Everything is unravelling at state hospitals, which have been going from one crisis to another with no end in sight. Okypy, the state health service running the hospitals, is engaged in never-ending exercises of crisis management as new problems appear with alarming regularity and none are dealt with effectively. Damage limitation seems to be the modus operandi of the board and top management that have seen public confidence in state hospitals hit an all-time low in the last few months, all patients going to private hospitals now that Gesy has given them a choice.
State hospitals had always been notorious for the hours people needed to see a doctor, even with an appointment, the long waiting lists for operations, the rudeness of staff, the impossibility of getting through on the phone etc. With the introduction of Gesy last year and the lucrative pay terms offered to personal doctors and subsequently specialists, there was an outflow of doctors from the hospitals causing staff shortages in many departments and making waiting lists longer and service to patients even worse. The outbreak of Covid-19 dealt another blow to their reputation as they effectively stopped seeing patients because staff refused to show up for work.
As if this were not bad enough, people have been hearing all kinds of reports about the disarray that hospitals are in. There have been reports about doctors on call refusing to show up when asked to do so, anaesthesiologists clocking off at the same time and no-one being present when a patient needed urgent attention. On Saturday, the head of the Larnaca and Famagusta hospitals said on a radio show that they were turning away patients needing operations because of a lack of consumables; he also alleged there was financial mismanagement by Okypy and called for the authorities to investigate. There may be no truth in these allegations, but they are indicative of a chaotic situation that is out of control.
While the responsibility for this chaos belongs to Okypy there are extenuating circumstances – it is dealing with public employees who have so many rights they cannot be managed. The fault for this belongs with the government, which was under the illusion that it could have autonomous, well-functioning, competitive hospitals staffed by public employees. Although the original plan was for doctors, nurses and other staff to be given contracts to join the autonomous hospitals the government, under pressure from the unions, agreed they could maintain their public employee status, which proved an unmitigated disaster.
This staff carried on enjoying public service working hours – finishing at 3pm – their promotions were decided by the public service commission and inevitably carried on doing as they pleased. Hospital management had no authority over them because they were public employees and not answerable to Okypy. The government had set up a dysfunctional system that is effectively run by the public service unions for the benefit of its members, patients being nothing more than an afterthought.
The doctors’ union demanded big pay rises to stop the departures and were satisfied without Okypy securing anything in exchange such as changing the absurd, office working hours. The nurses’ union then demanded that another 200 to 300 nurses were hired because of staff shortages and were satisfied as soon as they threatened to go on strike, thus causing staffing problems for private hospitals at which pay is market determined, rather than by union muscle, and working hours are not as attractive.
In short, the government established hospitals that are autonomous only in name. They are run by the unions, instead of Okypy, and operate exactly like the old public hospitals, with the only difference being that the doctors are much better paid for doing the same work. In fact, state hospital staff may have less work now because thanks to Gesy most patients are going to private hospitals. It is said that growing waiting lists in the private hospitals will force people to return to the state’s hospitals, which have more than half the total number of beds.
This is not good enough. State hospitals, with all the resources at their disposal, should have been the best as is the case in so many countries with people wanting to go there for treatment. In Cyprus, unfortunately, because they are run by the public sector unions, state hospitals are totally dysfunctional, their reputations in tatters, seen as the worst option by patients needing treatment. And this dysfunctionality will carry on being funded by the taxpayer for another five years, which is the unrealistic target set by the government for state hospitals to become self-sufficient.
With the unions running the show, they will never become self-sufficient. Their chaotic situation, however, also provides an opportunity for the government to take on the unions and limit their power. Doctors and nurses can go on indefinite strike to defend their privileges but their unions’ power is diminished now there is an alternative for patients – private hospitals. Of course, it requires the government having the political will to fight it out with the unions, something it has consistently shied away from.