The county hospital in Bolesławiec became a very significant medical facility in Poland during the pandemic. It is praised and visited by the most important politicians of the ruling party. In April, Prime Minister Mateusz Morawiecki visited the hospital. We will ask the director what the visit, closed to the public, was like. And how the hospital director views the Polish Deal and the proposals it contains for healthcare.
Interview transcript with director Kamil Barczyk
Grażyna Hanaf: – Good morning, everyone. Today our guest is Kamil Barczyk, director of the Bolesławiec hospital. Good morning, Mr Barczyk.
Kamil Barczyk: – Good morning, ma’am, and good morning to everyone.
Let’s start with a hot topic. Have the nurses at the Bolesławiec hospital walked away from patients’ beds, or are they planning to do so?
No. As far as our nursing team is concerned, there are currently no indications that the nurses intend to walk away from patients’ beds. It is a nationwide strike organised at 40 medical facilities across the country. It is an organised action through which the professional community is demanding that pay issues in the healthcare system be put in order, but also that attention be paid to staff shortages in healthcare.
Exactly, Mr Barczyk, do our nurses earn well? Do they earn more than the priests at the Bolesławiec hospital? We could only access data from wynagrodzenia.pl. It shows that a nurse earns PLN 27 gross per hour, while a charge nurse earns PLN 33.50 per hour. Calculations of how much the priests working at the hospital earn show PLN 53 per hour. So what are pay levels like here?
As far as pay at the Bolesławiec hospital is concerned, I think it may actually be slightly more attractive than at other medical facilities. But the pay problem throughout the system does not concern only nurses; it also affects paramedics, technicians, diagnosticians, hospital orderlies and the entire environment that contributes to treating patients. It is steadily increasing, sometimes disproportionately to the rise in average gross pay in the system. And this is where the problem of staff shortages arises again: these people are simply exhausted and cannot cope because they work as if they were two or three people. It is a very serious problem, and pay must increase significantly. This is determined by what the system provides—in other words, the insurance system, the National Health Fund, what it pays the hospital and what the hospital has at its disposal. The pay structure is, in reality, very, very diverse.
I understand, but put simply: do they earn more than a priest or not?
There are nurses who earn more than in that example, and there are those who earn less, so it cannot be determined unequivocally.
But you also agree that they should earn more and that there should be more people in this profession, because the information that the average age of a nurse is 63 is appalling, when the average life expectancy for women in Poland is 80. Do you agree that the women working in this profession are really so exhausted?
Everyone who works in the healthcare system is, in reality. Doctors too, because the average age in some medical specialties is very close to what you mentioned; nurses, and paramedics—the profession is relatively young, so their average age is certainly lower. But the staff shortages in the healthcare system mean that everyone really has to work as two, three or four people. It is difficult for us to imagine, but if someone works 400 hours or more a month in healthcare, at one, two, three or five hospitals, then clearly something is wrong. That is not a normal situation. It may be that the facilities’ needs are being met and that the pay is satisfying for that person, but it should not be this way, because it leads to errors.
Exactly, because the nurses themselves also emphasise that those with higher incomes do not earn more in their full-time jobs; they simply take on more work. Do you have staffing problems with nurses—would you hire more of them?
Absolutely. The Bolesławiec hospital is not exceptional in this respect, and the staffing problem among nurses affects us too. We really have to make a great effort and recruit nurses from various parts of Lower Silesia and Lubusz Voivodeship. Women commute to us to fill the schedules and be there for the patients. We manage to organise this. I hope that it is not only pay—and perhaps nowadays pay alone does not determine whether someone wants to work in a particular place—but also the atmosphere, development, investment, equipment and treatment outcomes. These are very important elements that enable us to provide decent working conditions.
We will talk more about the hospital’s prestige, but it is connected with the nurses’ strike and the changes in healthcare under the Polish Deal. I wanted to ask whether you are awaiting the changes announced by Law and Justice in the Polish Deal—and, if so, which ones in particular?
I understand that you mean the Polish Deal and probably its first priority: healthcare.
More money, more staff—all the things that have been announced.
There is indeed a healthcare reform ahead of us. A debate is currently under way, and documents concerning the reform have already been published. It was being planned in various directions. State institutions—the voivode or even the Marshal’s Office—were supposed to take over county hospitals, for example. That was one initial concept. The second concept involved nationwide centralisation. The third involved creating agencies, restructuring and emphasising the quality of patient treatment. It seems that the third concept is a kind of consensus between what is to be achieved and putting the patient first. In the current system, the patient is not always quite in first place. Above all, it is about the quality of treatment. The proposed reform will place a very strong emphasis on the quality of patient treatment and service. This is entirely new in the system, because no one in healthcare has assessed or counted treatment outcomes or the quality of patient service.
Mr Barczyk, can you give an example of how patient treatment quality has not been the priority so far?
Above all, hospitals are all essentially settled by patient-days: theoretically, the longer a patient stays, the more profitable it should be for the hospital. Yet treatment quality is measured by the brevity of hospitalisation.
Should I understand that money will now follow the patient who has been treated, rather than the patient who is staying at your hospital?
It is about treatment outcomes and comprehensive treatment. A patient cannot simply have an operation performed and have that operation paid for; the hospital must organise comprehensive care, including outpatient care, hospital care, follow-up outpatient care and rehabilitation. Then the patient can also be settled under comprehensive standards.
Do you completely believe that it will move in this direction?
We have to start. It certainly will not change within a year. Every reform takes time because it has many layers, and we should start with staff—increasing human resources and the medical workforce. That means more students in medical fields and promoting the profession. Pay is an important factor that motivates people to undertake such studies. I hope that if we reviewed it in 10 years, whether it was good or not, we would find that the general assumptions—these are only general assumptions; there are no draft laws or regulations yet—seem to have been very carefully considered. The mistakes made in previous years, which did not work, have already been removed.
And did Mateusz Morawiecki, who visited us in April, reveal anything—give you some hints about what it would look like? Will he look more favourably on the Bolesławiec hospital because he came here?
I do not think the visit itself determines whether the Bolesławiec hospital will be viewed more favourably. We have to demonstrate and prove ourselves that the hospital in Bolesławiec is needed by our community, Lower Silesia and even all of Poland. What we have shown is proof that the Bolesławiec hospital must operate and that it is a fundamental safeguard of the healthcare system in Lower Silesia. Our potential, above all our staff potential…
I understand that you boasted a little in front of Mr Morawiecki, hoping that he would look favourably on you…
Definitely! Definitely—we have to boast like that.
I have a question. You put up a large screen for Mr Morawiecki there. Whose idea was it and how much did it cost? Because nobody was allowed in.
The Prime Minister’s Chancellery was responsible for organising the visit. Due to security and the circumstances surrounding security, the organiser had various concepts for how the ceremony or event might proceed. In fact, among those concepts, the visit was supposed to be open—relatively open. For security reasons, the number of people was restricted essentially to medical staff. Only a small group of medical personnel from the hospital could be present, who…
So I understand that the large screen was ordered in case people came and it was eventually possible to enter?
Yes. Numerous guests were supposed to be invited to the ceremony. Naturally, because of epidemiological and infrastructural conditions, not everyone would have fit inside the modular hospital, so the interior was to be shown in an open space.
Was this the hospital’s initiative? Did the hospital rent the large screen? How much did it cost?
I do not remember, but it was not a large amount compared with everything else.
I have information that renting such a screen for one day costs PLN 5,000. Was the cost roughly that much?
It was probably thousands of zlotys, but I cannot say whether it was four, five or six thousand.
Did Mr Morawiecki use the screen? Did he at least glance at it?
Oh, I do not know; you would have to ask him. However, a wonderful archival feature compiled by our local journalist had been prepared. A film lasting more than 10 minutes was made for this purpose, showing and promoting the creation of the entire project, the construction of the entire hospital, how it proceeded, at what pace and what the hospital looked like inside, because it really is a very innovative hospital. It was built so quickly while achieving such high-quality results inside…
It is a shame nobody saw it… I stood by the fence and watched the people who, so to speak, seemed to pose the greatest threat to Mr Morawiecki. Did any patients complain that they suffered any harm to their health because of the shouts made by people in the street?
No, I did not hear about that. It was more curiosity than any negative effects on treatment—probably not.
Did Mr Morawiecki enter the hospital at all?
Absolutely, he entered the modular building and saw how it was organised in the clean section. He was very pleased with how it had been organised, what it looked like and what the patient rooms looked like. It really makes an impression, because this hospital is a completely different version of a temporary hospital from what we saw at the National Stadium and at Rakietowa in Wrocław. These are not halls; they are two- and single-bed rooms with bathrooms, created in genuinely very comfortable conditions.
So I understand that when the visit took place, patients were moved somewhere so that the prime minister could enter without patients present?
No. The priority of the Prime Minister’s Chancellery staff was not to disrupt the work of doctors, nurses or entire teams. There was also to be no inconvenience for patients. That was the priority, placed first, so that patients would not be transported elsewhere. Everything was to function normally and the work was not to be disrupted. And that is how it was.
One woman complained that she received lunch two and a half hours late because of the prime minister’s visit. Is that possible?
Probably not. Probably not. It was likely due to some other organisational reasons, perhaps involving another ward. It is difficult for me to explain; those are very specific details and probably not very important.
Important to that woman, which is why I allowed myself to ask. One final question. In your opinion, should the county head and the mayor have been there after all? They helped the hospital enormously so that it could be built. Wasn’t their absence a discordant note?
Of course it was a discordant note. And of course the county head and the mayor should have been there. There are also many other people who are genuinely very helpful, cooperative and supportive of the hospital. Even local media such as yourselves. But the hospital was not the organiser, and the conditions were presented to us with justification on security grounds and because of the unrest surrounding the visit, including in the structural area: SOK officers would not have been able to secure the prime minister’s visit if it had been open. It was logically restricted very substantially, although I deeply regret that you were not all invited. I really wanted everyone to see not only the prime minister, as one of the most important people in the country, but also our effort and the hard work we put into serving patients every day.
That would have been nice. The ceramic bowl with rice probably posed the greatest threat to the prime minister. Nobody there would have threatened him very much. But let us return to hospital matters. Hektor writes: Is it true that the hospital in Bolesławiec is currently one of the few COVID hospitals in Lower Silesia and that patients are being brought here from across the voivodeship? What does this mean for the safety of city residents in terms of providing care for people who do not have COVID but other conditions?
As far as epidemiological safety is concerned, it is true that at the Bolesławiec hospital, in the infectious diseases ward—so, in practice, we are now limiting this to the modular hospital—people with COVID-19 are hospitalised. In Lower Silesia, COVID wards are still operating in Legnica, Wałbrzych and Wrocław. So we are not the only hospital, although because of the capacity organised during the pandemic, we have been designated to protect the Lower Silesian voivodeship during the summer, together with the hospital on Koszarowa Street. I do not think this poses any threat whatsoever to the safety of Bolesławiec County residents, because the virus spreads in a completely different way. It spreads through direct contact, while patients are isolated from their surroundings.
I think that fully answers our reader. Thank you to our viewers for being with us. You can ask the director questions if you wish. I will return to the issue of prestige, because it really is very important for the hospital to talk about what is good and what is changing for the better. Good news is prepared very often, and we are happy to write about what is good at the hospital. But recently we have had a communication problem. When some mistakes occur, we receive no information from you. We have two such cases: first, the clinics where on 25 May it suddenly turned out that everyone had been registered for 8:30, while the doctor was late; and then information about a doctor who allegedly made some anti-vaccination suggestions. We cannot verify it, so we are writing about it. Perhaps let us start with the clinic. What happened—was everyone really registered for the same time?
Indeed, there was a day when, after the weekend, a great many emergency cases had to be admitted. The system really did become blocked because of those cases, and a large number of patients gathered at the same time. We sincerely apologise for that. We are now working to change the registration system so that we do not simultaneously limit the number of patients accepted, because this clinic is very important, while also ensuring that people wait in more comfortable conditions. This is also an investment process, because by the end of the year we will move the surgical clinic to another building due to the expansion of the infectious diseases ward by another 14 beds. The surgical clinic and other clinics will have to be moved to another part of the hospital, but we will certainly communicate about it. There will also be better conditions in the waiting room, so that more patients can wait for their appointments. As for…
Exactly—what about the anti-vaccination doctor? Did it actually happen? Did you speak to the doctor, and what did it look like?
Of course, I spoke to the doctor yesterday. The situation did occur, but from what he told me, the person apparently was not vaccinated either. The content of that conversation probably had a different character. It is difficult for me to assess; at this point it is one person’s word against another’s. It is hard to verify. Knowing the doctor, I believe he is honest and serious enough—and very experienced, having worked with COVID patients in the Hospital Emergency Department for more than a year—that he absolutely could not have been spreading anti-COVID theories. That would be contrary to policy… It is highly unlikely.
Then why do we not receive such information? We asked many times, and it mattered to us because sometimes information from you before an article is written changes its content entirely or adds a great deal. What happened with communication?
I think we have a lot of work, and I think that sometimes you may also be sensitive to a particular response. We will certainly answer all your questions, but it requires more thorough and careful analysis. Only yesterday did I, or other employees, have time to speak to the person concerned and verify the matter, because verifying a matter does not happen from one minute to the next; it requires an in-depth analysis. It simply takes appropriate time, so we try to respond within the relevant deadlines to all letters, appeals and questions, but it requires thorough analysis to ensure that the answer is accurate.
We do not always want to involve you; surely there are people there who could deal with it…
Absolutely every letter and every response must be verified, because I am responsible for every response. I do not prepare the replies personally in the end, but they must be authorised by me.
And finally, a reader’s question: why do people with referrals have to pay for an MRI scan? You boasted about this MRI—what happened?
We have explained this many times. I think you also wrote that, with support from the local government, all the municipalities, the city and the county, the hospital purchased a highly modern MRI scanner worth PLN 3.5 million. It was commissioned in March last year. In reality, it has operated since the beginning, practically since April, because we wanted it to be available to hospital patients, but also to provide services to outpatients. However, the hospital does not have a contract with the National Health Fund, so it cannot perform outpatient examinations for patients with referrals. This is a separately contracted service, for which a contract—so-called contracting with the National Health Fund—must be obtained, and no tender based on which such an agreement could be signed has yet been announced.
So this is the National Health Fund’s responsibility—that it has not yet organised this?
We have of course repeatedly contacted the National Health Fund and spoken to them. I even personally spoke with the director about the need to launch not only magnetic resonance imaging but also the CT scanner, as well as other wards, clinics and organisational units. But the pandemic thwarted everything. Under the COVID Act, which came into force in March last year, the possibility of announcing tenders at the National Health Fund was blocked.
We hope, Mr Director, that this will be a matter of the near future.
Yes. We already have a promise that such a tender will definitely be announced very soon—more likely within weeks than months. I hope that before long these devices will serve a wider section of society.
You speak of a fourth wave of the pandemic. Any advice for us? How should we behave and what should we do to get through it as gently and mildly as possible?
Above all, vaccinations. At present, vaccination is the key. Supplies are increasing day by day. There is an increasingly greater guarantee of vaccine deliveries. The organisation of the system is becoming more efficient and better. We should encourage everyone to get vaccinated.
Do you have a favourite vaccine—would you recommend a particular one or all of them?
All of them, every one. Every vaccine approved by the institutions and subsequently recommended by the Ministry of Health is authorised, safe and genuinely extremely effective. Not to mention the effects the vaccine will have on our health. We are rather convinced that there will be a fourth wave. What matters is that this wave will be much smaller than the last two. We are significantly better prepared for the fourth wave, so I think we should cope much better than we did during the second and third waves.
So let us wish one another good health and get vaccinated. I think that is a good way to end our conversation. Thank you very much, everyone, and thank you, Mr Director. Have a peaceful evening.
Thank you, thank you everyone.