Trade union leader: Budapest ambulance service teeters on the edge, rural ambulances key to averting collapse

Emergencies happen, and people call an ambulance. Sometimes, the ambulance comes on time – and sometimes, it doesn’t. Increasingly, in Budapest, it doesn’t. The Hungarian press has been filled with stories where ambulances did not arrive on time. Reports detailed how rural workers have been deployed to Budapest. They told of poor conditions and low wages. We spoke to Tibor Lengyel, President of the Association of Hungarian Ambulance Workers, about these issues and how they see the reality of the National Ambulance Service (OMSZ).

Átlátszó: How would you describe the current state of the OMSZ?

Tibor Lengyel: Well, it’s bad, to put it simply. What we see is that every single measure is aimed at finding solutions overnight, and these solutions are never long-term, comprehensive solutions that would address the root of the problem. They’re always ad hoc. It’s papering over cracks.

There have been an increasing number of stories about ambulance units being brought to Budapest from around the country.

It’s been near ten years now that ambulance units have been dispatched to Budapest. But ten years ago, units were only assigned to the city from stations close by. A little later, they’d be brought in from the whole Pest County, and then they’d also be called up from the surrounding counties. We’ve reached a point where units are being called in from the farthest corners of the country without second thought.

The way these transfers work is that there is a certain number of rescue units that have to be directed to Budapest in a planned calculation.

The Nagykata station is an example. Of the six ambulances in the station, one works in Budapest every weekday. Now, a second car has also been dispatched, without justification. At the same time, the ambulance delegated to the rescue point in Sülysáp has not been able to start for months because of staff shortages, even though the local government there has invested a lot of effort in setting up the rescue point. So – out of the six cars, one is stationary, two are in Budapest and only three remain at the station.

Yesterday I received information that cars were now being ordered from all the ambulance stations in the Central-Hungarian region – even from ambulance stations where there are two cars in total. Just think – in a rural two-car ambulance station, that’s 50% of the ambulance capacity taken away.

What we see is that there are all kinds of routes that are working to keep the Budapest ambulance alive, because the Budapest ambulance – without the rural help – would have collapsed a long time ago.

What’s the reason behind this?

There aren’t enough ambulance units, and the number of ambulances doesn’t correspond with the number of tasks that need to be done. So, which side of the issue should be improved? Should we recruit another thousand people to Budapest and have an ambulance on practically every street, so that we can always send an ambulance, or should we reduce the number of tasks they have to perform? Ambulances are being dispatched for ingrown toenails, herpes, upset stomachs, a paper cut.

You can think about what change would be a better start. At the moment, they are trying to increase the ambulance force – not through better pay or better working conditions that would attract more people, but through arbitrarily redeploying the existing ambulance units nationally, to somehow balance out the shortage in Budapest. But this is not really succeeding, and the problem is actually spreading.

Why send an ambulance when there is no need?

There is practically no background regulation of ambulance rescues, and particularly of rescue management. A rescue manager does not have the authority to refuse to send an ambulance. If they don’t send that ambulance, and the caller has a problem later on, the manager would be fired without a second thought. Emergency managers are under enormous pressure at the moment.

We’ve seen cases in recent years – remember János Gálvölgyi – where the ambulance didn’t arrive on time. The blame always ended up with the rescue management – the higher-ups never investigate, nor do they review the rules, instructions, standard modes of operation, best practices. They put the responsibility on the employees, and the employees don’t want to take that risk.

There’s been talk of debts with service partners. Is there any information on this?

This information has also been withheld. You can never get official information from the emergency services because we do not get any guidance from them, even on minor matters. Everything we know, we know through our colleagues’ feedback and anecdotal evidence. They tell us that they’ll take a car to the shop, where they’re told that the car may not be fixed in time due to the backlog in repairs. Last year, there were new guidelines that said that if a car repair cost more than a given amount, it had to be approved by the top management level.

There have also been accusations of fabricated or edited statistics. How does the union see it?

Embellishing statistics is a long-standing tradition in the ambulance service. We received information a long time ago that the statistics were being corrected, especially for Budapest. An example of this is the issue of transfers. In the morning, a car working in a region reports for work and this is recorded for the statistics in the morning. It is then assigned to Pest, when it logs into its ambulance management system and gets a new ambulance unit ID.

At 12:00, then, the cars sent to Budapest also recorded for a second time – this time, as Budapest cars.

There is no shortage of explanations. Mr Győrffy [the spokesman for the ambulance service – editor] always comes up with some explanation. The credibility of these is – how can I put it – very, very much questioned, by the ambulance workers if not by others. They are terribly unhappy with the communication from the National Ambulance Service, which has been very misleading.

What about equipment?

A few years ago, it was announced with all the razzle-dazzle that assets had been bought for HUF 1.6 billion. Every time an ambulance is handed over, there is a ministerial visit, and the handover is covered by the press. We don’t see a similar fanfare when they buy new batons for the police, nor do they parade the police around Budapest. So, why parade a new ambulance?

What about the medicine and healthcare equipment in the ambulances?

Basically, supplies come from central depots. This usually works, but in December, we had a crisis when there was an IV shortage. Every ambulance must have an IV.

There have even been instructions from above, that everyone should work to save money. Ambulances were begging hospitals to refill their IV supplies. The ambulance stations were messaging each other: “You, how much do you have? You’ve got two more, so send me one, because we don’t have any.”

Was the issue fixed by January?

So far, I have not received any information that would indicate that the situation is still ongoing. I am very hopeful that it has been resolved.

And what is the biggest issue for rescue workers?

Basically, the working conditions, which leave much to be desired. The workers don’t like to be sent up to Budapest, but they can’t refuse the order. They can’t eat because there’s nowhere to eat, they have to stop somewhere on the way to get something to eat – for which they are given 20 minutes. Or they eat in the ambulance, which, by the way, isn’t disinfected completely between two patients, because that would mean going to the station, taking the equipment out of the ambulance, disinfecting it, waiting, using an ozone generator, which takes at least three quarters of an hour.

With the current state of the Budapest ambulance, there are no resources for this sort of disinfection, even for one car. So, the paramedic on call often just eats in a car park, in soiled clothes, which they cannot change because they have nowhere to go.

When a trade union speaks out, their allegations are often immediately refuted. To what extent is the ambulance service leadership a cooperative partner?

I would describe the relationship as extremely cold. The ambulance service does not treat the union as a partner at all. There are two trade unions worth mentioning in the ambulance service: the Independent Trade Union of Ambulance Workers and the Association of Hungarian Ambulance Workers. The other union is practically dead. We do not see any activity there. In 2021, they took away the collective agreement that the union was entitled to. Up to that point, they were the ones used by the ambulance service to conclude the collective agreements, because they signed whatever was put in front of them.

In our correspondence with the Director-General, we regularly receive didactic replies – lectures. The Director-General does not involve us voluntarily in any employer action – neither consultation nor cooperation. Even after we ask, he doesn’t give us any opportunity to work with them. When we ask for information, he sends evasive, meaningless, condescending, and lecturing responses.

In principle, the leadership is hostile to trade unions, and is constantly curtailing their rights and their activities. They started doing this in 2012, when they took away the primary source of bargaining power: the veto. Until then, the union had veto power, so if the employer wanted to introduce a measure, the union could veto it. The employer could not introduce a measure until they reached an agreement with the union. That was taken away – in effect, the trade unions were half-gutted.

Next, they decided that, in the health sector, collective agreements covering all workers cannot be concluded in the framework of collective bargaining. So again – an important element of trade unionism was removed. Now, they have taken away the deduction for employer membership fees, which makes life difficult for trade unions. In the military, they have outright banned the union.

So, you can clearly see the government’s attitudes towards unions. In the ambulance service, the employer’s behaviour is in perfect sync with that attitude.

What about the salaries?

Basically, the problem starts with human resources. They’ve been touting a career model for years, but almost nothing has ever been implemented. An ambulance worker, if he comes here, cannot see any incentives to stay here for the next five, ten, twenty, thirty years other than the calling of the profession itself. You need money – money has become one of the primary incentives behind a job.

But fringe benefits have also become a joke in the ambulance service, a bad joke. Because we get HUF 100,000 a year on a Szép-Card, and we get HUF 6,000 for laundry allowance and HUF 7,000 for shoe money, and HUF 12,000 for bank account contributions. Those are our total fringe benefits in the ambulance service now, set in 2009 after they were agreed upon by the other union, and they have remained unchanged ever since.

You can’t wash clothes for six thousand forints.

Especially not the clothes of ambulance workers. There are special instructions on what detergent and what agents to use, which costs around HUF 6,000 a month. The clothing is not classified as protective, but as work clothes – which means that the worker is responsible for cleaning it. If it were protective clothing, the employer would have to clean it.

Was there an inflation-linked wage adjustment?

There were no inflation tracking measures in the ambulance service. A wage hike is being introduced in March, which is not a pay raise but a pay adjustment, a pay restructuring. They are restructuring the pay scales – simplifying them – which is fine. The problem is that there is a set minimum and maximum in each category, and the employer determines who receives what wages. Until now, the pay scales were banded, so we could see that every three years, the pay increased – even if by not much.

The third issue is the grading process. This has been introduced in the Health Service Act, but so far there has been nothing but silence on this. Now, guidance has finally been released.

Based on their ratings, ambulance worker salaries can be adjusted upwards by 40 percent, and downwards by 20 percent. The ambulance worker can only challenge their ratings in court, and even here, they cannot challenge the result itself – they can only challenge the justification given for their rating.

So, if I do my job badly according to my supervisor, they can say that I get 20 percent less, and if I do it well, they can say that I’ve earned 30 percent more?

That’s right.

And who decides thist?

The task is delegated – the regional leadership decides the ratings.

Obviously, a regional chief paramedic does not see or know the work of the 1,300 people in his region – so, the task is further delegated to the station managers, chief nurses, garage managers, technical supervisors – the managers in any given station.

There is a criterion that outlines the rating process, but obviously, how this applies to any individual is entirely up to the subjective judgement of a manager. This has clear financial consequences – whoever is in good with the boss will have a good rating.

But there are other upsetting things. The ambulance service still carries bad entrenched traditions from the previous system. I can give you a very typical example.

In the Nagykata ambulance station – perhaps around the 1960s – the technical supervisor responsible for the cars instructed workers to refuel ambulances to the nearest round liter because he was at odds with mathematics. He kept the accounts in a squared notebook.

That directive is still in force today, 16 January 2024, and when we asked if it could be changed, they said no. This is how it has always worked, and this is how it will continue to work.

And then, there is the abuse of the power to decide the roster. Rostering is a well-established and routine tool in the ambulance service, and it is naturally the prerogative of the employer.  But – it shouldn’t be a means of influencing and coercing employees into doing whatever the employer demands. Whenever anyone steps out too far, or if the employer decides someone needs to be disciplined for whatever reason, the roster is always the first tool.

They’ll take away the 24-hour shifts, or the worker won’t get the days off that they specifically requested, say, because he had something important to do that day. The worker will be scheduled to work on the day he asked off, or they’ll be assigned to a car in Budapest, and they’ll only get daytime shifts. This may seem a legitimate measure, but it becomes a means of unjustified pressure. These things can make it impossible for people to have a second job, to take care of family, to pursue hobbies. That’s what every ambulance worker fears. No one wants that, it’s bad for everyone, and it has a financial cost. You fall away from your benefits, you fall away from your second job, and nobody wants to risk that.

I must emphasize that ambulance services in Hungary today are only functioning because the rescue workers are doing their best. They are driven by their professionalism, and they do their best to care for the patients. This is what keeps the Ambulance Service alive. It’s not the incompetent management who focus primarily on playing nice with the politics, who hurl endless instructions at ambulance workers to shirk responsibility.

This is where we are right now, January 2024, in the National Ambulance Service in Hungary.

Translated by Vanda Mayer. The original, Hungarian version of this interview was conducted by Zsuzsa Zimre and can be found here.