French healthcare system faces a summer of discontent

Emmanuel Macron doesn’t like to talk about it, especially if there are foreigners present, but the French healthcare system is in trouble.

The problems it faces are much the same as those confronting the NHS in the UK: too many patients, too little money and a hard-pressed workforce in a state of incipient revolt. Matters could come to a head this summer. There have already been targeted strikes, resulting in operations being postponed and non-urgent referrals being turned away. Accident and emergency staff, in particular, have complained that they are being exploited,  Nurses and ancillary staff are even talking of “going on the sick” themselves and taking all the holidays and days-off to which they are entitled.

Should there be a prolonged heatwave – which is highly likely in several parts of the country in July and August – the number of emergency admissions could rise sharply, made up mainly of the elderly and the vulnerable, including pregnant women. With projected staffing cut to a minimum due to ongoing strike action and work-to-rule scheduling, events could quickly turn ugly.

The gilets-jaunes epidemic looks for the moment to have run its course, providing the President with breathing space in which to introduce much delayed social and economic reforms. But if the French find that they cannot rely on their much-vaunted healthcare system to take care of them when they most need it, they are likely to expend their rage and frustration not on doctors and nurses, but on a government that has cut spending and recruitment while urging those providing frontline services to come up with a seemingly non-stop programme of increased efficiencies.

The current healthcare budget, introduced last September as part of the finance bill for 2019, called for an increase in overall health spending of just 2.5 per cent, from €195bn (£173bn) to a little under €200bn, funded by social charges imposed on the working-age population some 8.8 per cent of whom are actually unemployed and contribute nothing. By way of comparison, the total NHS budget for England in 2019 is £127bn.

State-provided healthcare in France covers around 75 per cent of health-related expenditure, with the rest met out of private insurance. A decade ago, the sector accounted for some 10 per cent of total government spending. This year, the figure is expected to come to more like 11.5 per cent, and rising – a figure which Macron, and indeed the entire political class, considers unsustainable.

With the number of citizens aged 70 and over continuing to rise and with immigration still driving population growth, the 2.5% increase – intended to cover a full 12 months – has already been absorbed. Meanwhile, the Government has demanded savings in just about every sector, costed at some €3.8 billion (£3.38bn), leading to an enforced reduction in the recruitment and training of doctors and nurses, fewer available beds and restrictions on the use of certain patented drugs and treatments.

It is bad enough in the cities, but in the remoter parts of the country doctors under the age of 50 are fast becoming a rarity. Newly-trained clinicians and physicians are daunted by the pressure of the work in rural areas, where the elderly, exhibiting a wide range of age-related conditions, make up the majority of patients. Simultaneously, local hospitals are closing almost by the week, meaning an increased reliance on much larger, city-based facilities, whose staff are forced to run ever faster just to stand still.

There is no doubt that the French system has worked well down the years, causing successive governments to claim that France has the best healthcare of any developed country. But the problems are building up, just as they are in the UK, and France is beginning to drop down the international rankings, behind (depending on the means of assessment) Hongkong, Singapore, Switzerland, Norway, Belgium, Spain and the UK.

Last year, before the gilets-jaunes took to the streets, Macron boasted that “a lot of our neighbours envy the excellence of our health care system,” and this remains largely true. Those with serious conditions receive excellent care in generally first-rate facilities. The chronically ill are similarly well looked after. But if the cash is not found quickly to plug gaps in the system that have begun to look structural, the story in the future could be very different. The new health minister, Agnès Buzyn, promised this month to address the issue and to do whatever is necessary to reassure doctors and nurses that they have not been abandoned. If she fails, the gilets-jaunes could find could well find that they are not alone in a renewed wave of anti-government protests.