Tallinn has several major hospitals: Tallinn Children's Hospital, East Tallinn Central Hospital and West Tallinn Central Hospital. In addition, there is the state-owned North Estonia Medical Center. I want to emphasize that when I talk about merging, I am not referring to building a new mega-hospital in Lasnamäe, but rather to combining the workflows and workforce of multiple hospitals. The goal is to improve the quality of care and shorten waiting lists. Better management — or unified management — of the city's own hospitals is not the same as constructing a massive building.

Currently, these hospitals offer the same services separately, serve the same patients separately and each looks for new staff separately, which results in duplicate costs and inefficiency. For example, they develop separate IT systems and support services. Or one hospital spends millions of euros to purchase the same or multiple expensive devices that another hospital already owns.

In the private sector, it would be unthinkable for companies owned by the same entity to compete in such a way that service quality and investment efficiency suffer. That would not be considered healthy competition.

Unfortunately, the issue of the hospitals has become bogged down in political squabbling between the city and the state. In the eyes of opposition parties at the national level, the government is always to blame because it never provides enough funding. This was the case during the Center Party's time in power when the capital became a stronghold of opposition to the state. Instead of working to improve life in the capital, they sought ways to influence national politics through the Tallinn city government.

I hope — and I see an opportunity — that the current city government will focus on getting the job done rather than resorting to populist griping and the usual constant complaining. Unless, of course, the mayor (SDE's Jevgeni Ossinovski — ed.) or Isamaa, which is now full of former Center Party members, decides at the last minute to follow the Center Party's example. I would remind you of Prime Minister Kristen Michal's words: the door to the government has been left open for Isamaa so they can carry out the will of the voters. So far, they have declined that opportunity.

Why is the hospital reform needed?

First, better quality of care. There would be less shuttling of patients between hospitals and it would become possible to create stronger and more specialized centers of excellence (for example, in eye surgery or oncology). Patients would gain better access to a wider range of specialists and treatment options.

Second, a more comprehensive patient journey. This would mean things like integrated information systems, unified management and logistical solutions that would allow patients to move more smoothly between different departments.

Third, more efficient use of resources. A consolidated hospital would allow for better pooling of medical staff, equipment and financial resources. This would reduce duplication — Tallinn's hospitals would no longer need to maintain similar specialties, which is expensive, inefficient and hinders the development of centers of excellence.

Fourth, motivating staff. A stronger, more unified institution would offer better working conditions for doctors, nurses and other staff. The impact of staff shortages would be reduced, as personnel could be reassigned as needed.

Fifth, better use of investments as an important way to optimize costs. A unified hospital would be more cost-effective in delivering and managing new, modern medical services. For example, a single IT capability would allow for integrated patient services and support systems for doctors. In my estimation, the volume of investments could increase by more than €20 million in a single year.

What needs to be done?

The city could have long since begun talks on merging the hospitals it owns. This would have meant that the city government and the city council would quickly make a decision to establish a legal entity — either a public limited company or a foundation — along with a management board. Hospital and medical sector leaders would then begin discussions on the merger. They would agree on the process, set a timeline and start taking the first steps.

During this process, it would become clear when the goal might be achieved, whether any legislative changes would be necessary, what additional funding would be required and whether the state hospital — North Estonia Medical Center (PERH) — would or would not wish to join.

But the very beginning must be a unified political decision by the city government and the city council. Fortunately, the most recent meetings of the city government give hope that this may soon come to pass.

Why haven't things moved along?

Essentially, it is always possible to spend months asking for money and complaining about how things would happen if only the state provided funding. And, of course, the money must be requested for a building, because who really understands what mergers are being made or why the funding is needed? Concrete is visible — a building can be opened with a grand ribbon-cutting ceremony. The legal and operational merging of institutions cannot be turned into a big photo or video opportunity; it stays hidden from the media and social media.

Moreover, reorganizing workflows and legal structures actually requires real work and making decisions.

It is no longer possible to hide behind a stingy state where Isamaa is not part of the government. The door to the government has been open to them all spring, but, of course, it is always more comfortable to complain than to get to work.

Is there a way to get the ball rolling?

It all starts with political will, which has already begun to show quietly in the middle of spring. No one wants to end up being the "brake" that holds back initiatives which, while they may not generate a flood of photo opportunities, would earn recognition within the field.

The four governing parties of the Tallinn city government know that merging Tallinn's hospitals is a major and important step that will help improve the quality and accessibility of healthcare services. This will require cooperation between the state and the city, careful planning and adequate funding.

Just as with electric scooters and small mopeds, the city cannot simply throw up its hands and put on a show pretending there's nothing it can do and that only the state can act. For decades, we heard plenty of such lamenting from Edgar Savisaar and, to a lesser extent, Mihhail Kõlvart. It is high time for the city to take action.

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