Our View: If public hospitals want financial independence they must ditch unions

Everybody would like to see modern, well-equipped public hospitals and medical centres which provide patients with a good standard of health care, without making them wait for a long time to be seen or treated. This is what the state health services, Okypy, is working towards, said its chief executive Kypros Stavrides during a news conference at which he gave a rundown of the upgrade projects that have either been undertaken or are planned.

By 2024 a total of €250 million will have been spent, €100 million on new equipment and the rest on improving infrastructure, primarily refurbishing buildings. Stavrides said there would be a new mental health hospital by 2024, a new health centre in Akaki, upgrades of blood dialysis units in hospitals and expansion of services at regional hospitals; there was also significant investment in new equipment.

He understood that there would always be criticism of the public health services, regardless of the improvements that were being made, but that was unavoidable. The objective, he said was for Okypy facilities to compete on an equal footing with healthcare providers of the private sector and to ensure the financial autonomy of public hospitals. The target date for this autonomy, by which public hospitals would no longer by subsidized by the state, is 2024 but it is very unlikely it would be met.

Nobody doubts Stavrides’ sincerity, and everyone would like to see the establishment of autonomous, smoothly operating public hospitals that would compete on an equal footing with those of the private sector. How realistic are these objectives though, given that public hospitals are under the control of powerful public sector unions and operate under countless union-imposed restrictions that cannot be reversed?

For example, because of union agreements public hospitals need to have three or four times as many nurses per bed than private hospitals have. The insistence of unions on public service working hours in hospitals and overtime pay for any work outside these hours will always ensure unreasonably high operating costs; entry level wages for nurses are significantly higher at public hospitals. If we add the unjustified, across the board pay rises given to doctors in the last couple of years, it is difficult to understand how the hospitals will achieve financial autonomy and be on an equal footing with healthcare providers of the private sector.

The objective of autonomy, efficiency, optimum use of resources will not happen if the public hospitals are under union rule, forced to operate with countless, irrational restrictions imposed on them by the unions. Every improvement of the service requires endless negotiations (afternoon healthcare is one example) and invariably pushes up costs. If Okypy wants to improve the quality of the service provided by the public health sector it has to wrest back control of the hospitals from the unions, which, admittedly, is easier said than done.