This is how Rotterdam can get out of the healthcare crisis

Vulnerable Rotterdammers are at risk of falling by the wayside as a result of new tendering rules in the care and welfare sector in Rotterdam. In Studio Erasmus, Prof Martijn van der Steen (Erasmus School of Social and Behavioural Sciences) explains how it has come to this and how Rotterdam can get out of it. "We have to go back to socialisation and put aside the market model."

To inaugurate his mini-lecture at Studio Erasmus, Professor of Public Administration Martijn van der Steen plays music. Orfeo, a client of the care learning and work collective Pluspunt, can be heard rapping about what the organisation means to him. Social organisations like Pluspunt help bring order to life, which gives him and other clients a leg up and keeps their lives in balance. Facilities like Pluspunt are wonderful facilities worth a lot, according to the professor, and there are many of them in Rotterdam. But again, for how long?

Rotterdam is facing a healthcare crisis

Last January, the municipality of Rotterdam announced that it was facing a healthcare crisis. Since decentralisation, the municipality in the Netherlands has been responsible for care and support from the Social Support Act (Wmo) and youth care. This includes, for instance, home care and day care services, and this is running out of steam financially. Despite the fact that the municipality has started investing more in those facilities, the costs rose from 6 to 9 million, the costs will only increase further in the future because of the increasing demand for care.

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"Rotterdam is indeed facing a healthcare crisis", Van der Steen says during his mini-lecture. "The cost of care and support is rising enormously and that means the municipality has a financial problem. The municipality has to deal with that, which is also understandable. But, and this is less understandable, this is done in a way that is very damaging to social services, which are remarkably well developed in Rotterdam. These, in the attempt to curb the cost of care and support, are at risk of soon falling over. And that is bad news for Orfeo and his colleagues."

Where this leads

The healthcare crisis is causing a big problem in the budget of the municipality of Rotterdam. A problem the municipality is trying to solve within the rules of the market, observes Van der Steen: "The market now works according to the simple rule of p times q: there is price and there are numbers of operations. These together make up the total amount needed. The price is fixed, and if you then have to stay within budgetary limits, you automatically end up with q: the number of operations."

In the Rotterdam context, this means that the parties contracted in the tender have to look for holes to deliver care within the tendered amount. "They will first fill all their own facilities as fully as possible and only then refer to facilities like Pluspunt, which as a subcontractor is not a direct contract party of the municipality," Van der Steen continues his story. "That is business-smart operating, but it means that in the long run people like Orfeo can no longer go to Pluspunt. Instead, he has to go and get his day care at a house in the district, which are totally different facilities."

"On paper they get care, but in practice it means they get care that doesn't help them move forward or even helps them in the wrong direction"

The way forward

In the short term, this results in savings, but in the long term, you only have more costs. So what is the way forward? "If there is a heart attack, the heart needs oxygen, so to speak. Then you should not cut it off, but give it space," says Van der Steen. "You have to keep the social field in position right now. It is a vital infrastructure for good care in Rotterdam and it is a necessary facility for a lot of Rotterdammers."

Beyond the market, putting people first

According to Van der Steen, we need to return to socialisation instead of tendering. "We are now looking for the solution in the same market model that is causing the crisis. That is not sensible. We have to prevent this from adding to the long-term damage. And that can actually be done very easily. Simply by putting aside the market model and going back to what these facilities are meant for: giving people a hand to live the life they want. As a municipality, see if you can stand alongside the providers and make agreements with each other about how the facilities can be maintained. That way, all those Rotterdammers who use them can continue to be helped, even in times of budget squeeze."