Children’s heart centers quarrel over who provides the best care. Concerned parents who do not want to take their child to another heart center. The university hospital in Leiden that is in danger of losing the children’s IC.
The House of Representatives has sometimes had a debate on easier subjects. “This decision evokes many emotions: joy, frustration, uncertainty, unrest,” summarized Member of Parliament Chris Stoffer (SGP) on Wednesday evening during a debate about closing two children’s heart centers. “I am standing here with a stomach ache,” said Caroline van der Plas (BBB).
There are currently four pediatric heart centers (at five locations) where complicated operations are performed on patients with a congenital heart defect: Groningen, Rotterdam, Utrecht and Leiden/Amsterdam. About 1,200 children are born with a heart defect every year. Doctors have long agreed that this should be done in fewer locations. There are too few patients for four centers and there are not many specialized doctors and nurses.
Earlier, after months of research, the Dutch Healthcare Authority (NZa) NZa called on the minister not to take “irreversible decisions” yet. The NZa advocates a broader plan for the future of academic care: only then can a responsible decision be made about the pediatric heart centers.
Other decision
But Minister Kuipers (Public Health, D66) first took a decision about closing two children’s heart centers, in order to clarify in a transitional phase of 2.5 years what the rest of academic care will look like in the future. Kuipers chose Rotterdam because it is the ‘largest’, and Groningen ‘for the benefit of the regional spread’ of care.
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Remarkably enough, during a technical briefing prior to the parliamentary debate, it turned out that the NZa supports Kuipers. According to the NZa, the transition phase of 2.5 years should be sufficient to determine which patient groups that require ‘highly complex care’ for rare disorders can be moved to Utrecht and Leiden, by way of compensation for the disappearance of the pediatric heart centers. “What do I give up and what do I get in return? The centers need to get to work quickly on these questions,” said board chairman Marian Kaljouw. In the coming months, the NZa will map out which groups these could be, and what numbers are involved.
Emotion
Kuipers’ decision has led to a lot of commotion, both among the parents of the young heart patients and among the hospitals.
Leiden fears that the pediatric IC will have to close, and that this closure will have consequences for other specialties in the hospital. The hospital first lodges a formal objection – this is possible until February 27 – but says it will go to court if Kuipers sticks to his plan.
“The damage is very large in the places that have to close. The consequences are extremely hard”, concluded Member of Parliament Maarten Hijink (SP).
According to the NZa, Kuiper’s decision could also lead to staff leaving. The willingness of nurses to travel is very low, and there is also a limited willingness among medical specialists to want to work in another heart centre.
Prefer three centers
Many opposition parties therefore advocated keeping three or even four children’s heart centers open. They lack arguments to go back to two. Maarten Hijink called Kuipers’ plan “poorly substantiated and ill-considered. With one stroke of the pen, a lot of expertise and skill is thrown overboard.” But according to Kuipers, the advantage of two centers is that quality improves, the workload of specialists decreases (because they have to work 24/7 less often) and that doctors are “more often exposed to complex operations, which means they can gain more experience” .
There is also the fear that the Rotterdam heart center will eventually be the only one left, because too few children will come to Groningen.
The coalition does support Kuipers, referring to the long time that this discussion has been going on. “A difficult but necessary step,” said Wieke Paulusma (D66). Joba van den Berg (CDA): “I understand that the minister is now taking the plunge.” Kuipers himself spoke of “quite impossible choices”, but he also added: “We are not going to kick this can any further.”