The Netherlands Health Care Authority (NZa) is highly critical of the government’s decision to remove specialized pediatric cardiac care from UMC Groningen and Leiden UMC. According to NZa, a new plan is needed before responsible reforms in cardiac care can be undertaken.
In analyzing the impact of the plan to halve the number of centers of expertise for operations on children with congenital heart disease, published today, the healthcare regulator advised Minister Kuipers not to implement the decision of his predecessor de Jong. If he did, pediatric acute care would be at risk, according to the NZA. Kuipers will make a decision later.
In the cabinet plan, only Erasmus MC Rotterdam and UMC Utrecht may retain this sponsorship. The idea is that in the future doctors will also perform enough operations each year to update their expertise. However, NZa warns that this scheme undermines access to care at an academic level in Leiden as well as at a regional level in Overijssel, Drenthe, Friesland and Groningen.
A threat to acute care continuity in the northern Netherlands
In recent provinces, UMC Groningen is preparing the spider in the web for the treatment of patients with a congenital heart defect. Without cardiac specialists, this unified medical center can no longer support regional hospitals in a way that maintains the current quality of care.
NZa predicts that heart patients in the northern counties would be at risk in an emergency if they lost a heart specialty there. This is partly because another university medical center simply cannot take over Groningen’s role.
In addition, UMC Groningen is the only place in the region where critically ill children can receive IC care. The existence of this care facility is therefore essential for northern hospitals to be accredited again in extreme emergency situations. Without experience in cardiac care, full acute care in the area automatically disappears. According to NZa, this poses a great danger to the people of the North.
Leiden may lose academic status
The consequences will also be significant in Leiden. LUMC’s entire pediatric intensive care unit would disappear if specialized cardiac care was no longer provided there. Without heart patients, there are very few patients to keep this ICU open.
This also has consequences for other healthcare. For example, stem cell transplantation in children will no longer be possible. Children with serious viral infections, such as RS, will also not be able to come to Leiden. The same applies to children who have been seriously injured.
NZa warns that LUMC may lose its academic status in the field of pediatric care.
Patients were forced to go abroad
The impact analysis also shows that other medical specialties unique to the Netherlands will be lost if the decision is implemented. Because these specialties cannot be dispensed with without cardiologists.
For example, LUMC is the only center in the Netherlands where heart operations are performed on a fetus in the womb. It is performed in close collaboration by the fetal surgeon and the pediatric interventional cardiologist.
Groningen is the only expert in the Netherlands in several fields. These include lung transplants, liver transplants, combined organ transplants, and treatment of pulmonary hypertension. This is a lung disease that affects half of all heart patients.
According to NZa, these specialties cannot be transferred directly within the Netherlands, which means that patients have to travel abroad to receive this care.
VWS chose the riskier option
Last year, the Department of Health (VWS) had to decide which medical centers could continue to offer pediatric cardiac care. Although everyone agreed on the need to focus care to maintain quality, after years of discussions and disagreements, hospitals could not agree.
VWS can choose between four, three, or two hospitals. The choice fell on two types of hospitals, Erasmus MC and UMC Utrecht. The ministry believed that this would ensure the quality of pediatric cardiac care in the future.
Impact analysis now shows that this scenario is the most severe in terms of access to specialized care in the Netherlands. Given the expected loss of specialties that are rare even at the European level, the NZA advises Minister Kuipers to limit the time.
In addition, it is recommended that university medical centers jointly develop a comprehensive view of the distribution of medical specialties in the Netherlands before the summer. After all, more care should be focused.
“As long as this integrative perspective on the future-confident academic care landscape does not exist, we find it undesirable that irreversible steps should be taken to focus on interventional cardiac care,” NZa writes.
“These steps anticipate the future design of the academic care landscape and therefore pose a risk to continuity of care in the current situation and in the near future.”