By Ross Tieman

France’s vociferous Committees for the Defence of local Hospital and Maternity Units are getting their marching boots back on after the country’s Health Ministry confirmed it will announce a raft of hospital operating theatre closures by the year end.

The Ministry says the decree will target about 180 theatres which each carry out fewer than 1,500 operations a year. Theatres that carry out fewer than 100 gynaecological operations a year are also thought to be threatened, though the Ministry wouldn’t confirm it.

National opposition to closures of this sort began back in 2004, at the instigation of defenders of my “local” hospital in Saint-Affrique, southern Aveyron. Although it’s not much bigger than a cottage hospital, it still seems to be functioning, five years on, though I’d never dream of going there.

For anything serious, people round here head to the public hospital in Albi, which is larger, or to university hospitals in Toulouse.

With a healthcare funding deficit expected to top €9.4bn this year, it’s easy to accuse the Health Ministry of closing operating theatres to save cash. Health Minister Roselyne Bachelot seems to have dusted off a report produced in 2006 by a panel from the Surgeon’s Academy and the National Surgery Council chaired by Paris urologist Professor Guy Valencien, which recommended the closure of all theatres performing fewer than 2,000 operations a year.

Rather than leaping on the barricades, it’s worth re-reading what Prof Valencien said about his group’s reasoning at the time. “One can no longer accept that hospitals or operating theatres run at half or quarter capacity,” he said. “Safety is at stake. When there’s a low level of activity, the risk of complications increases.”

The report’s oft-forgotten concomitant recommendation was that local hospitals be kitted out with the latest technology for remote diagnostics and monitoring, becoming centres of community care. The report also called for more helicopter ambulances, to move patients quickly to specialist hospitals when needed.

“I want ‘Saint Bernards’ to transport people from small towns to big cities,” he said.

Proponents of concentrating surgery in cities with specialist teams argue that modern ambulances are equipped, and their crews trained, to stabilise patients while they are transported to expert centres where their prospects of survival and recovery are much better.

Meantime, they argue, better local care and monitoring would avoid many cases becoming acute in the first place. Medical science and technology is constantly improving. If medical structures fail to evolve, patients will receive sub-optimal care.

As the hospital defence campaigns show, there are many people opposed to that evolution, and maybe they have some good arguments.

But what I do know is that patients in France have a choice, and many are only too happy to get in a car or ambulance and travel hundreds of kilometres to be treated by the best experts. If that also saves money for the healthcare system which we taxpayers fund, we are all winners from consolidation. But give us rural folk the flying Saint Bernards too.

October 30, 2009 3:31pm in Delivery, Economics, Effectiveness, Politics, Public Health | Comment