If a minister goes to work in the field after his or her departure that he or she previously made policy about, we are all rightly indignant about this. A cooling-off period has even been introduced to first untangle the possible conflicts of interest.
But oddly enough, we think the reverse is permissible. We are happy if we can recruit a minister who has previously worked in the field. Finally an expert calling the shots. A diplomat at Foreign Affairs, a scientist at Education, Culture and Science, and a gastroenterologist at Public Health.
The current minister at the latter ministry, Ernst Kuipers (D66), is currently making far-reaching decisions about who is allowed to provide which care in the Netherlands, with the only ideology being the dubious paradigm that centering care is always better. Pediatric heart surgery is therefore disappearing from Utrecht and Leiden and is being concentrated in Groningen (UMCG) and Rotterdam (Erasmus MC). The consequences for academic hospitals and for patients are immense. And you wonder whether the minister would have made the same decision if he had not been the head of the Erasmus MC, but of the LUMC.
Or take birth care in the region, traditionally a point of contention between medical specialists and midwives. In Zutphen, the delivery rooms will close due to too few children. Zutphen children will soon have Deventer or Apeldoorn as their place of birth. This also has far-reaching consequences, for more than just the gynecology department. Because children are often born at home in the Netherlands. That is the ultimate accessible care, and an important achievement of Dutch women. But does the midwife still dare to do that, knowing that the nearest hospital is a long drive away? That home birth can only be safe if the support is excellent. And it will soon only be available in the city. Not in the region. You would almost vote BBB.
Would Minister Kuipers have made the same decisions if he had not viewed the world for a long time from the perspective of a Rotterdam medical specialist? What if he had been a midwife before? Would he have made the same decisions if centering care as a surgeon in the periphery would have condemned him to perform the same monotonous operation until the end of time? What if Kuipers had been a doctor in a hospital where all complex and interesting cases were always collected in ambulances instead of delivered?
“I understand that changes in the healthcare landscape evoke emotions”, the minister replies to parliamentary questions from PvdA party leader Attje Kuiken. But there is a “standard established by law” and all decisions are within that standard.
“I understand the emotions.” That is the eternal D66 answer. I understand the emotions, but here’s a standard, here’s the law, here’s a policy, here’s a fact.
Proclaiming facts is also the hobbyhorse of D66 minister Robbert Dijkgraaf (Science). An advisory for its new independent science communication center was presented this week. Fortunately, the quartermasters managed to weaken Dijkgraaf’s roaring facts considerably. The center will not send science, but rather connect organizations and stimulate dialogue with society. Independent communication, no marketing of research results.
Yet this echoes: science is often not well understood by society, it needs more explanation. Again typical D66: we need to explain it better.
The center would certainly have been a wonderful initiative if science were a toothless, cuddly institution spewing out nothing but neutral facts. But that’s not science. Science has power. Dijkgraaf has power, RIVM has power, the nitrogen professors have power; from 2020 to 2022, the Netherlands was de facto ruled by the scientists in the OMT. And more and more often the Dutch are the object of policy disguised as science, their objections are dismissed as emotion or labeled as incomprehension. Of course this can be solved by explaining it all better. Because of these changes in power relations, your science should communicate less and control more. And that control, for example by journalists, becomes more difficult as the communication budget increases.
My proposal is to introduce a cooling-off period before anyone becomes a minister.
Rosanne Hertzberger is a microbiologist.
A version of this article also appeared in the newspaper of April 15, 2023.