ICELAND: Outsourcing of Hospital Services Opposed

Lowana Veal

REYKJAVIK, Jun 13 2008 (IPS) – I was so shocked when I went there just now, said Arndis Lilja Nielsdottir, referring to the situation in a new ward at Landakot geriatric hospital. The ward is now being run by Grund, a company providing residential and nursing home care for the elderly.
The food is worse, he (someone in care) had not been cleaned, and the staff don t talk to the patients like they did in the ward upstairs, she continued. I went straight upstairs to where he used to be, and the staff there said they had received similar complaints from other relatives.

They encouraged me to talk to relatives of the other residents, complain, and talk to the media. And that s what I m going to do.

The ward, which is intended to house 18 individuals with Alzheimer s disease, had been closed for about four months because of staffing problems, but was reopened May 14. It is intended to act as an interim ward until residents can be transferred to other nursing homes.

According to the Ministry of Health, the Icelandic state will save about 213,000 dollars a year by the new arrangement.

Hospitals and residential homes for the elderly have been understaffed for years in Iceland. Because the hospital itself could not staff the ward, and because of the long waiting list for admission to residential homes, the hospital put management of the ward out to tender.
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We wanted to increase the variety of care options, says Gudrun Bjorg Sigurbjornsdottir, assistant director of nursing at Landspitali University Hospital.

Grund was awarded the tender in early April. But where have the staff come from? Grund itself is understaffed.

Some people have been employed directly and some have been moved from the nursing home, says Helga J. Karlsdottir, personnel manager at Grund. For the permanent positions that could not be filled, temporary summer staff have been employed.

The employees are a mix of Icelanders and foreigners, many of them students. In Iceland, school and university students usually work from mid-May till late August. I don t know what the situation will be like in autumn, Karlsdottir said.

It s more difficult to recruit staff to work with patients who have dementia, said Sigurbjornsdottir.

The temporary staff are delightful but completely inexperienced, says Nielsdottir. And I met someone in the lift who I m sure doesn t talk English, let alone Icelandic, she added.

The public relations officer for Grund, Gudbjorg Gudmundsdottir, says that foreigners who cannot speak Icelandic are allocated to cleaning until their Icelandic is good enough to communicate with residents. Grund provides its foreign employees with Icelandic teaching during work hours.

According to the agreement, Grund will provide meals, medical support, physiotherapy, occupational therapy, manicures and pedicures, hairdressing and laundry facilities, using their existing staff and facilities at their main residential and nursing home in Reykjavik.

The hospital will provide nursing cover for night shifts and weekends.

British public health professor Allyson Pollock recently visited Iceland and related her views on privatisation of medical care. In an interview to the newspaper Morgunbladid, she said that privatisation of healthcare in the UK had produced mixed results, and increased administration costs.

The research evidence from the U.S. shows that commercialisation of this sector is associated with lower quality of care, staffing levels and staffing standards, and serious difficulties in regulating due to the capture of regulators, she told IPS by email.

Regulatory capture refers to a situation in which inspectors and monitors are captured by industry interests.

Research in the UK shows that there is no evidence to support value for money or high quality care (in private care), and that privatisation results in money being lost from the public system, leading to reductions in service provision and fragmentation of care and responsibilities with loss of continuity. If staff shortages are a problem, how does commercialisation result in more choice or more care options? How is this sector being regulated, and what about risk? Who carries risks and liabilities? Was this opened up for debate and discussion in the community?

But Gudmundsdottir says: The residents in our ward at Landakot receive the best possible care, and the food is prepared from scratch by our cooks and baker at Grund. The food is tailored to the wishes and tastes of elderly people while we use the nutritional guidelines of the Public Health Institute as a base. Nobody should eat heavy meals twice a day.