Swiss Review 5/2021

Swiss Review / October 2021 / No.5 9 Prescriptions to avert an emergency Since the pandemic began, the public has certainly become more conscious of the work that carers put in around the clock. The “Strong healthcare” popular initiative aims to give nurses a shot in the arm. It will be put to the people on 28 November. For years, nurses have been calling for bet- ter working conditions, greater recognition andmore autonomy. The Swiss professional association of nurses (SBK-ASI) now wants to takematters into its own hands at the bal- lot box. “Our health system will be on the brink of intensive care itself if we fail to make our profession more attractive,” says SBK-ASI director Yvonne Ribi. Supporters of the initiativewant greater investment in ed- ucation and further training. For example, they say that apprentice wages need to be increased to boost the number of graduates entering the profession. The initiative also wants more people working per shift to ensure quality as well as patient safety. Rotas and working hours have to be more family friendly. In future, nurses need greater scope to prescribe, carry out and invoice certain treatments themselves. “Giving nurses more responsi- bility will ease the pressure on doctors,” says nursing academic and initiative com- mittee member Rebecca Spirig. Counterproposal to promote training Policymakers have lent nurses a sympa- thetic ear. The federal parliament has ap- proved a counterproposal, favouring a strat- egy that promotes training. Almost 500 million Swiss francs fromthe federal coffers has been earmarked for the proposal, with the cantons set to match this amount. That is too little, says the initiative committee. It believes that more is needed if carers are to have greater job satisfaction and stay longer in the nursing profession. The campaigners also want higher staffing ratios. Hence vot- ers will have the last word on 28 November. The Federal Council and majorities in the National Council and Council of States op- pose the initiative. They are unwilling to af- ford nurses special treatment in the federal constitution. Health insurers also belong to the no camp, unhappy that the initiative would allow nurses to prescribe certain medical services themselves. They warn that this would lead to more frequent treat- ments and additional costs. The opposite is true, counter supporters. Not having to rely on a doctor’s signature all the timewill save time and money, they say. (ERU) Efforts are being made to make primary care more interconnected and efficient – not least in rural areas, where group practices have sprung up, pooling together different specialist areas. Models involv- ing top-quality home care providers and a seamless interfacewith in- patient care also exist. These receive a degree of public funding. “We have evaluated some good solutions,” says Spirig. But there is a lack of political will to promote and implement thesemodels across Switzer- land, she adds. Meidert shares this view: “Many authorities only act when all other options have been exhausted.” Stakeholders pursuing their own interests The complexity of the system makes it harder to form correlations and initiate fundamental reform in the long term. Indecision seems to reign among national policymakers, who often get caught up in matters of principle and are rarely able to compromise. Many pro- posed improvements fail to get past parliament, where key stakehold- ers like the Swiss Medical Association, health insurers, and the phar- maceutical industry have a notable lobby. But voters also tend to be sceptical of reform proposals. In 2012, for example, the electorate re- jected a plan that aimed to improve the coordination and quality of primary care. Thosewho oppose innovative solutions warn of higher costs, reflecting a common concern (see adjacent text, “The public pays a lot”). However, studies suggest that uniformstructures and efficient processes help to keep the costs in check. Once the various professions work together more effectively, staff will also be happier and remain in healthcare for longer. Rebecca Spirig, who is one of the committee members tabling the popular initiative, hopes that a yes votewill help to boost collaboration. “It would pave the way for reforms not only in nursing but within healthcare as a whole,” she says.