On 20 December 2021, the former minister of Health, Welfare and Sports Hugo de Jonge made a decision; The Erasmus Medical Centre (Erasmus MC) in Rotterdam and the University Medical Centre Utrecht (UMC Utrecht) will be the only paediatric heart centres in the Netherlands from now on. However, according to multiple experts, the way this decision has been made and the decision itself are dubious. Martin Buijsen, Professor of Healthcare at Erasmus School of Law, is one of them; “The whole process is carried out bizarrely”.
Why close?
Paediatric heart surgery nowadays takes place in four centres: the Erasmus MC, the Centre for Congenital Heart Defects (a joint venture of Leiden UMC and Amsterdam UMC), the UMC Utrecht and UMC Groningen. And that is too much in the opinion of De Jonge. This downsizing is not breaking news. From 1993 onwards, the Health Council of the Netherlands, an independent advisory body, already emphasizes the necessity to concentrate heart patients in a maximum of three centres. Otherwise, surgeons cannot perform the number of surgeries required to keep their skills up to date. Moreover, a lot of senior cardiac surgeons will retire soon. A concentration of heart care in specific centres is needed to preserve the overall care quality.
The divestment of specific paediatric heart centres does not appear out of thin air: from September 2020 onwards, multiple conversations regarding this have taken place. The absence of a mutual decision which centres have to close forced De Jonge to take one himself at the end of 2021.
Heartache
Erasmus MC and UMC Utrecht are happy with the decision, but Groningen, Leiden and Amsterdam are full of disbelief. How did De Jonge make this decision? In addition, internal memos of the ministry show no clear picture of the impact of the decision. The ministry even refused an impact analysis.
Martin Buijsen studied the decision-making process and concluded that events were unusual. “The minister has the authority to determine that it is forbidden to perform certain medical procedures without a permit”, says Buijsen. De Jonge had announced that he would make a permit obligatory for specific complex cardiac care. The two permits the minister will make available are subject to specific rules and conditions. In this way, cardiac care could become more concentrated. “Before the defining of these conditions, it was already clear who would meet them”, says Buijsen. “I can imagine that doctors might think that their colleagues in Rotterdam and Utrecht have the minister on rather a short leash.”
Right choice?
There are more things twisted in the decision-making process. The hospitals understand the choice for Erasmus MC as an expert centre; they are known as a qualitatively outstanding hospital, and it is the biggest cardiac centre in The Netherlands. The choice for UMC Utrecht is not as obvious. The ministry lacks transparent data collection and crucial information, and rumours are that an ex-politician, who is very close to De Jonge, has lobbied for UMC Utrecht. Furthermore, the ministry has decided not to take geography into account. Has the right decision been made?
Inherited problems
Currently, Ernst Kuipers is the one to clarify the situation. Although he agrees with De Jonge’s decision, he is prepared to reconsider the choice for Rotterdam and Utrecht if there are legitimate grounds for this. The Dutch Healthcare Authority is currently executing an impact analysis. Before this summer, a definitive decision has to be made for paediatric heart centres to close up.
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