The European experience

My family have been testing out European health systems. The comparison is interesting.

In January, my sister suffered a serious fall while hill-walking and began a tour of Spanish hospitals. Dazed and bleeding, she was turned away from the first medical establishment. Surprisingly, ‘<em>Urgencia</em>’ does not mean urgent care. The next unit cleaned her wounds and sent her to an emergency department. There she had a comprehensive assessment and spent the night on a trolley. A home from home.

She was transferred to a fourth hospital to see a specialist, but there was a delay. Yes, the scans were left behind. The surgeon recommended an operation within a few days but, greatly embarrassed, advised her to return to Ireland. Due to shortage of staff, theatre lists were full. Things are not as good abroad as we think.

Despite arriving into Dublin on the busiest trolley day ever, she was very well and kindly looked after. Once again, Irish healthcare wins.

The two-tier system applies abroad too. At the IMO AGM, Minister Leo Varadkar told us of a relative who languished on a trolley in Paris until proof of health insurance came to the rescue.

Also at the IMO AGM, I discovered the Minister knows it is rubbish about Ireland having more nurses than France. Sure, the OECD shows a very high number on the Nursing Register in Ireland, but that bears no relation to the much smaller number employed by the HSE, or the tiny number on Irish hospital wards.

But that OECD myth allows HSE managers to load extra patients from the ED onto the wards, while at the same time replacing nurses with healthcare assistants.

In February, another relative went away for a few days and bravely tested the health system in the south of France. Just off the plane, on the way to their first delicious meal, she tripped, hit her head and blacked out. Four paramedics arrived. After much debate, they drove her half an hour to a hospital — where she found herself on a trolley. Actually, there was a queue of trolleys.

She waited and she waited. Hours later, she was wheeled into an examination room and a handsome young Frenchman said: “Take off your clothes.”

At this point, I am reminded of a friend working in Paris who was sent for an insurance medical. After giving her medical details in an office, she was instructed “Take off your clothes.” Here? All of them? “Yes.” The next command was, “follow me.” Out of this room? Wearing nothing?

“Of course.”

Mortified and attempting in vain to cover herself with the bundle of clothes, she followed. Out of the room, up one corridor, down another corridor, past various people and eventually into the sanctuary of another room, where the examination was completed.

Next day, she told her French colleagues of her strange experience. They looked at her blankly and said “You have a problem with this?”

It seems we Irish are the bizarre ones. In Germany and other countries, they don’t bother with curtains between beds on a ward. Even when examining patients? Even for, ahem, more intimate examinations?

“Of course.”

It’s not just the confusing OECD numbers, or the trolley experience or the two-tier systems; even privacy and dignity have different meanings. It seems international comparisons are always tricky.

That should be of interest to another health minister: former Minister Mary Harney, who is now the Chair of the European Steering Group for Sustainable Healthcare.

It’s supported by AbbVie, a biopharma company. That makes me wonder if there’s a word missing from that title: Maybe it should read “Sustainable Commercial Healthcare”. Under Ms Harney, health policy often seemed to promote commercial healthcare rather than the public system.

Some would say that both systems, public and private, have struggled to find a sustainable path ever since.

Meanwhile, back near Nice, the patient had given up all hope of dinner or a glass of wine. But the tests were completed and the doctors were deep in discussion. Then she was wheeled back to the throng of patients and families in the trolley park, and told “you can go”. Her clothes were handed back. Of course there were no curtains.

It was 2am in the south of France and winter. There were no trains or buses; no taxis at night. There was no food, just a machine selling chocolate bars. At 6am, a taxi finally appeared.

Maybe Ireland isn’t so bad after all.