A narrow majority of the House of Representatives supports the plan of Health Minister Ernst Kuipers to concentrate pediatric heart surgery in Groningen and Rotterdam and to close the pediatric heart centers in Utrecht and Leiden.
The coalition parties will support the minister, they hinted during the parliamentary debate on Wednesday evening. But almost the entire opposition thinks that Kuipers should opt for three centers or even keep all four open. Nevertheless, Kuipers also received support from opposition parties such as PvdA, GroenLinks and BBB for his choice for Groningen instead of Utrecht, with which he revoked the decision of his predecessor Hugo de Jonge at the end of 2021.
There is broad support in the House for the choice of the UMC Groningen in order to counteract the decline of acute care throughout the Northern Netherlands. Liane den Haan, formerly 50Plus, was actually the only group that clearly opted for Utrecht over Groningen, because according to her the North is still a shrinking region and more people live in the Randstad.
Mud throwing and hatchet burial
During the debate, Minister Kuipers and the coalition parties VVD, CDA, D66 and ChristenUnie again pointed out that patient organizations and doctors have been asking for years to concentrate on a maximum of two locations in order to maintain the quality of the interventions. All these years, the four university hospitals have not been able to reach a mutual agreement, which is why, according to the coalition parties, it is necessary to make a decision now.
MPs Joba van den Berg of the CDA and Wieke Paulusma of D66 hoped that hospitals would stop throwing mud at each other and, according to VVD MP Judith Tielen, patients are being made insecure by the long-drawn-out discussion. Kuipers therefore hoped that the hospitals would now bury the hatchet.
According to Kuipers, two centers instead of three are also necessary because there are many rare heart defects. Surgeons need experience with rare abnormalities, and they are more likely to spot them if all operations are concentrated in one or two hospitals. ,,Three is very minimal, then it remains too vulnerable”, said Kuipers.
‘Hidden agenda’ about Groningen
Fleur Agema of the PVV and Liane den Haan fear that Groningen will do too few children’s heart operations because most patients will go to Rotterdam. According to them, Groningen will still be closed in a few years and Den Haan even called this a “hidden agenda”, to the chagrin of the coalition parties.
Julian Bushoff of the PvdA pointed out that hospitals can make mutual agreements about the distribution of patients. A little later, the minister also said that he was absolutely not afraid that too few patients would be treated in Groningen, because patients are often referred to a specific hospital for operations. “People are willing to travel for such a procedure that may be done once in a lifetime.”
Last year, Kuipers was forced by the Chamber to postpone the decision of his predecessor Hugo de Jonge to concentrate operations in Rotterdam and Utrecht and he had an investigation carried out by the Dutch Healthcare Authority NZa. He stated that the consequences of a complete concentration and exchange of complex operations must first be investigated. But Kuipers first decided on two locations, but then chose Groningen over Utrecht.
Too many pediatric heart surgeons?
The NZa also pointed out in the report that there are a total of fourteen pediatric heart surgeons in the Netherlands. If those fourteen have to work 24-hour shifts in four different hospitals, it is difficult to keep up. But if two centers are created, according to the NZa report, a few pediatric heart surgeons are at risk of becoming redundant. SP Member of Parliament Maarten Hijink thought that the world was upside down because the decision was prompted precisely by a shortage of doctors. But according to Kuipers, this redundancy will not go that fast because the total number of operations will remain the same.
The factions asked the minister for more certainty about measures to limit the problems that arise in Utrecht and Leiden. For example, Leiden UMC fears having to close the children’s intensive care unit and operations on children in the womb are only performed in Leiden. Utrecht also has the only children’s cancer center, the Princess Máxima Center, and every year about sixty children are treated there for cancer who also need heart surgery.
Those points will be discussed over the next two and a half years, Kuipers replied. In addition, a general exchange of complex care between hospitals is also on the table.