Reykjavík Grapevine - 04.12.2015, Qupperneq 14

Coupled with years of tough austerity
measures, faltering morale, and an in-
frastructure in dire disrepair, there was
not much slack to give. In an in-depth
analysis, we at the Grapevine tried to fig-
ure out what, exactly, was going on, and
where we were headed.
Not much has changed since our
healthcare feature ran in December of
2014. Sure, Landspítalinn—the National
University Hospital—is still standing,
and its employees are still working. Nev-
ertheless, it’s been a tough year. Here’s a
rundown of what’s happened since.
Collective agreement,
systematic failure
The doctor’s strike came to a close on
January 7, eleven weeks after it com-
menced, with a new agreement promis-
ing wage increases and better working
conditions, such as time off in lieu of paid
overtime. The strike worked.
Last year we spoke to Dr. Íris Ösp
Vésteinsdóttir, then head of the Icelan-
dic Association of Junior Doctors, who
was worried about what would happen
if job prospects remained dour for newly
specialised doctors, as 35% of Icelandic
specialists are slated to retire in the next
decade.
At the time, she said that Icelandic
wages were far from competitive, and
with modern technology it was increas-
ingly easy to stay in touch with loved ones
from abroad. She said: “Since the eco-
nomic crisis started, healthcare profes-
sionals have been driven hard for a long
time, and now they are tired and want
something in return.”
Dr. Íris has a more optimistic outlook
on the current situation. She says that the
contract benefits some wards more than
others, with base rate wages increasing
11-27% over a three-year period.
“What’s bad about this situation,
however,” Dr. Íris says, “is that the pay-
roll comes out of the hospital’s budget,
and the directors say they didn’t receive
increased funding to accommodate these
changes. They are therefore restructur-
ing the shifts, as they can’t grant doctors
the time off their contract commands.”
Despite this, the word on the street
is that doctors are happy with their new
contract, Dr. Íris tells me, with number of
doctors making arrangements to return
from studies or positions abroad.

Strike after
strike
While doctors were successful in their
negotiations with the state, the rest of
Iceland’s healthcare workers’ attempts
to secure better wages and working con-
ditions proved less fruitful. Negotiation
efforts saw numerous unions with ties to
Icelandic healthcare banding together,
forming a wave of strikes. BHM (The As-
sociation of Academics),
to which radiologists
and many other hospi-
tal workers belong, un-
dertook a particularly
long strike, with coor-
dinated work stoppages
occurring from October 27, 2014 to Octo-
ber 28, 2015. In May, the Icelandic Nurs-
es’ Association voted to strike if their
demands were not met. The government
came down hard, forcing through legis-
lation that effectively banned any fur-
ther strike actions on the nurses’ behalf.
Thoroughly unamused, Iceland’s nurses
responded by resigning en masse.
As summer drew to a close, an arbi-
tration committee ruled in the nurses’
favour, determining that they deserved
a 21.7% wage increase over the next four
years. However, the damage was already
done.
Ólafur G. Skúlason, chair of the Ice-
landic Nurses’ Association, tells me that
out of the 300 nurses that resigned from
Landspítalinn, some 45 did not return to
work. In fact, he says that even though
there are funds to hire an additional 100
nurses at the hospital, there are simply
not enough applicants left in the country.
“This staff shortage adds even more
pressure onto the nurses working at the
hospital,” he says, “and it will only get
worse, as around 900 nurses country-
wide will reach retirement age over the
next three years.
“Research shows
that well-manned
shifts lead to bet-
ter patient care, a
lower mortality rate,
fewer complications
and shorter hospital
stays, as well as being more cost-effec-
tive,” he says. “It’s obvious that a health-
care system that doesn’t have enough
nurses cannot ensure the same levels of
patient safety as a well-staffed one.”
Retired GP Dr. Haukur S. Magnús-
son, who has practiced medicine since
1961, concurs, adding that both research
and experience show that when the pri-
mary care and family medicine facets are
well manned and easily accessible, gen-
eral health improves across the board,
alleviating pressure from the rest of the
system.
Cumulative
effects
The eleven-week doctors strike led to
the delay of 790 elective surgeries. The
spring strikes resulted in 900 more being
postponed. Statistics provided by Land-
spítalinn show that in October, 4,023 in-
dividuals had been awaiting operations
for three months or longer, compared to
3,058 at the same time last year—a 32%
increase.
Dr. Íris says this year has seen numer-
ous outpatient appointments delayed,
and the shelving of diag-
nostic operations such
as X-rays and blood
tests. While she main-
tains that essential tests
are being performed,
she struggles with an-
swering whether or not
people’s lives have been
at risk. “There have cer-
tainly been instances
where I have wished I’d seen a blood
test earlier, or known about something
sooner, or seen a person get somewhere
quicker.”
Some departments were particularly
badly affected, such as the hospital’s
gynaecology ward, which disclosed in
November that a chronic shortage of sur-
gical nurses meant they could only keep
two out of three operating rooms run-
ning. Some 275 women await pelvic floor
operations at present—and the depart-
ment has only been able to perform thir-
teen such operations per month this year,
as opposed to eighteen in 2014, resulting
in waiting periods stretching upwards of
two years. Speaking to newspaper Frét-
tablaðið, senior physician Dr. Kristín
Jónsdóttir remarked: “If we got a chance
to work in peace and made a concentrat-
ed effort, we could cut the waiting times
down, but right now it’s like we’re always
chasing our own tail.”
Priorities
At this point, healthcare workers’ sal-
ary negotiations have been settled for the
time being, and most of them are back
to work, with no strikes on the horizon.
However, those tasked with running Ice-
land’s healthcare system are still strug-
gling with a weighty problem: securing
the funds to keep it running.
Like every facet of Iceland’s health-
care system, Landspítalinn has already
been subjected to numerous cost-cutting
measures, even as records demonstrate
that it is even more cost-efficient than the
Swedish Karolinska University Hospital,
a facility three times the size. Indeed, the
hospital had been forced to operate on a
shoestring budget even before the eco-
nomic collapse. Naturally, frustrations at
Landspítalinn have been steadily grow-
ing, resulting, among other things, in its
former director, Björn Zoega, resigning
in protest two years ago, declaring that
he refused to take part in running the
hospital into the ground.
Last year, Landspítalinn’s operating
budget was increased by one billion ISK,
its first budget increase in over five years,
with funds also allocated for the renewal
of medical equip-
ment and other
functions. The 2016
budget, however,
has drawn more ire
than praise from the
hospital staff.
In the last two
weekly newsletters
to his staff, Univer-
sity Hospital direc-
tor Dr. Páll Matthíasson, PhD, criticised
the government’s proposed 2016 budget
for not being proportional to the tasks at
hand. The problem, he argued, is three-
fold.
Firstly, there is the exorbitant cost
of maintaining the hospital’s 130,000
square metre facilities, which spread
out over 100 buildings. Secondly, the al-
located funds fail to reflect foreseeable
changes in Icelandic society’s composi-
tion, leading to a de facto 1.7% yearly re-
trenchment since 2010. Thirdly, payroll
estimates from the Ministry of Finance
seem to be the product of wishful think-
ing rather than the reality at hand, being
routinely lower than the actual costs.
Páll also made it clear that the sys-
tem’s ever-growing waiting lists would
not get any shorter without the allocation
of additional funds.
However, Páll praised the proposed
budget for its stated intent of increasing
funds for elderly care and the metropoli-
tan healthcare clinics, which he believes
will lessen the burden on Landspítalinn.
Additionally, in early November, ground
was broken for the first part of a long-
promised state-of-the-art hospital, slated
for completion in 2020. Páll estimates
that the new hospital will save around
2.63 billion ISK per year once operation-
al.
As before, the fate of Iceland’s health-
care system seems largely up to politi-
cians and their priorities.
One year ago, Iceland’s lauded universal healthcare
system seemed to be teetering off the edge. Doctors’
wages had stagnated after the economic crash, and
following a bout of failed negotiations, they went on
strike for the first time ever. While they coordinated
their actions to avoid endangering patients’ lives, the
doctors’ message was clear: if demands were not met,
they would seek employment elsewhere.
Thoroughly
unamused, Iceland’s
nurses responded by
resigning en masse.
“If we got a chance
to work in peace and
made a concentrated
effort, we could cut
the waiting times
down, but right now
it’s like we’re always
chasing our own tail.”
by GABRÍEL BENJAMIN – photos courtesy of LANDSSPÍTALINN

Healthcare | Annual check-up!
14
The Reykjavík Grapevine
Issue 18 — 2015