Cutting night shifts won't bring big savings, but it can worsen the personnel shortage, says Kanta-Häme's welfare regional director Olli Naukkarinen.
Hospitals by abolishing night shifts, it is unlikely that significant savings will be achieved, says the director of the Kanta-Häme welfare area Olli Naukkarinen.
Naukkarinen is one of the four welfare regional directors who left a dissenting opinion from the one published last week from the hospital examination. The report was made by a working group of civil servants appointed by the Ministry of Social Affairs and Health (STM), and Naukkarinen and others who left a dissenting opinion sat in the working group's steering group.
The report shows that Finland's hospital network is being consolidated. In the first phase, among other things, the nighttime emergency centers of primary care would be abolished, and the night emergencies of five smaller hospitals would be at stake.
In the second phase, the number of central hospitals would be reduced. While there are 15 of them now, there would be 5–8 of them in the future. Some of the current central hospitals would turn into “acute hospitals”, where there would be no 24-hour operating room availability, maternity care or intensive care.
One The hospital that will become an acute hospital might be the Kanta-Häme Central Hospital in Hämeenlinna, managed by Naukkarinen. Naukkarinen emphasizes, however, that he had reasons for submitting a dissenting opinion that were not related to defending his own hospital.
The most important of them is that no impact assessments were made for the working group's presentation, for example on how the changes would affect costs or the availability of personnel.
“A conclusion has been drawn, even though there are no calculations. Such a starting point is completely wrong.”
Naukkarinen emphasizes that the dissenting opinion only concerned the second phase of the plan, i.e. the reduction of central hospital-level hospitals. In other respects, the report deserves praise from him.
“Like a working group leader [Päijät-Hämeen hyvinvointialuejohtaja] Petri Virolainen meritoriously stated, the estimate of the number of central hospitals has been made only from a medical point of view. There are also other points of view, and when they are taken into account, the conclusion about the number may be different.”
First of all, according to Naukkarinen, the opportunity costs must be taken into account: when the emergency room and births are further away, more first aid is needed, for example.
“If you want to justify the change with financial considerations, then those calculations must be done first.”
Naukkarinen estimates that it is not possible to achieve very large savings simply by cutting night shifts in hospitals.
“If the hospital is not on duty 24/7, but all other costs remain the same and at the same time the resources of primary care need to be strengthened, then the savings cannot be very large. If we want the expenses to decrease significantly, we should be ready to close the hospitals completely. I want to say it honestly out loud.”
According to the government's program, changes in the distribution of work in hospitals should save 75 million euros in 2027. However, according to the working group's proposal, central hospitals would be cut back in 2028 at the earliest.
Working group the main justification for the changes he presented is the labor shortage in the health and social services sector. There is a shortage of specialists as well as nurses. The labor shortage will continue to worsen in the coming years, as more people are retiring from the social security sector than are entering the sector.
According to the working group, the hospital network should be planned based on the number of the population, not the borders of welfare areas. In most of Finland, the population is decreasing.
However, according to Naukkarinen, abandoning night shifts is in itself a threat to the region's labor shortage. Even if the doctor situation were to ease, centralization through migration could cause a shortage of nurses in other social security services, for example services for the elderly. On the other hand, if doctors do not want to transfer to a hospital in another region, they will probably transfer to a private one.
Specialized medical care was concentrated in Finland most recently Juha Sipilä (central) during the government period. STM ordered from an external liquidator the report about how the regulations affected the recruitment of personnel.
According to the report, the recruitment situation in the non-extensive emergency medical care districts in the specialties needed in the emergency department worsened in 2016–2017, i.e. when the laws were made. However, the trend did not continue in 2018.
However, the report points out that the difficulty of recruiting specialists in Finland had already been a clear problem in the past. During the years 2016–2017, there were also recruitment problems in extensive emergency medical care districts: in them, the vacancy rate was a couple of percent lower than in non-extensive emergency medical care districts.
According to the report, the easiest way to recruit is at university hospitals.
Nosy admits that as the director of the welfare area, he is of course also concerned about the future of the hospital in his own area. However, in his opinion, criticism is too easily reduced to mere drumbeat politics.
“I'm not a regional politician and I don't think that everything that is current should be preserved. I am in no way denying that something needs to be done. In my own official career, quite a lot of quite unpleasant spending cuts have been implemented. But the essential thing is to use methods that actually save money.”
The most recent example is the end of night duty at Forssa hospital at the beginning of this year, which was decided by the Kanta-Häme regional council last year. According to Naukkarinen, only a few people visited the night duty at night.
“By the way, it wasn't an easy conversation. But yes, the regions now have a screen place here. Now it seems that the ministry is starting to enact laws when the regional councils themselves are unable to make decisions.”
According to Naukkarinen, right now is a bad time to start dictating the number of central hospitals from above. The welfare areas have only been up for a year.
“Everything is really uncertain and incomplete anyway. Bringing such a show does not create stability but chaos.”
Government has agreed to outline the division of labor between hospitals and emergency rooms during 2024.
The governing party Rkp rejected the report right away. Party chairman Anna-Maja Henriksson announced that Rkp will not agree to the proposals of the report.
Prime minister Petteri Orpo (cook) commented on the report on Saturday to a rather different tone than Henriksson. Orpo said that the personnel is not enough to maintain the current hospital network and that it is a threat to Finnish health services.
“We look at what is necessary to ensure the availability of personnel and high-quality health services for Finns,” Orpo said.
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