In the midst of the corona crisis, the Ministry of Health, Welfare and Sport has discouraged hospitals from expanding their intensive care unit (ICU) with extra beds. While the country was in lockdown to prevent the hospitals being overloaded, the department and hospitals argued about the reimbursement of extra IC beds and the conditions under which this should happen.
This is evident from research by NRC† Some hospitals were even advised to “clear” beds, to set up less than agreed.
Read the NRC research here: Where were the extra IC beds?
At the start of the epidemic, the number of ICU beds turned out to be the Achilles heel of corona care. That is why the corona policy was tailored to the number of beds available in intensive care and existing ICUs should be expanded.
Immediately after the first wave, in June 2020, the sector made a plan for extra beds. The ministry released half a billion and devised a subsidy scheme. It was agreed per hospital how many IC beds would be added to the wards. The total number of beds would thus gradually grow from 1,000 to 1,700 beds.
In October 2020, this resulted in a “scaling up list” that took on a life of its own. Civil servants in The Hague were so fixated on the agreed numbers that hospitals that wanted to expand more than agreed in the following months were met with no response, according to a reconstruction.
In Amsterdam, two hospitals were forced to expand their intensive care units in December 2020 due to the influx of patients, but the ministry declined reimbursement. Subsidy “was not possible because only hospitals from the upscaling list” were eligible, according to the ministry according to an internal memorandum. That list stipulated that these two hospitals would not expand.
Delete beds
The ministry has been at odds with at least one in five hospitals. The discussion focused on how many ICU beds were there before the pandemic broke out. Because the minister used numbers that were too high, the hospitals risked not being reimbursed for bed extensions. Six hospitals hired a lawyer and prepared preliminary relief proceedings.
The quarrel about the subsidy conditions caused a delay in the expansion, a hospital informed the ministry. The department, internal notes show, was aware that the dispute over money could jeopardize the IC expansion. It is possible, officials write at the beginning of November 2020, that “there will only be a definitive answer in 2021, as a result of which there may be no scaling up in accordance with the Subsidy Scheme until then”.
Nevertheless, for financial reasons, at a certain point “maximum efforts were made to prevent an increase in the number of beds,” officials wrote to the minister.
In December 2020, at least four hospitals were advised to ‘delete’ beds from the Ministry of Health, Welfare and Sport. This happened at the moment when the national coordination center for patient distribution made an urgent appeal to hospitals to increase their number of beds.
Two days before, Prime Minister Mark Rutte had special television speech declared a nationwide lockdown. All schools, shops, hairdressers and restaurants were closed by order of the government. The Netherlands was locked down to keep healthcare accessible. “That there is a bed for you if you need it,” said the prime minister. A month later, the government imposed a curfew to ease pressure on the ICU.
NRC asked questions to the Ministry of Health twenty days ago about his position and his advice to delete IC beds. At the time, the department was unable to provide answers to the questions “if they can be traced at all,” a spokesman said.
Where were the extra IC beds? page 8-11