France's world renowned health service has been creaking for a while.
A toxic blend of the financial squeeze and strikes and protests among discontented health professionals across the system has left a health service, judged not so long ago as the best in the world, in serious danger of losing its lustre.
One health union leader recently told The Local that the chronic lack of investment meant the state of France's public hospitals was like Britain's National Health Service under former Conservative Prime Minister Margaret Thatcher.
Recent months have seen strikes and protests by disgruntled GPs, doctors in emergency wards, and thousands of health professionals working in Paris hospitals.
The background to the protests has been the need to make spending cuts to bring the country's budget deficit into line with the European Union including €3 billion off the hospitals' bills – which will see 22,000 jobs deleted.
All in all it's looking pretty grim for a health service ranked number one by the World Health Organization back in 2000.
Marisol Touraine, the country's under-fire health and social affairs minister (albeit in a government where every minister seems to be under-fire) believes the country can continue to provide quality care and “social protection”, but says things — or, more to the point, health professionals — have to change.
“All the analysis and the predictions that we have done suggest that financially we can provide this secure system of social protection on condition that we profoundly reorganize it,” the 56-year-old minister said.
“It will disturb the habits of doctors and health professionals but we can do it – and as a left-wing government we must do it”.
Touraine says France's aging population, increasing costs of medicines and growing number of chronic illnesses all provide a stern challenge to the country's health service.
It was with this in mind that she tabled a wide-ranging draft of health reforms that are going through parliament and have provoked the ire of doctors and led to huge street protests.
But Touraine, who told The Local and other members of the Anglo American Press Association in Paris this week that she had received personal abuse over the reforms, is adamant things must change.
“There a huge malaise among doctors today, but it's not because of me. I am just the one saying to them 'You have worked in a certain way for decades but today, for multiple reasons, you have to change the way you work.'
“There’s a generational problem and a need to transform the way of working which is very difficult,” she said.
Touraine describes herself as a “modernizer and a reformer” battling against “conservatism and opposition to change that is sometimes characteristic in France”.
The minister said that in a climate of cutbacks it was entirely normal that the government imposed new rules on the game to keep the system running.
But it will hardly be a surprise to those health professionals who have protested in recent months that Touraine accepted the French health service was far from perfect.
Of particular concern to her was waiting times in hospital emergency awards, particularly in Paris where she described the situation as “disastrous”.
Earlier this year a leaked memo from France's intelligence services warned that hospital emergency wards were on the brink of “social implosion”, which was causing “tensions that are linked to a degradation in the quality of care.”
She also said France has far too many specialist doctors and not enough general practitioners.
Touraine also said the France must take lessons from across the English Channel and look at the work the UK health service does in preventative healthcare.
“The strength of Britain is the public health strategy of prevention, notably around tobacco.”
“We are a country that has spectacular results when it comes to curing people but prevention is not integrated, although everyone says we have to do it,” she said
On the other hand, Touraine said her British counterparts eyed France's cancer survival rates with envy and that she doesn't rate Britain's GP service.
In particular her government must do more to tackle high alcohol and smoking rates, especially among pregnant women, the minister said.
Touraine blasted the country's wine lobby for being too powerful and said France was in a kind of denial over its levels of alcohol consumption – which sees the French drink the equivalent of 120 bottles of wine each year on average.
Alcohol abuse is believed to be the cause of around 50,000 premature deaths in France per year.
Improving prevention may be the key to relieving the pressure on the country's health service and the rest of the welfare state, which according to a recent OECD study is simply unaffordable.
“The French system is already in deficit. If nothing is done about it, then the welfare system won't be sustainable. There needs to be reforms,” said the author of the report.