Heath minister Ernst Kuipers is making a push for the concentration of pediatric surgical care for congenital heart defects in two centres, following years of discussion. Currently these surgeries are performed in four medical centers spread across five locations in the Netherlands – UMC Groningen, Erasmus MC Rotterdam, UMC Utrecht, UMC Leiden and Amsterdam UMC. In 2021 Hugo de Jonge, at the time Minister of Health, Welfare and Sport, after consultations with several parties made a decision that pediatric heart surgery would be concentrated in Rotterdam and Utrecht only. The decision, however, was not well received, which led to an impasse. As De Jonge noted back then, the concentration would have several negative consequences for patients, healthcare professionals and healthcare facilities.
In the Netherlands, the prevalence of congenital heart defects (CHD) per 10,000 births is 77.45. This means that annually, in the Netherlands about 180 children are born with CHD. These defects range from simple to complex and occur in many types. Treating patients with congenital heart defects requires the involvement of a wide range of specialists including cardiologists, cardiothoracic surgeons, pediatric interventional cardiologists, pediatric ICU nurses, and more. According to a report by the Dutch Healthcare Authority last year, there are ten cardiothoracic surgeons specialized in CHD and twelve pediatric interventional cardiologists working in the Netherlands, of whom some are heading towards retirement age.
The quality of care in all current pediatric heart surgery centers is at a good standard. Nevertheless, there are challenges to the quality and continuity of care in the near future that cannot be solved within the current care structure. The treatment of congenital heart defects requires complex and highly specialized knowledge. With the current distribution of patients, the specialists’ ability to adequately maintain and develop the required knowledge and skills remains limited. To put it simply, there are not enough patients to justify having this many centres for treating CHD. To optimize the survival rate, one centre needs to perform at least 60 surgeries on newborns (babies younger than 30 days) a year. This means that doctors at the centres currently do not see enough patients to learn and maintain the required skills.
In January Ernst Kuipers, the Minister of Health, Welfare and Sport, asked the Dutch Association of University Medical Centers (NFU) to choose two hospitals where pediatric heart surgery should be concentrated. On 9 February, the organization responded, endorsing the idea of concentration as a possible means of improving the quality of care and securing it for the future. However, the NFU was not able to provide an answer to the minister’s request of naming two centres. Therefore, minister Kuipers made the decision himself to only maintain the centres in Rotterdam and Groningen. This choice of centers ensures an even distribution of the accessibility of interventions for patients with congenital heart defects across the country.
The centers that are supposed to lose the license for the surgical treatment of congenital heart defects are disappointed. Douwe Biesma, chairman of the UMC Leiden Executive Board, said that his institution objects and – if needed – will go to court. UMC Utrecht believes that it should keep the right to perform pediatric heart surgeries for the sake of ensuring proper care for the pediatric oncological patients at the Princess Máxima Center, as some of these patients require cardiac surgery, for example due to side effects to the heart and lungs resulting from cancer treatment. The NFU also underlined that mitigation measures are needed for the medical centers that will lose the license to perform pediatric heart surgeries for congenital defects. Moreover, as the Dutch Healthcare Authority points out, closure of the departments may lead to closure of pediatric intensive care units and pose a risk to the regional availability of acute care.
As Kuipers outlined in an official letter, the transition period is set to take 2.5 years. Following the concentration, the centers that no longer do operations will still be allowed to perform check-ups, outpatient appointments as well as pre- and postoperative care. Erasmus MC and UMC Groningen expressed satisfaction with the minister’s decision and eagerness to intensify the cooperation with all parties involved, particularly the other pediatric heart surgery centers, to ensure accessible pediatric cardiac care.
Written by Zuzanna Kuffel