While trade relations between Britain and France nose-dived, a meeting of minds on health highlighted much common ground, writes Barbara Millar

While Britain and France teetered on the verge of a trade war, there was at least one place where relations remained cordial, with managers from the two countries' health systems meeting in Edinburgh to share their thoughts.

And, despite bemusement over terms such as 'clinical governance', there turned out to be striking similarities: as Valenciennes Hospital director Philippe Domy explained, half of all French hospitals face a shake-up as the system goes through merger and 'regrouping'.

The process of restructuring France's hospital service follows the setting up of state-controlled regional health agencies, charged with distributing resources to individual hospitals.

The new bodies are responsible for health planning and are able to take account of 'the need to correct inequalities within and between regions', as Mr Domy told delegates to the third Health Rendezvous conference linking managers from the two countries.

The Federation Hospitaliere de France, which promotes the interests of public hospitals - private clinics are also big players - had decided to support restructuring 'even though it will mean the sacrifice of some hospitals', said spokeswoman Marie Christine Burnier. She stressed that the new arrangements would need close monitoring 'to make sure treatment is guaranteed in all regions'.

The federation is playing an active role in helping to draft laws to fight social exclusion, helping hospitals prepare to implement the 35-hour week introduced by the European Commission, and trying to resolve acute shortages in some medical specialties.

Ms Burnier added that there were concerns in France about whether the social security system, which was experiencing 'continuous problems', could continue unchanged. New private insurance schemes were emerging, but these were complex, and presented 'a real threat to equity and availability of services, the cornerstones of public hospital values', she warned.

Another development was that, for the first time, the French parliament could debate health issues and vote on health expenditure. Previously there was no debate on health at this level and the finance minister decided funding.

'When we come to the UK we are always surprised to see so much debate on health in Parliament and in the media, ' said Ms Burnier. 'This has not been the case in France, which is why we are delighted at the changes.'

But they needed to go further, she insisted, so French MPs could also decide on health policy issues.

Chantal Lachenaye-Llanas, director of accreditation at the National Association of Accreditation and Evaluation, explained the introduction of a new quality system 'centred on the patient'. 'This is a break away from French tradition.'

Blois Hospital director Jean Pierre Gusching told delegates that mergers would mean big human resources changes, with staff having to move into new jobs.

This was difficult to achieve in France, where staff suffered from 'Jerusalem artichoke syndrome'. This, he explained, is 'a terrible vegetable which, when it is thrown on the ground, puts down strong roots. It cannot be uprooted.'

More money would have to be spent on training, he suggested. HR directors were also worried about the 35hour week. Private clinics have to introduce it by 1 January 2000, then it will be the turn of public hospitals.

Pascal Forcioli, director of the Eaubonne-Montmorency Hospital, said both public and private hospitals were beginning a more open dialogue.

'We are getting together to exchange ideas and get more involved in common projects, ' he said.

But French hospitals had to improve communication with staff and patients, he admitted. At present the only real communication with patients was the hospital 'welcome brochure' sent to those about to be admitted and this left much to be desired, he said.

Mr Forcioli also acknowledged the need for better relations with the press. But he hoped the French press would continue to remain 'courteous' and not become 'evil and nasty' like its British counterpart.

Delegates also heard from Tayside University Hospitals trust chief executive Paul White. Unfortunately, his contribution on clinical governance appeared to lose something in translation. The French delegates had to ask for a repeat performance.