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Our View: Time to go back to the drawing board on status of public hospitals

Photo: CNA

THE SECOND phase of the national health scheme Gesy is set to begin, as scheduled, on June 1, health minister Constantinou Ioannou’s calculation that the majority of private hospitals and clinics would join before the deadline proving correct. What was more surprising was that 42 private healthcare providers that were in negotiations with the Health Insurance Organisation (HIO) agreed to join, despite the latter’s 6 per cent cut in the prices agreed for inpatient care until the end of this year. Together with the eight public hospitals, this means 75 per cent of available hospital beds (more than 2,000) will be at Gesy’s disposal.

But while the private sector healthcare providers will take patients on Gesy, from Monday, public hospitals are not ready, according to doctors’ unions who are claiming structures were a problem as well as several other issues that would affect the quality of the healthcare provided. Why would the quality of the healthcare be any different than it was before the pandemic-forced closure of the public hospitals? Has it suddenly deteriorated or was it always poor but the doctors’ unions have only realised it now they are demanding more money from the State Health Services (Okypy) which is in charge of the public hospitals?

It has been said that Covid-19 exposed the disarray in which public hospitals were in, something highlighted by the fact that, during the lockdown all urgent cases were sent to private hospitals for treatment. This may have been the case because the hospital workers, being public employees, decided to take advantage of the lockdown and stayed at home. The disarray claim however has also been promoted by the unions, as part of their negotiating tactic – they are demanding, apart from significantly higher pay for all doctors, the recruitment of more doctors. Nursing union are also threatening to take action unless 350 more nurses are hired.

Most of the doctors that left to join Gesy as specialists or personal doctors have been replaced by Okypy, which has hired more than 100 doctors recently. There are currently just 30 vacant positions for doctors at public hospitals, in theory. The unions however want all clinics to be staffed by a director, an assistant director plus medical officers, hence the claim about the poor structures. There is no concern about the cost this would involve over and above the hefty pay rises to existing staff. And there has been no offer by the unions for lifting the restrictive work practices that significantly increase overtime pay.

Everything could be fixed, without prohibitive extra costs if Okypy did not have to deal with entitled, undisciplined public employees that are accustomed to imposing their diktats through threats. The alleged unpreparedness of the public hospitals is another way of the two doctors’ unions applying pressure on Okypy to give in to their demands. They do not seem to realise that no Gesy patient would want to be treated at public hospitals after this unrelentingly bad press by the doctors.

In negotiations that began last year, the unions demanded extortionate pay increases so their earnings would be closer to those of the Gesy personal doctors and specialists. Okypy, quite correctly, has offered an incentivised pay scheme, which it started paying since December based on how many patients a doctor sees or how many operations they perform. The unions want horizontal pay-rises (80 per cent of amount available shared equally among all doctors) regardless of productivity and performance, insisting on the incentivising of laziness that exists throughout the broader public sector.

And they are so concerned about the preparedness of the public hospitals for the sake of Gesy, that the biggest doctors’ union has threatened mass resignations, while the Pasydy branch doctors have warned they would go on strike if their demands were not met. Now the nursing unions have joined them. Why Okypy is discussing pay rises with the doctors and the hiring of more staff at a time of economic crisis when private hospitals have had to agree to price cuts, hence lower rewards for doctors, to join Gesy? When the state is spending hundreds of millions to protect jobs and keep businesses afloat is not the time for pay rises and hiring in the public sector.

Okypy has been criticised for mismanaging the hospitals and its executives have been accused of not being up to the challenge. While there may be some truth in this, the reality is that not even the ablest administrators could manage organisations of undisciplined public employees backed by unions that nobody dares to confront. Public hospitals are staffed by 6,000 public employees accustomed to doing as they please with impunity, and being paid top money for it. These hospitals will be the biggest drain on Gesy and the taxpayer and will never become self-sufficient, not in five or 10 years.

It is time the government went back to the drawing board and started studying the prospect on privatisation or the contracting out of the administration of public hospitals. This is not a popular idea, but if the viability of Gesy is the objective, there is no alternative.

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