Daily Postimees obtained access to the full text of the audit, which was made available in summary last year but which will not be fully declassified until 2023.

Findings included the risk of major power outage, which would hamper hospitals' functioning and could be caused by a simple autumn storm, and the lack of funds for finding adequate solutions to these issues.

"Hospitals are usually not prepared for lengthier disruptions, because this would require investment, but no separate funding is provided for this from the state budget under the Health Services Organization Act 2001," the audit revealed, Postimees reports.

"These expenses are also not taken into account in the financial model of the Health Insurance Fund (Haigekassa)," the report said.

The audit office added that those responsible have not sufficiently stepped up to the plate.

"The inability of critical service providers to independently maintain their own business continuity has been known to the Ministry of Social Affairs, the Health Board, the Ministry of the Interior and other providers of critical services. The Government of the Republic has decided that the Ministry of Social Affairs must solve the problem by 2020, but there is no clarity on how to finance this or allocate expenses," the audit stated, according to Postimees.

Postimees added that only some wards or departments at a few individual hospitals have an autonomous power supply, and even these only last up to 12 hours, from what the daily could glean from the report.

The audit does not however specify how many such hospitals there are, or their location. 

Of greater significance was the disparity between Ministry of Social Affairs requirements that larger hospitals be able to provide services for a minimum of 72 hours, and smaller hospitals for 16 hours, in such cases. 

This would mean only the most critical machines and medical work could be maintained in the event of major power outage, according to the daily.

"In the event of a major power outage, the level of medical care will be significantly lower as early as a day later, and patient admission would have to be restricted," the office said. 

Elektriklevi would prioritize hospitals in event of major outage

In such emergencies, electricity distribution system operator Elektrilevi has a list of priority objects. This also includes hospitals, which have priority for restoration of power in the event of an electrical failure.

"At the same time, it is also important for all providers of vital services to assess the risks of a prolonged power outage in the event of a real crisis," said Andres Tõnissaar, Elektrilevi board member.

"The likelihood of a vital service being left without power for a long period of time is low, but when people's lives are at stake, preparations have to be made for low probability incidents as well," he added.

Martin Kadai, head of the Health Board's (Terviseamet) emergency medicine department, told Postimees it was: "... clear that the normal capacity of a hospital would fall significantly in such a situation."

Solution cost could exceed government budgets

The Health Board, responsible for the issue, has calculated what hospitals would need financially, to be able to provide emergency care to those in need in difficult circumstances. The board made a proposal replete with a €21 million price tag, something the government would be unlikely to find in its primary state budget strategy.

"Considering the situation with the state budget, it was in fact questionable altogether whether to submit this application," Kadai said.

"But we will submit [the application again] and continue to do so because the need does not change. We cannot accept that if a small hospital is without power, there is no service," he added.

Spring storms left thousands of homes temporarily without power on the islands of Saaremaa and Hiiumaa in April and May, while snowstorms left 12-13,000 electricity customers without electricity in northern Estonia, Jõgeva, Viljandi and, again, Saaremaa, in January and February.

PPA concerns

The National Audit Office also assessed the organization of training for institutions over the period 2013–2017. According to Postimees, the PPA was met with particular criticism in this arena.

"The PPA does not always follow its own procedures when conducting exercises, which makes it difficult for it to draw conclusions from said exercises and to plan the solving of shortcomings," the audit office reportedly said, pointing to summaries of exercises which did not generally comply with their original instructions.

Some of the requested exercises could not be assessed by the audit office, since the PPA was unable to even locate the necessary documents, nor had it kept a record of money spent on the training or who participated. There was also no certainty that staff who needed specific exercises most had attended.

PPA response

"Yes, the exercises had recurring mistakes and were not systematically addressed as much as they should have been," said Marko Ild, leading law enforcement official at the PPA's readiness and response office said in response to the findings.

"As of today, we have taken a big step forward and started to overhaul this system. We will summarize the main conclusions of the exercises and decide what weaknesses we will address," he added.

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