Hospital war stepped up

Nuns clench their fists as they roar through megaphones, nurses mount roadblocks on busy streets, consultants petition passers-by for signatures and the entire staff of one hospital threatens to go on hunger strike.

Even by the standards of Berlin, where political demonstrations are part of everyday life, the latest campaign against hospital closures in the German capital is quite spectacular.

Desperately short of cash, the city government wants to close or merge more than a dozen hospitals, with a loss of 4,500 beds and up to 8,000 jobs. Germany's health insurance companies claim that unless savings are made soon, Berlin's system of medical care will collapse. And they warn that they cannot continue to subsidise Berlin's hospitals at the present level of DM 1 billion (£404 million) a year.

Nobody denies that Berlin has more hospital beds than it needs but the problem is, more than anything else, a legacy of the city's post-war division and its extraordinary political circumstances.

Ten years ago, before the Berlin Wall fell, East Berlin had 28 hospitals, many of which served the whole of East Germany. Diplomats, government officials and members of the secret police were treated in special clinics, from which other citizens were excluded.

West Berlin had no fewer than 85 hospitals, many of which could boast the most expensive, state of the art equipment and some of Germany's most distinguished doctors. Like so much in West Berlin, the medical system was a showpiece that proclaimed the superiority of the western system of government.

"The disproportionate level of hospital care was politically determined. There was enough money," according to Dr Gunther Jonitz, head of Berlin's Chamber of Doctors.

Forty-five of Berlin's hospitals have closed since unification, leaving just 68 today, but Berliners are still generously supplied with hospital beds. In the smart suburb of Zehlen dorf, for example, there are 22 hospital beds for every 1,000 residents - making it the best place in Europe to get ill.

Enviable as it may seem in comparison with European cities plagued by lengthening hospital waiting lists, Berlin's abundance of beds is not always in the patient's best interests. And the latest threat of cuts and closures has placed every visitor to a hospital out-patients' clinic under the real threat of being admitted for a few days, whether they need inpatient treatment or not.

One difficulty faced by the hospitals is the expansion and improvement of primary medical care, which means that many general practitioners now run mini-clinics equipped with the most sophisticated diagnostic devices. An over-supply of doctors has heightened competition within the profession and those who offer the most comprehensive service have the best chance of survival.

The German health care system is among the most generous in Europe, even paying for regular spa holidays for healthy patients. But rising costs, an ageing population and higher expectations from medicine are threatening to make the system unaffordable.

The new Health Minister, Ms Andrea Fischer, a convivial Green, has promised to introduce drastic reforms to save the system.

BUT Berlin's threatened hospital staff are determined that they will not be the first victims of reform and they appear to be winning the battle for survival. The angry nuns have drafted in a friendly archbishop, Cardinal Georg Sterzinsky, to put pressure on Berlin's Christian Democrats to save the city's Catholic hospitals.

The Christian Democrats govern Berlin in a grand coalition with the Social Democrats but an election is looming in October and both parties are preparing for a tough fight. The Social Democrats are hoping to emerge as the largest party and to form a new coalition with the Greens. To this end, they have selected as their candidate for mayor Mr Walter Momper, who occupied the post 10 years ago but holds no post in the present coalition.

Fearful that they will be blamed for all of the present coalition's failings, the Christian Democrats are preparing to water down the hospital closure plans, saving hospitals in their own districts and protecting clinics run by religious groups.

The Social Democrats warn that they will retaliate by blocking other closures, a move that would ensure that Berlin's generous supply of hospital beds would be safe - at least until after the election.