In the town’s other, privately run, hospital, I was kept waiting
for 90 minutes. Nobody apologised or explained. An MRI scan performed at a
stand-alone private diagnostic centre in another town finally detected a
rare abnormality of the joint lubricating fluid that in my case had caused a
slow-growing, nonmalignant tumour which had ruptured into my knee. I was
then referred to a rheumatologist and readmitted, this time to Caen
University hospital.
In Caen it was clear that the intention was to keep me over a second weekend
to prevent the bed being taken by a tiresome emergency case. Only when I
remonstrated was I told that the “unorthodox” decision would be taken to
puncture my knee and draw off the fluid causing the swelling, on a Friday
afternoon. The next day I was reluctantly released.
French voters go to the polls today to decide on their new president.
Healthcare provision was scarcely mentioned in the election campaigns of any
of the contenders – maybe because of a mistaken belief that it is not a
problem.
The system faces identical problems to the NHS, and ones that are threatening
healthcare provision across the developed world. The population is ageing,
and demand for hospital treatment in Vire is increasing at a rate of 5% a
year.
Ordinary French patients pay for their care with a mixture of state funding
and private insurance. For those without private insurance, treatment for
costly or rare conditions may be limited. There is not enough capacity in
the system because of the classic problem of “bed blocking” that is just as
familiar in Britain – old people who can’t be discharged from hospital
because intermediate care or convalescent homes no longer exist.
British people have been infected with the welcome American attitude to
competition and customer service. If something isn’t good enough, they
complain. In Europe and especially France, people still meekly put up with
being sold bad food and bad consumer products and services.
Despite France’s claim to one of the best healthcare services in the world,
the only appreciable difference with the NHS appeared to be cleanliness.
Instead of the mute mop-draggers, there were armies of cheery diligent
cleaners everywhere.
It is not too ridiculous to suggest that while French hospital managers could
certainly teach their NHS counterparts about managing a cleaning service,
healthcare managers here could teach them a thing or two about concepts of
consumer rights. It might help them to treat all their patients with a bit
more humanity.
