Why are Ukrainian nurses transferred to the minimum wage

After tax deductions it is 16 and 10.7 thousand respectively. But in January 2023, the Cabinet of Ministers adopted a decree № 28, allowing to reduce these payments to the level of minimum wage, if the hospital lacks funding.

About whom of the medics affected by the cut in salary and whether they can resist it, writes Socportal.

What is the salary of medics in Ukraine

According to the Ministry of Finance, in 2022, the average salary of employees of health care institutions was 14.3 thousand hryvnia, which is 21% more than in 2021 and 1.5 times more than in 2020.

This year, a similar figure for the salaries of medics is also voiced by the State Employment Service. According to the data on vacancies, as of June 2023, nurses are offered about 14 thousand. That is, close to the established norms of the amount.

However, in the nurses' Facebook group "Be Like Nina", medics are complaining en masse about cuts or no pay at all. According to the survey, which was conducted among the participants and members of the group showed that in fact nurses on average receive "net" 9.5 thousand. The median is 10.4 thousand, which is still below the guaranteed amount.

As for junior staff, i.e., orderlies, it is actually always about the "minimum wage". Similarly, nurses in schools, kindergartens, or nursing homes receive a salary close to the minimum. Since these institutions are not subordinate to the Ministry of Health, the norm of 13.5 does not apply to them.

Half of the nurses in medical institutions note that they work overtime. And another 15 per cent of staff have been transferred to part-time work, which allows them to pay lower salaries.

Nurses in rural areas are paid the least, the highest — in the capital and regional centers. There is also a difference by levels of medical care: the lowest salaries are for nurses in "primary care", i.e. those who work with family doctors. The highest salaries are for emergency medical care.

As for regional differences, the highest salaries are for nurses in Donetsk Oblast and the city of Kyiv. The lowest are in Rivne, Zaporizhzhya and Chernihiv regions. Moreover, the last two are considered frontline regions. Doctors there should receive from 23 to 28 thousand hryvnias, nurses – from 15.5 to 18, and junior staff — from 8 to 9.

Only 1% of respondents indicated that they receive the "frontline" minimum wage. Almost 11% of nurses indicated that they are entitled to such a salary but do not receive it, and another 15% do not know whether they are entitled to it. You can check this on the website of the Ministry of Regional Development, where the list of frontline territories is listed.

Also, not all nurses receive other additional payments due (for length of service, harmful conditions, work with disinfectants, etc.). One third indicated that they are entitled to but do not receive, one quarter do not receive everything, and only 15% receive all the additional payments due.

It is indicated that the study is not representative, but it demonstrates that Decree No. 28 has had an impact on the level of salaries - a significant part of medical centres took the opportunity to cut staff salaries. It also seems that the widely announced additional payments to medics in the frontline territories are still available to a very limited circle.

The situation is similar to that with the "kovidnye" allowances. Not everyone received them. And payment of compensation for infection at the workplace had to be achieved by one's own efforts.

In addition, a number of recent changes in legislation have left the vast majority of doctors without payments for health improvement, which also affects their total income.

Why cuts in the salaries of medical professionals have become possible

The reduction in the salaries of doctors over the past year is probably due to a decrease in funding for the healthcare sector.

In the 2022 budget, spending on it totalled 215.3bn hryvnias. After the start of the Russian invasion, Ukraine also received a $1.7bn grant from the United States for medical salaries. That is almost 67bn hryvnias more. This year, the financing of the healthcare sector has been reduced by almost 8bn - to UAH 207bn.

Therefore, the norm of 20 thousand for doctors and 13.5 thousand for nurses, which was fixed in January 2022, was changed in early 2023 by Resolution No. 28 "On some issues of remuneration of medical, pharmaceutical workers and rehabilitation specialists of state and municipal health care institutions" of 13 January. With this document, the Cabinet of Ministers authorised to reduce staff salaries in conditions of hospital budget deficit.

Subparagraph 4 of paragraph 1 of the decree № 28 says that when labour costs exceed 85% of the money received in the current month, taking into account the accumulated balances, the minimum wage for medical workers is set within the available wage fund, but in an amount not less than the minimum wage," explains lawyer and head of the NGO "Social Movement" Vitaliy Dudin.

According to him, it is quite easy for hospital managers to cut wages to the minimum level, as the competent authorities do not recognise this as a change in the essential working conditions. Therefore, the directors of the KNP do not consider it necessary to warn the employee in advance about the changes.

According to the logic of Articles 97 and 103 of the Labour Code of Ukraine, the employer cannot unilaterally make sudden decisions that worsen the conditions of remuneration. But the norms of Resolution No. 28 are interpreted by officials and employers in the healthcare sector as allowing them to bypass the above-mentioned norms of the law. Therefore, in practice, medical workers are paid at the level of UAH 6,700 without their advance warning. Previously, the requirements of the CMU resolution were clearer, but now payments depend on the hospital budget. In essence, the minimum wage is guaranteed, and the administration can cut the rest of the additional payments at its discretion," says the lawyer.

A striking example of a sole decision to cut salaries was a case in one of the hospitals in Lviv region. There, relatives of a deceased woman in labour sued the hospital for almost UAH 4 million in moral compensation. However, these payments were imposed not on the specific perpetrators of the tragedy, but on the entire hospital staff, using the above-mentioned Resolution No. 28.

A slightly different mechanism is in place to cut salaries at the "primary". It is specified that it is possible to cut salaries to medics if they are chosen by less than 70% of patients from the "optimal volume of primary care practice".

At the same time, according to lawyer Vitaly Dudin, in what form the administration should formalise the decision to switch to the "minimum wage" is unknown. Often no orders about it are not disclosed.

For example, when the employer initiated the procedure of changing the essential labour conditions, it usually indicates in the order at least cursorily the economic reasons, the essence of the changes, whether it will bring some positive effect, whether it was agreed with the trade union, and most importantly - how long it will last, - says Vitaly Dudin.

Therefore, according to him, the staff can simply put before the fact.

And people can already see in their payments that their wages have decreased. And because of this legal uncertainty, it is virtually impossible to appeal against such actions of the administration in court," emphasises the lawyer.

According to the head of the medical movement "Be like Nina" Oksana Slobodiane, such legislative changes have led to the fact that more and more absurd cases become the basis for transferring doctors to the minimum wage.

Such an order is absolutely not conducive to a balance in relations. It allows the administration to arbitrarily worsen the situation of medics, and they have nothing to grasp and no legislation to appeal to," says the activist.

According to Oksana Slobodiane, the practice of applying Resolution No. 28 is extremely unfavourable for medical personnel.

Medics have no leverage. In fact, this decree discourages and encourages the administration to look for some methods to improve the financial situation of the hospital. Because it is much easier for them to simply cut the salaries of all the staff, even if they are working under bombs, than to change something for the better and demand additional funding for the institution," says the activist.

How medics can fight for the return of proper salaries

According to lawyer Vitaly Dudin, there are several ways to oppose salary cuts.

Decree No. 28 states that staff salaries can be reduced if the salary fund exceeds 85 per cent of the hospital's total budget. However, how can this be verified? A public information request is a useful tool. This can be sent by any individual to the hospital administration requesting information on the available budget and the size of the payroll. Such information is in the public interest and must therefore be disclosed upon request. If the request is refused, the Ombudsman should be called upon to hold the KNP officials administratively liable," he said.

Similar requests can also be addressed to local authorities or the National Health Service of Ukraine. If there is a suggestion of abuse on the part of the administration, the State Audit Service should be contacted.

If it turns out that the budget does exceed 85 per cent, it should then be clarified what percentage of this goes to pay the administration.

If the hospital has a trade union, Article 251 of the Labour Code of Ukraine may be useful:

The employer is obliged within a week to provide, at the request of trade unions, their associations, information about the conditions and remuneration of employees, the social and economic development of the enterprise, institution, organisation and the implementation of collective agreements and contracts. In case of delay in payment of wages, the employer is obliged, at the request of elected trade union bodies, to provide written permission to obtain information from banks on the availability of funds in the accounts of the enterprise, institution, organisation or to obtain such information from banks and provide it to the trade union body.

The Facebook group Successful Doctor Academy offers an effective tool for achieving transparency. It suggests checking the financial statements of hospitals on the website of the National Health Service of Ukraine.

There are 22 analytical panels with various indicators of medical institutions' performance in the section "E-data"/"Analytical panels (Dashboards)". There you can select data by region, reporting period, type of medical care, locality or medical institution.

Among other things, there is the "Report on income and expenditures of health care providers (selected indicators)". There you can find information about salaries of heads of medical centres, doctors, nurses and other workers.

However, it should be borne in mind that these data are average for the staff. However, it is possible to find out the salary of the administration in this way. Therefore, in cases where staff have significantly cut their salaries, but managers continue to receive high incomes, it is possible to report abuse to the Ministry of Health and the NHRI.

However, the changes should also be at the system level. Oksana Slobodyana notes that it is necessary to immediately make changes to the Cabinet of Ministers Resolution No. 28.

The corresponding appeal to the representatives of the authorities is published on the website of Medruh "Be like Nina".

When adopting the new legislative act, the content and scope of the existing rights and freedoms were narrowed. In essence, the new norms violate the general rule of Article 97 of the Labour Code of Ukraine on the prohibition of the employer to unilaterally make decisions on remuneration of labour, worsening the conditions established by law, - says the appeal.

Therefore, medics have three main demands:

• to remove the norm on the possibility of reducing salaries, as well as to remove the gaps that allow forcibly transferring staff to part-time work;

• to extend the norm about the salary of 13.5 thousand UAH to all nurses, including those working in educational institutions and social institutions;

• transparently agree with the staff "front-line" additional payments.

Currently, the appeal has been signed by more than a hundred hospitals. It was handed over to the Ministry of Health on Medics' Day.