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Because France's health system is not free, each one of us is a client, a customer, not merely a statistic" Because France's health system is not free, each one of us is a client, a customer, not merely a statistic

Once more I turned to Roselyn as my touchstone, to check I had certain facts, or possibly thoughts, right.

(Frankly, taking the duster out of her hand and sitting her down with a coffee is often much less stressful than hearing her smash and crash around the house.)

She listened horrified, hand to her mouth as I told her about the Liverpool Care Pathway – the withdrawal of food, fluids and treatment from hospital patients.

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Her eyes grew larger as I outlined the latest suggestion that doctors select one in 100 of their patients most likely to die in the next 12 months, effectively dooming them to wither under the LCP. Virtually all of these, I told Roselyn, would be old. To be old in the UK is usually deemed as 60 upwards.

Her shock was two-fold:

a) she could not envisage such a callous plan actually being implemented in a civilised country

b) she could not grasp the concept that the elderly should be any less valued.

I realised with a jolt that I could have been describing my tribe's reasons for eating the brains of our enemies, after battle, to a 17th century European explorer charged with bringing God's plan to the heathens.

Bear in mind though, that present day France is a secular country so there was no religious background in her distaste of what I was saying.

"You know I work with mamis - old ladies, grandmothers, who need a little extra care each day? They are 80, sometimes more, some of them – I could not imagine allowing such a thing to happen to them.

"We respect our old people. They are the heart of our family. They have the knowledge, the wisdom. The family, the system, is geared to keeping them at home until it is absolutely impossible.

"I can't believe what you are telling me. Bof! I don't know if they do that in Paris or Toulouse, but we don't do that here. Never."

Searching policy documents and newspaper files on the subject, I too have found nothing similar. This does not mean it doesn't exist, only that here, in my region, and as far as I can research, it seems not to, at this moment at least.

My mind was drawn to the subject after a celebratory lunch with friends last week. J had been given a total, 100% all-clear from colon cancer. The surgeon had told him: "Go, enjoy the rest of your life . You're still a young man, so enjoy."

He is not a young man. He will be 70 in December, but from the moment of vague symptoms he was swept up into a process that valued his life, regardless of age.

X-rays, exploratory ops leading to the ultimate one, happened in days and weeks – not months. At each stage, he and his wife were part of the discussion, part of the decision making. Always there was hope.

Although he speaks good French, an English-speaking nurse was by his side when he awoke from his anaesthetic – just in case.

My friends had their house on the market before he was diagnosed. They had decided they needed to look ahead to what would happen if one or the other became ill and agreed it was better to be close to one daughter.

They are no longer selling.

"I firmly believe I might not be here had I been in the NHS," says J now. "It's a dreadful thing to say, but my experience in France, and that of other Brits, tells me so.

"Not for one second did I ever get the feeling that my life was somehow worth less because of my age. Sadly, by all accounts, it seems it would have been worth less in my own country."

Of course all is not perfect in France's health system. The government is already looking at the cost of a population living longer, at a time when the hugely expensive programme is threatened by global forces. But, because it is not free, each one of us is a client, a customer, not merely a statistic. National Insurance may service the NHS but it does not bring with it a similar courtesy.

The French service is geared to keeping people in their homes. Care workers, nurses, physios, and even alternative practitioners are organised on a daily basis, regardless of family help. Ambulances, cars and drivers pick up and deliver the less mobile to clinic and surgery. Above all, I've found, is the relentless drive to keep people well before they become ill.

Because of my carte vitale (health card) I am invited to seminars, cancer screenings, health checks – most of which are not offered on the NHS.

Bar one doctor, I have never been harangued on my smoking and I have never been dismissed with: "What do you expect, it's your age."

That was said to me in Glasgow when I was 42 years old.

So, when J, his wife and myself, raised a glass of champagne to his health last Sunday, we also added: "Thank God you were in France." n

cookfidelma@hotmail.com

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