Her father was still there three months ago and he was lovingly cared for, says Renate Evertse from Rotterdam. They always go the extra mile, says a general practitioner from a practice just outside Rotterdam: “If all emergency rooms are closed, they will still make room there, in my experience.”
The Ikazia Hospital, in the middle of Rotterdam South, is a popular hospital. Originally Protestant Christian – founded in 1968 after a collection by churches and citizens. That’s where the name comes from. Ikazia means: interdenominational action hospital under construction.
People in the Rotterdam region die earlier than in the rest of the country. People here live an average of 3.5 years less in good health. In South Rotterdam, residents already develop chronic health problems around the age of sixty. Diabetes, COPD, cardiovascular disease, cancer. In Rotterdam, this results in less expenditure on care for the elderly and more on ‘normal’ health care costs, according to an analysis of insurers.
Ikazia’s patients mostly come from the poorer South district and Christian villages in the area. It is a lively hospital, with a lot of acute care. Every year 3,000 babies are born, 25,000 people come to the emergency room and a total of 345,000 patients visit the hospital.
But Monday, the annual report showed that the hospital (turnover 200 million) is on the verge of bankruptcy. It no longer meets the conditions of its bank loans, as a result of which they have become immediately due and payable. House banker ING has canceled all loans as of October. For the third year in a row, Ikazia is suffering losses: just like last year, it is heading for a loss of 10 million euros.
emergency consultation
Is there anything left to do? Ad interim financial director Rik Riemens, who has been in office since June, is optimistic. On July 12, he says, the hospital convened its creditors for emergency consultations. The hospital presented an initial emergency plan to banks and health insurers in which rates for patients will go up and insurers would have to advance a little more money.
Instead of more care for more patients, entire departments were empty during the crisis
The health insurers are not looking to exclude this hospital, they underline when asked. Earlier, in Flevoland and Amsterdam-West, it turned out that insurers had already given up the IJsselmeer hospitals and the Slotervaart, respectively, before the bankruptcy. That is not the case in Rotterdam, says Riemens. They immediately gave Ikazia some extra financial support in the middle of summer.
But the banks and insurers demanded a bigger recovery plan. The hospital management is now working hard on this, with advisors from accountancy firm PwC. Top priority: the hospital should no longer suffer losses. That still happens every month. Ikazia will have to consider providing less care, so that less staff is needed.
The many expensive self-employed nurses (double within a few years to almost 7 percent of personnel costs) are an advantage in that respect. The ‘flexible shell’ will be the first to go out before compulsory redundancies are introduced. But Riemens does not expect that and also points to the open vacancies.
Also read: Ikazia hospital again suffers loss of millions
How could a healthy hospital get into such trouble?
The hospital took financial risks – in hindsight at the wrong time. There were growth ambitions: a six-storey new building was added a few years ago. That was more expensive than expected, according to annual reports.
The corona pandemic broke out at the moment that this building had to pay for itself. Instead of more care for extra patients, which was the intention, entire wards in the Ikazia were empty. “That growth, nothing more came of it,” says Riemens.
Doctors and nurses worked overtime in intensive care in 2020 and 2021. Ikazia normally has twelve beds of intensive care, at one point there were more than forty patients, Riemens knows.
Corona crisis
The corona crisis leaves traces at all Dutch hospitals. Firstly, there is still discussion with insurers and the Ministry of Health about the final settlement of the extraordinary costs of corona patients. This creates financial uncertainty for hospitals. Second, nurse absenteeism across the country is much higher than before, at 8 percent. Some are struggling with long-term Covid complaints, others are burned out. Those people don’t work, but the hospital has to pay them. A large number of nurses have left care altogether, increasing the workload for the others.
At Ikazia, the hangover is even greater because the hospital did above average a lot in corona time, says Riemens. According to him, this is one of the explanations for the above-average absenteeism due to illness at Ikazia, the strong growth in personnel costs and the rapid increase in hired personnel. It all resulted in deep red numbers. Riemens: „We were one lean and mean- hospital, but in corona time that has tilted. We are out of balance and that is threatening.”
It is an exciting time for all 2,400 employees of Ikazia, Riemens realizes. And there is also a group of employees who already have bad experiences in this area. They worked at the now bankrupt Ruwaard van Putten Hospital in Spijkenisse, nearby. That went bankrupt in 2013 and has partly been ‘restarted’ under the wings of Ikazia. “They find this very exciting. For them, this is a kind of déjà vu.”
Also read: Popular Ikazia hospital in Rotterdam is doing too well