In July this year, the Supreme Audit Office (NIK) will commence an audit of the recruitment and remuneration of medical staff, primarily to identify the systemic mechanisms governing salary increases within the public healthcare sector. It will also be important to determine the actual salaries of staff within the medical specialisations selected for the audit and to carry out a comparative analysis of these. The Office will then examine how these mechanisms operate within specific healthcare entities.
This audit – which has been in preparation for some time – concerning the introduction of systemic mechanisms leading to salary increases will also consider the request from the Prime Minister to conduct a comprehensive audit of the funding of salaries and services provided by medical staff in publicly funded healthcare facilities, which was received by the Office on 19 June of this year.
The working hours of medical staff have a direct impact on the quality of care and patient safety. Significantly extending these hours has negative consequences for healthcare workers and may adversely affect the health or lives of patients. The result is extremely high salaries for some persons, whilst posing a risk to the quality of care provided.
NIK on healthcare – ongoing audits
The latest audit in this area, which has just been published, concerns standards for the provision of perinatal care. It showed that, although the quality of these services in Poland is steadily improving, systemic changes are needed and supervision of standards must be strengthened.
Among the irregularities identified were, amongst other things, excessively long working hours – the requirement to ensure 11 hours’ daily rest and 35 hours’ weekly rest was not being met by salaried doctors. In all the hospitals audited, doctors employed on civil-law contracts worked continuously for over 24 hours (719 such cases were recorded). The longest shifts lasted as long as 96 hours, posing a direct threat to patients and the doctors themselves.
In the coming weeks, NIK will publish the results of three further audits in the healthcare sector:
- June: teaching hospitals – whether they properly performed their clinical, teaching, and research activities,
- early July: Warsaw South Hospital – clinical activities as well as asset and financial management,
- late July: the emergency medical services system – whether it ensured an efficient response to medical emergencies.
In each of these audits, one of the areas examined was working hours of medical staff – as this has a direct impact on the quality of care and patient safety.
How does NIK work?
Audit work is a process that takes place over time. It involves collecting and verifying data from a number of entities, analysing documentation, establishing the facts, and drafting a post-audit report. For audits covering several entities, the Office compiles a summary report of the findings, containing conclusions, assessments, and recommendations.
The Supreme Audit Office operates according to an annual work plan, adopted by its Board. However, when it receives reports or identifies areas where irregularities may have occurred, the Office analyses the validity of the claims and the feasibility of taking action. In each case, the results of previous audits and activities already planned in the NIK’s work plan or intended to be undertaken as part of ad hoc activities are also considered.
The NIK is open to requests concerning matters affecting the functioning of the state and the Office itself, submitted by external bodies – including representatives of the government, self-government, civil society organisations, or citizens.
Pursuant to the Act on the Supreme Audit Office, the Office also undertakes audits at the request of the Polish Parliament (Sejm) or its bodies and following consideration of a request from the President of the Republic of Poland or the Prime Minister.
The aim of the Office's activities is not merely to identify irregularities, but also to formulate observations and recommendations that will lead to a tangible improvement in the functioning of the audited entities and the areas for which they are responsible.
