The Polish Mother's Memorial Hospital in Łódź is in a critical condition, the worst one of all sixteen institutes supervised by the Minister of Health: the liabilities of PLN 175 million need to be paid immediately. The standing of the Children’s Memorial Health Institute and the Institute of Rheumatology is equally bad.
In the past years, only one institution - the Institute of Mother and Child - has significantly reduced its debt, paying the most urgent liabilities. However, this as well as other institutes have gradually fallen into bigger and bigger trouble. In 2008, nine of them reported a loss, but in June last year it was as many as 15 in 16 institutions. Only the Institute of Physiology and Pathology of Hearing did not generate any losses.
The very difficult financial condition may affect both patients and employees. Potential liquidation of any institute will create a big gap in the health care system. Despite that, though, the audited institutes did not implement any effective recovery programmes.
The audit revealed enormous accumulation of liabilities and irregularities in the most indebted institutes. These circumstances make it impossible to stabilise the economic standing without the support of the Minister of Health who is in charge of the institutions.
As many as 10 of 16 currently functioning institutes were founded in the 50’s of the past century, in entirely different economic conditions. It is extremely difficult to implement any system reforms, among others due to the deficit of integrated IT systems. In the Centre of Oncology, which is the largest one in Poland, electronic registration of patients was introduced only in 2011. There are no tools or tradition of evaluating and associating work results with the salary and bonus levels.
In the audited period, the headcount went up in three institutes by nearly 250 full-time jobs (of which by 191 in the Centre of Oncology). Despite the total headcount increase, the number of academic employees in institutes was falling systematically. In none of the audited institutions did the employment level exceed 10 percent. In the Polish Mother's Memorial Hospital academic staff represented less than 2 percent of all employees, and since 2009 this hospital did not hire a single academic employee on a full-time basis. The research equipment made up from 2 to 8 percent of the institutes’ property, proceeds from the sale of research projects totalled not more than 1 percent, whereas the revenue from academic activity ranged from 4-12 percent (except for the Institute of Psychiatry - 21 percent).
NIK alarms that grave negligence occurred in many areas of the institutes’ activity. They involved for instance:
- conduct of clinical research - in the Centre of Oncology the principles of research conduct, reporting, costs calculation and budget division were defined only in September 2011. Before that date, there was no mechanism of automatic reporting on the procedures carried out as part of the clinical research, the Institute’s finance staff were passive and inertial and the institution itself tolerated the defective system of financial settlements. All that enabled the procedure of concealing the clinical research from the research team, support personnel and assistant staff under the disguise of standard medical treatment procedures. According to estimates, the revenue lost by the Centre in that area from January 2009 to the end of October 2010 is higher than PLN 771.8 thousand;
- property administration - according to the agreements signed with external companies, the Institute of Psychiatry and Neurology earned PLN 595 per month on the car parking fees (on the parking space of above 4 thousand m²), although the fee rates for an hour’s parking were higher than in the paid parking zone in Warsaw;
- mandating research to subcontractors without the required consent of the Ministry and concluding contracts to perform a specific work (to conduct research) with their own employees (the Institute of Mother and Child), thus breaching agreements with the Ministry;
- abusing the sole-source contracts - in the Polish Mother's Memorial Hospital individual orders, e.g. for medical equipment, totalled about PLN 90-150 thousand.
NIK points out that the cash injection is not enough to rescue the institutes reporting to the Minister of Health. The institutions with the biggest debts and the ones in a bit better financial shape necessitate a fully-fledged recovery plan. It has to comprise not only the property administration of individual institutes but also the management methods, personnel policy and development strategy taking account of intensified academic and research activity.
NIK has audited the following institutions: the Centre of Oncology - Maria Skłodowska-Curie Institute; the Children’s Memorial Health Institute in Warsaw; the Institute of Mother and Child; the Institute of Psychiatry and Neurology in Warsaw; Prof. Eleonora Reicher Institute of Rheumatology in Warsaw; the Polish Mother's Memorial Hospital in Łódź.
