January 14, 2024 at 5:03 am Update: one hour ago
The attempt by then Minister Ernst Kuipers (Public Health) to concentrate pediatric heart surgery was stopped by a judge this week. This statement is an interesting example also for the rest of specialist care.
In short:
- Ernst Kuipers’ attempt to concentrate pediatric heart surgery was stopped by a judge this week.
- The judge underlined that the consequences of the closure of the pediatric cardiac surgery departments must also be taken into account for the other health departments.
- The ruling also puts other concentrations in the healthcare sector in difficulty.
Summary done using artificial intelligence.
Now more than ever we must work together to keep healthcare good and sustainable. This is one of the conclusions of the Agreement on Integrated Care adopted two years ago under the leadership of Kuipers. But the attempt to do this in pediatric cardiac surgery has now been blocked.
The idea behind this concentration of care is that the more often a team operates, the better it becomes at it. It is therefore best that interventions are carried out only a few hundred times a year and in as few places as possible.
Pediatric cardiac surgery must also deal with it. Operations are currently carried out in four locations: UMC Groningen, UMC Utrecht, Erasmus MC in Rotterdam and Leiden (through a partnership between LUMC and Amsterdam UMC).
It should be less. The treatment is good now, but it can be even better. And there are worries about the future. Someone must always be ready to operate quickly. This creates a large workload among current teams. The workload could be better distributed if there were fewer operational sites. Additionally, there are few pediatric heart surgeons, which means new people need to be trained.
Nobody wants to lose their department
Hospitals also agree: they also want care to become better and future-proof. But no hospital wants to lose its department. They fear the consequences for their care and often make this message public.
The UMC in Utrecht aims for collaboration with the adjacent pediatric oncology centre, the LUMC in Leiden fears the loss of intensive care for children and the department in Groningen aims for close collaboration with the other treatment departments of the hospital.
There is less pressure from Rotterdam. Erasmus MC has the largest team and performs the largest number of surgeries, which has made the hospital relatively confident.
The plan stirs emotions not only among hospitals, but also among patients and their parents. They may have to travel further and therefore be away from their familiar surroundings for longer. Other patients say they don’t mind if they receive even better care in exchange.
The patients’ clubs themselves also recognize the importance of concentration in care, but above all point out that all involved need clarity in this long-standing dossier.
Kuipers ignored “his own” advice
Kuipers hoped to achieve this last year by making the decision himself: the operations could only take place at UMC Groningen and Erasmus MC. Groningen was chosen for its location and Erasmus MC is the largest centre.
But in doing so, the minister ignored important advice from the Dutch Health Authority (NZa). The supervisor, on behalf of Kuipers, had investigated the consequences of the closure of the departments. The conclusion was that such a decision should not be made yet. First, a broader plan had to be developed to concentrate all specialist care. This would make the impact of either of these decisions less intense.
Partly because of this, Kuipers’ attempt to end the years of disputes over pediatric heart surgery actually ended up taking even longer. The “losing” hospitals in Utrecht and Leiden went to court. Was Kuipers’ decision made correctly?
The declaration brings the concentration of assistance back to the centre
No, says the judge now. Even if the court finds that Kuipers made the decision, he did not do it correctly. According to the judge, such a drastic decision must be well motivated. It is notable that Kuipers did not follow the NZa’s advice. Furthermore, according to the judge, he should have examined more closely the consequences for care in the hospitals involved.
The statement is an interesting example for the rest of healthcare. It is a fact that in the coming years there will be a greater concentration of specialist care. But the judge emphasizes to all parties how carefully this must be done. In the interest lobbying that arises around such a decision, it must not be forgotten that these interests are carefully weighed against each other.
The case has also put a strain on relations between hospitals. Now everyone insists on the need for good cooperation. The UMCs in Utrecht and Leiden have already started to do this and are now asking other hospitals to jointly develop a plan for the future of pediatric cardiac surgery.
It is not yet clear what exactly will happen. It is clear that all four centers will remain open for now. The Ministry of Health is studying the ruling and will then announce the next steps.
2024-01-14 04:03:50
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