The plans to close the pediatric heart centers of the academic hospitals in Leiden, Amsterdam and Utrecht may go ahead. That has the court in Utrecht decided on Friday. The Leiden University Medical Center, the Amsterdam UMC and the UMC Utrecht had filed summary proceedings because they disagree with the closure of their specialist centers.
The case will be dealt with further in November, but the university hospitals probably wanted a provisional provision because of the unrest among their employees. For example, they are already being offered jobs at the centers that will remain in the future. The judge does not agree with the request of the hospitals because there are currently no “irreversible consequences” and a break is “not in the interest of patients and public health”.
Read also: Battle over closing heart centers: are children the victims?
At the moment there are four children’s heart centers, connected to five universities (Leiden and Amsterdam form one center with branches in both cities). The approximately 1,500 children who are born each year with a heart defect, some of whom require highly specialized surgery, are treated here. For some time now, hospitals have agreed that concentrating this care is a good idea: there are too few patients for four centers and centralization reduces the workload of the limited number of specialists and nurses. The return also improves the expertise of the doctors: the more patients they can operate on, the more experience they gain.
But hospitals have been discussing the way in which this centralization should take place for thirty years. They do not agree on the number of centers that should remain open and in which places. None of the hospitals wants to give up pediatric cardiac care, for fear that the loss of this department will have consequences for other departments, such as the pediatric IC and the emergency department. Minister Ernst Kuipers (Public Health, D66) had given the academic hospitals until April 1 to come to an agreement together, after his predecessor’s choice for Rotterdam and Utrecht had led to much dissatisfaction, but they failed to do so.
Regional spread
In April, Minister Kuipers attempted to end the dragging discussion by announcing that at the end of 2025 only the children’s heart centers in Rotterdam’s Erasmus MC and UMC Groningen will remain open. He chose Erasmus MC because it is ‘the largest’, and Groningen ‘for the benefit of regional spread’. The centers in Amsterdam, Utrecht and Leiden are no longer allowed to perform operations, but can remain open for checks and outpatient appointments. The UMCs decided not to accept Kuipers’ decision and went to court.
With his decision, Kuipers disregarded the advice of the National Healthcare Authority (NZa). At the end of 2022, the regulator strongly advised the minister against taking a decision now because closing the centers could have “major irreversible consequences” for hospitals, patients and acute care. The NZa advised waiting for a broader plan for the future of academic care. But Kuipers believes that given “the current vulnerable situation” there is no time to wait: according to him, the choice for Rotterdam and Groningen is precisely “the starting point”, after which it must become clear how the rest of the care will be arranged.
Kuiper’s decision led to a lot of emotion among the parents of young children with heart problems, who often have a strong bond with their own heart center and the practitioners and are afraid of long travel times. And the hospitals also got involved: the Leiden UMC warns that the disappearance of the heart center will lead to the abolition of the children’s IC, because two thirds of the patients suddenly drop out.
Employees of the children’s heart center in Utrecht sent an urgent letter to NRC. It contained figures and calculations that were supposed to show that Groningen ‘performs substantially worse’ than Utrecht. The NZa does not share this conclusion: after examining, among other things, the mortality figures, it sees “no significant differences in mortality between the current four intervention centers”, is in a report.
Also read this report in the UMC Utrecht: Parents of heart patients cherish a relationship with their practitioners: ‘We don’t want to leave here’