Health system marred by overcrowded Athens hospitals

The National Health System of Greece (ESY) is beset by numerous shortcomings, which is why it meets with less acceptance from Greeks than do the health systems of other European countries from the general public. One of ESY’s problems is that of patients being left on gurneys in the corridors of large hospitals in Athens, which is painful for the patient, runs counter to good medical practice and demeans all of us who work in such places. In my view, it is one of the greatest blots on the public health sector; we want to do away with it and are prepared to assist any attempt to achieve that. Twenty years since the inception of ESY we have still not acquired a well-organized, reliable primary healthcare system – it was only two years ago that the effort to decentralize the system began with the establishment of the regional health system program (PESYP). Because of the lack of a primary healthcare system, large numbers of people seek help for minor ailments at hospitals in Athens. The system did not develop evenly throughout Greece, leading to poorer-quality services in the provinces compared with the capital and the hospitalization in Athens of many patients who live outside the city. The popularity of certain large hospitals in Athens also contributes to the gurney phenomenon. A permanent cure for this problem demands the removal of its causes. The government and the health minister have already made an effort in this direction. Two months ago a new proposal for a duty rota to operate on a pilot basis in Athens hospitals was announced. Piraeus hospitals were to continue unchanged. The proposal, however, had serious drawbacks. The basic aim was to increase the number of hospitals on duty for outside patients in the morning. Formerly, four groups of hospitals used to be on duty, one group every four days; each of those groups include one large hospital (Evangelismos, the General State Hospital of Athens, the Laiko Hospital, the Red Cross and the Ippocrateio). The proposal in general was as follows: a) Major hospitals would never be on duty in the morning; b) The groups would remain unchanged, with one group of hospitals on duty from 2.30 p.m. until 8 a.m.; c) Only small hospitals would be on duty in the morning, and in groups of two; and d) The same system would apply at weekends and on public holidays. The proposal was risky because no major hospital would do morning duty, and unfeasible because it would exhaust the resources of smaller, understaffed hospitals. On November 29 the Health Ministry implemented a duty rota plan that differed from its original proposal and took into account the observations made by the Athens-Piraeus Union of Hospital Doctors (EINAP): The duty rota remains as it was at weekends and on public holidays, and all the hospitals of two groups are on duty weekdays 8 a.m. to 2.30 p.m. This system appeals more to the public because more hospitals are on morning duty. It is also closer to our expressed views on all-day operation for all hospitals. To make this effort durable, the ministry must immediately take steps to tackle the serious shortages of nurses and doctors and secure the cost of additional duty rotas. Health sector employees are living in the Middle Ages when it comes to working conditions. The performance and active participation of all are essential if we are to attain the common goal. Proposals The pilot system is now in its second month. I propose some changes to make the system more productive and practicable: 1. That one full group of hospitals be on general duty each day, from 8 a.m. to 8 a.m. the following day; 2. That small hospitals supplement the duty rota of a second group of hospitals on weekday mornings until 1.30 p.m.; and 3. That small hospitals carrying additional morning duty not be on duty the days preceding and following their general duty day. And, of course, once the requisite staffing has been secured, we must take action so that all hospitals are open to the public. (1) Stathis Tsoukalos is president of the Athens-Piraeus Union of Hospital Doctors (EINAP).