Problems of the health care system according to the Ombudsman. The list is long

- The information presented in this letter is only a part of the measures I have recently taken to improve the situation of patients in the area of health care," Marcin Wiącek wrote to Bartholomew Chmiellow. He addressed the ROP on problems in the health care system that require increased oversight.

Access to anesthesia during labor. According to data from the National Health Service, more than half of maternity hospitals did not provide a single epidural during labor in 2022. And on average, nationally, the percentage of deliveries with anesthesia is only 14%.

The NHF's legal guarantee of the possibility of receiving a particular service in the absence of a real possibility of obtaining it in many hospitals may therefore be a sham. On the other hand, the lack of an actual possibility of administering anesthesia may indicate a violation of the patient's rights to respect for dignity and intimacy and treatment of pain, as well as the right to health services that meet the requirements of current medical knowledge.

There is no regulation of the use of coercive measures against patients in non-psychiatric wards, such as oncology patients or patients after surgery. Only the use of coercion on patients with mental disorders is regulated by law. Meanwhile, direct coercion in non-psychiatric wards is commonly used because in patients, such as after surgery, the patient does not control his behavior. It is then necessary to use direct coercion, but there is no legal framework defining the permissible limits of its use, the obligation to report or the maximum immobilization of the person

Long queues for specialists. While the law makes non-discriminatory provision for how a patient's place in the queue is determined, in the case of some specialties (e.g., rehabilitation) the long waiting period makes the possibility of real access to free health care a sham.

The problem of where to apply immobilization in psychiatric wards. Today, the regulations explicitly do not obligate a separate single room where this measure could be applied. As a result, immobilization is mostly performed in multi-bed rooms, and patient intimacy is supposed to be guaranteed by screens. However, this does not ensure intimacy and respect for the patient's dignity.

There is a lack of specialized facilities to provide assistance to those who suffer from autoimmunity. Currently, they are housed in psychiatric hospitals - where they are restrained with belts - or at home - where the family is unable to keep them safe. In turn, there is a shortage of facilities for auto-aggression sufferers that provide specialized round-the-clock care.

No funding for the medicinal products Kaftrio and Kalydeco for the treatment of cystic fibrosis under RDTL. In addition, the scope of the previously requested reimbursement may be questionable. The NIK requested in its 2022 audit speeches to the Ministry of Health to reliably develop lists of drugs not subject to RDTL funding.

Patients waiting to be put on the waiting list for more than one service. According to the regulations, one can be put on the waiting list for the same service only once. If the referral is for another part of the body, the planned rehabilitation should take into account all dysfunctions and provide the patient with a holistic benefit. Sometimes hospitals do not take a comprehensive approach to rehabilitation. The patient is then forced to complete rehabilitation for one condition in order to be re-enrolled in the queue for another. This significantly increases the waiting time to receive medical care.

Lack of accessibility of gynecological offices for women with disabilities. The Strategy for Persons with Disabilities provides for the development of systemic solutions in this regard through the development of standards to include accessibility at all stages of medical services. Currently, there are few such facilities, and they are available mainly in large cities.

Lack of chair scales for people with disabilities and the elderly. This can make it impossible to determine a patient's weight, which is necessary when selecting the appropriate dose of medication. As of early 2023, there were such scales in only 67 facilities. In the Lower Silesian, Warmian-Masurian or West Pomeranian provinces, only one facility has an accessible scale, and in some provinces there are none.

Difficulties in obtaining portable oxygen concentrators. Its cost is four times that of a stationary one - many people cannot afford to buy one. The Regulation of the Minister of Health on the list of medical devices issued by order does not include these concentrators. They can only be rented from Home Oxygen Treatment Centers, which have contracts with the National Health Fund.

Provision of nursing staff in nursing homes. Problems arise from wage disparity in social welfare and health sector units.

The situation of people in crisis of homelessness in need of convalescence after hospital treatment. This refers to situations when, on the one hand, it is not justified to prolong the hospital stay for non-medical reasons, and, on the other hand, it is necessary, taking into account the well-being of the sick person.

Verification of working time standards and staffing of on-call doctors. The NIK audit indicates that hospitals have failed to ensure adequate health security for patients, as well as for doctors, by allowing them to perform uninterrupted on-call duties with civilian employment.

Disregard for the needs of the deaf in health care facilities, and even poor, degrading treatment of them by medical personnel. The situation of deaf people in psychiatric hospitals is particularly dramatic. Among other things, they are forced to participate in group activities, which they find extremely stressful without a PJM interpreter. Deaf people's behavior is misinterpreted by staff who are not prepared to interact. This contributes to poor diagnoses and inappropriate therapy.

The situation of the elderly in access to health care. Health care and social assistance systems do not comprehensively address the complexity of their medical and care needs. They do not guarantee the required availability of services, their continuity and comprehensiveness, i.e. coordination of specialized care by the family doctor and supervision of medications taken, nursing care for chronically ill patients at home, collection of laboratory tests at home, access to rehabilitation services, care services, support of a senior assistant, provision of transportation.

For the elderly, unequal access to health care and care support is particularly noticeable, especially in rural areas, and very limited access to geriatric, hospice and palliative care.

Inequality in the rules for admitting elderly people to treatment and care facilities and nursing homes, as well as in the payment of family members for their stay in treatment and care facilities and nursing homes.

Hepatitis C diagnosis and treatment among inmates. Correspondence between the MZ and MS shows that the final form of the agreement has not been drafted as of November 2023, and that there is a risk that the implementation of the program will not involve screening of inmates. The problem has been of interest to the RPO for years, as the elimination of HCV from the prison population is in the public interest.

The situation of patients of the National Center for the Prevention of Dyssocial Behaviorwhose health condition is so severe that they require specialized services. It is not always possible to provide them with adequate services at KOZZD, and the court often does not agree to let them leave the center. Prison health care facilities have priority in providing medical services to KOZZD patients. However, they are reluctant to hospitalize KOZZD patients, since only convicts and detainees are allowed in hospitals on prison grounds. Admission of KOZZD patients to the hospital, on the other hand, entails placing them in a single room, and KOZZD security personnel must be present around the clock.

Source: RPO