The coronavirus forced Ernst Kuipers, as national ‘bed boss’, to do his utmost to arrange sufficient IC beds, but when he became minister, the epidemiological tide suddenly turned in his favor. Rutte IV was sworn in on January 10, in the middle of the last lockdown, Kuipers and his colleagues were still standing on the steps with a distance of one and a half meters. Yet Kuipers was able to announce relaxations that same month and would never have to take controversial freedom-restricting measures again. While the virus demanded all the attention of his predecessor Hugo de Jonge (CDA), Kuipers (D66) was able to quickly focus on his great ambition: reforming the faltering Dutch healthcare system.
It was not what Kuipers had hoped for. Last summer, the Rutte IV cabinet fell, just a year and a half after it took office. That is relatively little time for great deeds. Kuipers announced Wednesday that he will immediately resign as outgoing minister, due to an as yet unknown new job abroad.
When he took office, expectations were high. Kuipers was the first doctor to lead the Ministry of Health since Els Borst. As chairman of the board of Erasmus MC, he was a man with authority and a professional with vision, it was said everywhere. To what extent was he able to make his mark in that short time?
No longer leading
From the start of his ministership, it was noticeable that Kuipers honestly identified the problems of healthcare. In an interview with a trade magazine Medical Contact he said last year that Dutch healthcare is no longer leading. “We have long maintained the message: our care is at the top level, we have the best care in Europe. And I don’t agree with that.”
For example, he mentioned the shortage of general practitioners and dentists and the long waiting lists in mental health care. Together with colleague Conny Helder (Long-term Care, VVD), also from the sector, he consistently stated: in order to keep healthcare future-proof and affordable in the long term, it must be organized differently and better.
Kuipers’ solution was more concentration of (specialized) care and more cooperation. To achieve that, he also dared to make unpopular choices. Soon after taking office, Kuipers decided that of the four children’s heart centers in the country, only Rotterdam’s Erasmus MC and UMC Groningen could remain open from 2025. Leiden and Amsterdam had to close. There are too few patients for four centers and centralization reduces the workload of the limited number of specialists and nurses. The four hospitals have agreed on this for some time, but for years they could not agree on which centers would remain open.
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To the judge
Kuipers made the decision, against the wishes of his former colleagues in Leiden and Amsterdam, who went to court. That the hospitals agreed this Thursday: Kuipers’ decision was annulled because he had not substantiated his decision with sufficient care and factual substantiation. The ruling, less than a day after his departure, is an ugly blow to Kuipers’ legacy and shows how difficult it can be to concentrate care by force.
Kuipers was also busy introducing more central coordination in acute (emergency) care, but those plans were still in their infancy and had already met resistance from the Association of Emergency Physicians (NVSHA).
Kuipers took another sensitive decision this year regarding the new cancer drug Trodelvy. Although the Healthcare Institute considered it “certainly of added value” for breast cancer patients from a medical point of view, Kuipers decided not to reimburse it due to the sky-high costs. In a letter to the House of Representatives, he wrote that it is “not inconceivable” that effective medicines will often no longer be reimbursed in the future due to rapidly rising healthcare costs.
Kuipers was also criticized for not taking long Covid seriously, the condition in which patients have long-term complaints after a corona destination. Doctors, patient organizations and the House of Representatives have been calling for separate treatment centers for years, but Kuipers did not want to do so, just as he did not think it was necessary to register the number of long Covid patients due to the administrative burden. The examples of the cancer drug and long Covid show that Kuipers strongly wanted to convey that choices have to be made in healthcare, and that not everything is always possible.
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‘From competition to cooperation’
Kuipers’ most important achievement is concluding the Integrated Care Agreement (IZA). In a statement on X, he called the agreement, concluded in September 2022, “a much-needed step from competition to cooperation.” It contains numerous agreements for the coming years about better cooperation and coordination between healthcare institutions and also reflected Kuipers’ wish for far-reaching concentration of care. An agreement like the IZA is also a paper tiger and has been criticized because it contains many vague intentions. And community nurses and general practitioners were dissatisfied with the financial resources allocated, while this so-called ‘first line’ in healthcare has been receiving many additional care tasks for years.
Kuipers had a difficult relationship with the general practitioners. They initially refused to sign the IZA because they did not feel taken seriously enough when it came to issues such as more time for the patient. An illustrative incident was a demonstration of general practitioners in The Hague on July 1, 2022. The general practitioners wanted to talk to Kuipers at the Binnenhof, but were sent to the Malieveld by the police. Kuipers promised to come to the event, but did not make it because the Council of Ministers was late. It was not unwillingness, he emphasized, but it did not diminish the disappointment among general practitioners.
Kuipers said in an interview with the magazine last summer EW know that it is a shame that he did not get the chance to become a minister. However, he already gave a hint about his next step abroad, namely the United States. “I worked in Nashville before, and I really enjoyed it. The kids are out, so come on, let’s go again.”
D66 wants to appoint a successor to Kuipers for the months that remain in the outgoing government. In The Hague, the names of former MPs Pia Dijkstra and Vera Bergkamp, former senator (and ICU doctor) Peter van der Voort and current party chairman Victor Everhardt are heard.
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