The hospital staff goes on strike: no knee surgery, but profiteroles without cream

Hospital staff will go on strike on Thursday. At least, as far as possible. Just like before, the garbage collectors and bus drivers, hospital employees are now going on strike after the collective labor agreement negotiations with hospital umbrella organization NVZ have stalled. They will work for 24 hours as if it were a Sunday: only the most necessary care is provided, planable care is postponed.

200,000 people fall under the hospital collective agreement. University hospitals – the UMCs – do not participate in the actions; they have a different collective agreement, in which a salary increase of 10 percent was agreed at the end of last year. Medical specialists are also not involved in the current negotiations and actions with their own employment conditions.

At various locations, hospital employees have previously held actions in which they sat down in the hall of the hospital. This Thursday there will be actions at 64 hospital locations. In many hospitals, banners have been hanging for months with texts such as: “We have to strike, otherwise we will soon be under this sheet ourselves”, “The NVZ says no, we will become self-employed” and “If the NVZ does not cooperate, we will go to a UMC”.

What exactly are the strikes about and what do they mean for patients? Four questions.

1 What do hospital staff want?

First of all: more salary increase than the employers offer. The Dutch Association of Hospitals offers 13 percent, for a period of two years. It doesn’t get any better, says the NVZ. But it goes in steps – now 5 percent, again in December, and in June next year the last 3 percent – ​​and that is why the healthcare unions do not think it is enough, they previously told NRC. Moreover, the unions do not want to be pinned down to a 3 percent increase in 2024. If there is more insight into inflation by then, a decision should be made at that time. The unions want 10 percent more wages this year, just like the university hospitals.

Second: a better travel allowance. Hospital employees are now allowed to declare 8 cents per kilometer, for a maximum of 30 kilometers. The employers want to raise the rate to 11 cents this year and to 14 cents next year. In other sectors, most employers pay at least the amount that can be paid without tax: 21 cents per kilometer. Next year it will be 23 cents.

Staff also often have to pay for parking on the hospital grounds. And train tickets are not fully reimbursed. That essentially means employees have to pay to work, the unions say.

A third point for employees is on-call services. If an employee takes on an extra shift within 72 hours, they will receive an extra compensation as a reward for the flexibility. The unions also want employees to be able to be paid in time to recover from the extra working hours.

2 What are the consequences of the actions on Thursday for patients?

Hospitals participating in the campaigns largely work according to a Sunday schedule. There is less staff and much planned care has been cancelled. Patients for whom knee surgery is scheduled, for example, have been notified that their procedure will be moved. Emergency care continues in hospitals. The emergency room remains open, admissions to the intensive care unit, the maternity ward, oncology and cardiac monitoring continue, as do fertility treatments.

What patients notice about the actions depends on the hospital they visit – and which departments participate. The OLVG in Amsterdam is on strike, but all outpatient clinics remain open, while two are closing in the Franciscus Gasthuis & Vlietland in Rotterdam: the dermatology and vaccination outpatient clinics.

At the Antoni van Leeuwenhoek hospital in Amsterdam, for oncology, employees are laying down for the first time. Fewer staff are present in the nursing wards on Thursday. There are no ‘large patient visits’, the spokesperson explains, and when doctors visit patients, there is no nurse there that day, for example. Supportive care staff are also on strike: psychologists and dietitians are not working, the physiotherapist only visits patients for emergencies. The laboratory and outpatient clinics remain open, radiotherapy continues. The company restaurant is closed. With reference to the collective labor agreement, profiteroles without cream are distributed.

3 What can the strikes mean for the negotiations?

Ad Melkert, chairman of the NVZ, says he wants to return to the negotiating table as soon as possible. But there is no more room, he immediately adds. “We can discuss priorities. Travel allowances are an important point for employees: we can talk about that again. But more money is not possible from us.” In other words: if the NVZ meets the demands of the unions, this will be at the expense of other points in the offer. “Unless the government and health insurers step in,” adds Melkert.

It makes it unlikely that the unions will join again soon: they only want to renegotiate on the condition that more money is allocated. “Otherwise it makes no sense to us,” says Elise Merlijn, director at FNV Zorg & Welzijn. “We have not rejected this offer for nothing.”

If no money is added, the next action will be “even bigger,” says Merlijn. “The NVZ can also say: we are just going to pay. Yes, then problems will arise – but let The Hague solve them afterwards.”

Is there an impasse? Merlin thinks so. “It is now up to the NVZ to break through that.” Melkert thinks not. “We will work it out together. We have to work it out together.”

Yes, problems will arise – but let The Hague solve them afterwards

4 What does it mean if employers go along with the demands?

With the current offer, the hospitals are already exploring the edges of what is financially possible, according to the NVZ. Accountancy and consultancy organization KPMG calculated on the basis of annual accounts from 2021 what it means for hospitals if they indeed promise a wage increase of 10 percent this year. All hospitals would therefore make a loss, was the conclusion. And that calculation only included the wage increase, not rising costs for energy and materials.

But, says Arno de Vries, one of the researchers, most hospitals can fall back on buffers and therefore suffer a loss for one or two years. De Vries works for the health branch of KPMG and calls the requested wage increase justified: “There is already a pay gap for certain positions in healthcare compared to comparable positions in other sectors.” Out a report of the Social and Economic Council from 2021 indeed shows that wages in healthcare are on average 6 to 9 percent lower than for comparable positions in other sectors – a nurse versus a security guard, for example.

Insurers could step in to prevent hospitals from falling too far into the red, says De Vries. Previously, NVZ chairman Ad Melkert already asked health insurers and Minister Ernst Kuipers (Public Health, D66) to contribute to the collective labor agreement. But the consequence of this would logically be an increase in health care premiums for citizens. Last Friday Kuipers warned for rising health care costs.

According to De Vries, ‘spreading the pain’ is the best option: hospitals have to draw on their own funds and health insurers could also tap into reserves, so that the premium increase does not turn out too sharply. “This is how we bear the burden together.”

These are temporary measures, according to De Vries. He also argues for structural solutions: working smarter, and in particular reducing regulatory pressure and administrative burdens. “About half of the time of healthcare workers goes to administration. If you reduce that by 10 percent, that saves a lot of unnecessary hours.”