Nurses face impossible task under new contract

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By Marjut Lindberg
     
      All sides having something to do with the emergence of the labour contract in the nursing field have found something historic in the agreement that emerged at the beginning of the week. For some it is the fact that the state is sharing the costs, and for others it is the exceptionally high percentage of the pay increase.
      There is one aspect in the contract that truly made history. The organisation representing more than 120,000 nurses has, in exchange for a promise of an additional two per cent pay hike, taken it upon itself to organise the entire personnel structure of the municipal social and health care sector so that the number of employees does not grow from the present level at all between now and 2010.
      Members of the Union of Health and Social Care Professionals (Tehy) are to get one percentage point more if the total personnel grows by no more than 1,300 employees a year.
     
According to the protocol approved last Monday there were about 240,000 people working in the municipal social and health care sector in 2006, and if the private sector is included, the number is 340,000. Of the people involved in municipal social and health care work, about 130,000 are in health care and 110,000 are in the social sector. A majority of health care professionals work in hospitals.
      There is room for development in social and health services, and personnel could be utilised more efficiently in some places. However, Tehy has no means to push through these reforms.
     
The biggest wastage in specialised health care is in oversized laboratory and imaging services, and in the excessive number of hospitals. It is sheer waste to maintain a hospital network with hospitals located at 20-kilometre intervals, in which the same surgeries are performed in each one.
      Thought should also be given to what kind of training is required for each job. Is a polytech-level degree really needed for pushing a food trolley, or sorting bed sheets, or would something less be sufficient?
      The ideas are not new ones - they have been repeated for years. However, Tehy and its members are not the people best suited to solving the problem. Decisions on closing laboratories or entire hospitals are made in municipalities, joint municipal authorities, or health care districts, and Tehy members are not even asked for their opinions when the decisions are made - unless some Tehy member also happens to be one of the members of a council making the decisions.
      Decisions affecting the structures of health care are difficult for a number of reasons, including the fact that they include a huge amount of regional and image politics. How can a city worthy of the name not have a regional hospital?
     
Two thirds of social care personnel in the municipalities are involved in actual care work, with children, the elderly, substance abusers, the mentally handicapped, veterans, and those recovering from mental illness. All those in need of these services complain that there is not enough staff.
      It has often been repeated that there are about 6,000 pairs of hands missing in care for the elderly. If the people for that could be found somewhere, and if the municipalities would hire them, Tehy can simply forget its extra pay hikes in 2011.
     
Cutting personnel in municipal social and health care is not difficult as such. All that is needed is to refrain from replacing those who retire. By 2011 25,000 employees are to retire.
      The government explained as the reason for the law passed a couple of weeks ago, which was aimed at obliging nurses to work, that people have the right to get the treatment that they need. This principle should be kept in mind now as well.
      The National Research and Development Centre for Welfare and Health (STAKES) recently published a report according to which demand for treatment will grow partly because the population is growing older. Demand for treatment will certainly also increase; medical science is finding new and more efficient treatments for illnesses. Equipment and medicines do not work by themselves, however. Trained people are needed to use them.
      Electronic information systems are seen as potentially offering great relief to health care arrangements, but even they do not function on their own. If anything might be guessed on the basis of the initial difficulties of the projects, it is unlikely that very much help will be found from information management.
     
The only way that the goal accepted by Tehy can be reached, which would not involve imposing limits on treatment, is a tighter pace at work for health and social care employees. The contract also eliminates the option of buying more services from private providers. Bought services are counted as work years in the same way as those involving the institution’s own staff.
      The Tehy contract does not specifically say how service vouchers are to be taken into consideration as purchased services. However, vouchers will not solve the problem, as the aim is to save money, even though the unit that is calculated in the contract is the employee.
      Turning health care and social work personnel into entrepreneurs selling services in exchange for vouchers - play money that can be exchanged for the real kind - would not bring about any savings.
     
It seems quite strange that in the part of the contract concerning personnel savings, the question of quality of health care is skirted over with a pious statement that "maintaining quality is a special challenge".
      Is it no longer self-evident that alongside availability, quality in health care is the a top priority? Care without quality or effectiveness can be achieved with fewer people, but it will not cure anyone, or save any money.
     
When Tehy signed its contract it took on an impossible task, which should not even belong to it. The job of managing social and health care work is different from that of actually caring for people. Staunch professional skill is needed in both tasks, but it is unusual for the skills needed for both to be found in the same person.
      If Tehy were to succeed in stopping growth in the number of social and health care personnel without a decline in quality, then the people in the organisation would deserve a pay rise of more than two per cent. After that there would be demand for Tehy members in developing the whole municipal and regional field. There would be a further reduction in the number of carers, as Tehy members take on jobs as highly-paid consultants.
     
Helsingin Sanomat / First published in print 25.11.2007


Previously in HS International Edition:
  Experts disagree on whether Tehy contract applies to non-union members (21.11.2007)
  Nurses: contract accepted, resignations cancelled, disagreement on implementation (20.11.2007)

MARJUT LINDBERG / Helsingin Sanomat
marjut.lindberg@hs.fi