The Labor Party and Rødt are advocating for limiting private healthcare provision through legislation. The backdrop is a lack of health personnel. The Health Personnel Commission’s report points to failing recruitment to the public health service already today – and warns of increasing problems in the future. At the same time, the commission states that Norway is particularly well equipped, with many doctors and nurses. However, the Commission makes no attempt to explain these contradictory findings. If we look in the rearview mirror, we will find that important explanations lie in the present day. Those of us who have been employed in the hospitals since the late 90s have witnessed major changes. Formerly independent hospitals are subordinated to and incorporated into large health enterprises under the management of company-like boards, often located in another city. The hospitals’ traditional professional management has been phased out in favor of state enterprise management, a management management system – derived and inspired by management methodology in the private sector. With the changes, the hospitals have become larger, the management more distant, and the value set in the sector has been replaced. Patient treatment has also changed significantly. In the wake of closures and centralisation, the number of beds has been greatly reduced, also in the municipal health service. More patients are treated as outpatients or receive home care. The circulation rate for inpatients increases as the length of stay decreases. The inpatients are sicker than before, both in hospitals and nursing homes. A newly qualified healthcare worker is faced with a completely different everyday work life than what faced us a few decades ago. When we started our professional careers, hospitals were generally perceived as attractive workplaces that looked after both patients and staff in a good and caring way. We often experienced the working day as hectic. But strenuous days alternated with calmer moments and days. Today, everyday life is different. Totally different. Patient treatment in today’s hospitals is designed according to templates from manufacturing companies. Pressure to constantly increase production pervades most things. The support staff has been greatly reduced. We are placed at an assembly line that many feel goes just a little too fast. Too little space, too few beds, too few staff, for too many sick patients. The new norm is sustained high work pressure without quiet moments. The requirement for a long planning horizon means that requests for absence must be reported to the management with at least six months’ notice. The hospitals’ care for employees has also changed. We are no longer met by HR departments that want to find solutions and make it easier for everyday life to improve. Employees are today to a greater extent just a number in a row in the large organisations, and are treated accordingly by the hospitals’ HR departments. The many thousands of staff homes that the hospitals could offer new graduates in the establishment phase have been sold. For newly qualified health personnel, meeting with employers and everyday working life in hospitals and municipal health institutions can be a shocking experience; they have not previously experienced such tough work requirements, such high “production pressure” and an employer who is so inflexible. Everyday life doesn’t go well. Many new employees quickly draw the conclusion that this is not a permanent place. In some departments, the average turnover rate for employees is down to between one and two years. This means that the workforce at all times mainly consists of employees with short working hours and little experience. The working environment is further weakened by staff turnover and the widespread use of temporary workers. The salary conditions for employees in the public sector follow the front subject model. But the model does not take into account other working conditions – which can be just as important when employees have to choose a life that must fit in with family and other obligations. In the health sector, these have deteriorated over several decades. The development in the rest of working life has gone in the opposite direction. The fact that healthcare personnel choose to move away from burdensome rotation arrangements and tougher working conditions in the public healthcare system can therefore be easily explained. So what is the Health Personnel Commission’s response to these challenges? The government commissioned the commission to propose effective measures to recruit and retain qualified health personnel. The recommendation from the majority in the commission is to give the employer unilateral access to set up rotations and to be able to impose an increased frequency of weekend work. For employees in the hospitals, this will mean reduced influence, less flexibility and increased workload. Continuation of the current development is not sustainable – the recruitment failure will only increase with further deterioration of working conditions. The majority proposals of the commission are the wrong medicine. Nor can the solution be to ban private healthcare activities – as the Labor Party is now about to propose. It will not be possible to get broad political support behind such a proposal. And employees will be able to apply to other sectors anyway. The obvious solution is today: to strengthen working conditions in the sector. Hospitals and municipalities must make arrangements for healthcare workers to feel that the workplace is a good and permanent place to work. Then our public health service will recruit well – because this is where most of us want to work.
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Why don’t healthcare professionals want to work in public healthcare? – Speech
