The court in Utrecht will today consider whether the decision to close the two pediatric cardiac surgery departments was taken correctly. Because although hospitals agree that it’s good to centralize care, no one wants to lose it.
Vijf jaar geleden verrees naast het UMC Utrecht en het Wilhelmina Kinderziekenhuis het Prinses Máxima Centrum (‘Máxima’), waar in Nederland alle kinderen met kanker worden behandeld. De zorginstellingen werken nauw samen en dat is onder meer te zien aan de felgekleurde brug die het Máxima verbindt met de operatiekamers en de intensive care van het WKZ.
De samenwerking laat zien dat het voor de kwaliteit van zorg goed is om een bepaalde tak van zorg op één plek samen te voegen. Tegelijkertijd staat volgens het Máxima en het UMC Utrecht ook juist deze samenwerking op losse schroeven door weer een andere concentratie van zorg: kinderhartchirurgie.
De kinderhartoperaties moeten straks namelijk niet meer plaatsvinden in Utrecht, of Amsterdam/Leiden, maar alleen in Groningen en Rotterdam. Tot teleurstelling van het UMC Utrecht en het UMC in Leiden. Zij stapten naar de rechter omdat ze vinden dat het besluit niet op de juiste manier is genomen.
Focus is more than just closing sections
First of all: Healthcare professionals also advocate focusing care. Because the more surgery a doctor performs, the better a person becomes at it. In the case of pediatric heart surgery, these are highly specialized operations and are performed only dozens of times a year.
This decision was influenced not only by the feelings of the parents or healthcare personnel involved, but also by the interests of the hospitals. They cited the possibility of losing academic status (Leiden) or retaining regional emergency care (Groningen).
People in Utrecht are now very concerned about cooperation with the Children’s Cancer Centre. The Maxima Center was created by merging seven pediatric cancer centers. Since then, complications from cancer surgeries have decreased dramatically, according to medical director and pediatric oncologist Rob Peters.
During these treatments, Maxima works closely with the Pediatric Cardiology Department at UMC Utrecht. Take children who develop fluid in the pericardium after a bone marrow transplant. You can’t travel with these children; They need immediate surgery, Peters explains. This is happening on the other side of the bridge, in collaboration with pediatric heart surgeons at UMC Utrecht. If they left, it would have dire consequences for treatment at Maxima.
The puzzle does not progress by eliminating the first piece
Intensive care has also been compared to putting together a puzzle, and according to Kuipers, pediatric heart surgery should be the first piece. “But the first part is already there: pediatric oncology,” Peters says. “If you throw away the first piece of the focus puzzle with that decision, the entire puzzle won’t advance.”
Across the bridge, at UMC Utrecht, a few academic hospitals appear to be starting to solve the concentration puzzle themselves. Early next year, UMC Utrecht and the hospitals in Amsterdam and Leiden will form a joint pediatric cardiac surgery team.
Meanwhile, childcare continues. The number of operating rooms at Children’s Hospital will be expanded and the intensive care unit will be larger. Health care workers are primarily concerned with providing that care, not politics, according to voices in the hallways.
Sanne Oving is binnenlandverslaggever bij NU.nl
Sanne volgt voor NU.nl grote binnenlandse thema’s, zoals zorg en asiel.
“Decision making independent of institutional interests”
But the focus on pediatric heart surgery has become political. Academic hospitals were asked to come up with a solution on their own, but were unable to do so. Kuipers’ subsequent decision is now being appealed and all hospitals prefer to keep their own department.
In founding Maxima, Peters also saw how these interests played a role. “All the UMCs liked our initiative, but it had to be brought up to them. That was a very long discussion.” According to Peter, medical professionals and institutes are the most important factor in this type of decision. “If the Minister then decides that the area is in danger of not being decided, he must be able to make the decision independently of those interests.”
Putting patients at the top, Peters concludes. “Focus is good, but you also have to do it the right way.” Put all the highly specialized parts of pediatrics in one place
A limited number of places, and — for example, gastrointestinal disorders in adults — in others, he says. According to him, a specialty like pediatrics should not be performed in multiple places. “Give every academic hospital an important specialty, but don’t give everyone a slice of pediatrics.”
Reactie ministerie
Een woordvoerder van het ministerie van Volksgezondheid, Welzijn en Sport zegt dat het de partijen vrij staat om naar de rechter te stappen. “Het ministerie betreurt echter wel dat de instellingen er onderling niet zijn uitgekomen om met een voorstel tot concentratie te komen, toen de minister gevraagd hebben de knoop door te hakken en daar vervolgens tegen in beroep gaan.”
“Dat concentratie moet gebeuren, daar is het iedereen het over eens. Concentratie zal de kwaliteit van zorg ook in de toekomst behouden en verder verbeteren en de toegankelijkheid van zorg toekomst bestendig maken. Concentratie is dus in het belang van de patiënt. De indruk is dat de UMC’s naar de rechter gaan om hun eigen belang te bevechten, in plaats van het belang van de patiënt voorop te stellen. De voorzieningen zijn er voor de patiënt, niet andersom.”