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‘Everyone in healthcare realises that something has to change’

Good, accessible and affordable healthcare is increasingly difficult to provide. The demand for healthcare services is rising against the backdrop of a healthcare worker shortage. Martin Schalij from the Leiden University Medical Center’s Board of Directors understands that this can keep people in the Netherlands awake at night. ‘By 2040, one in four Dutch workers will be needed in the healthcare system. That’s almost inconceivable, isn’t it?’

From campus to cabinet

This article is part of our From Campus to Cabinet series. From 30 October onwards, we will be looking with researchers at key issues in the polls:healthcare, housing, livelihood security, immigration and asylum, the climate and sustainability. Which aspects should a new government bear in mind? Our researchers reflect on this in a series of articles.

There are waiting lists in the Netherlands and people wonder whether they will get the care they need. You still work as a cardiologist one day a week. Do patients tell you that this keeps them awake at night?

‘My patients often have such acute heart problems that they always receive immediate help. The waiting lists are mainly for mental health services and help at home. For example, if someone breaks their hip, will they get a place in a nursing home as soon as they need it? I completely understand people’s concerns, especially since every night there’s someone on TV saying that more money is needed for something or other. Then you create negativity. Whereas I think things are actually going pretty well. We just need to organise our care differently.’  

One solution is a greater focus on prevention and healthy living, which should reduce healthcare needs. For example, eating healthily and exercising, smoking less and drinking less alcohol.

‘Prevention is all very well but it doesn’t have an immediate effect. Even if we all start being healthy, the demand for care won’t decrease straight away. And people will get older and older and need care later in life anyway. Prevention is important of course. That’s why one of the LUMC’s priorities is population health, which involves trying to improve the health of large groups of people. And as a cardiologist, I encourage patients to exercise more and stop smoking. But we need to do more than that alone.’

In the Netherlands, we are aiming where possible for remote care: this means people receive care close to home or digital care, for instance through the internet. Is that the solution?

‘It’s good to make people responsible for their own well-being. We started doing that in our cardiology department ten years ago. After a heart attack, people do their own tests at home. With The Box, a package of various devices, they can take their blood pressure, for instance, and do an ECG. Older people have also proven to be more than capable of doing that. And if people can’t manage it, regardless of the generation, they just come in instead.’

There is a huge staff shortage in healthcare. Would more remote care help us reduce staffing needs?

‘Remote care helps a bit but if you want to give patients an IV at home, you need people to do that. The question remains how to find enough staff. The LUMC can’t provide care without “people at the bedside”. I think it is appalling that the asylum centres are full of talented young people and that we are not actively hiring them for the healthcare system. And if you want to recruit and retain nursing staff, the main thing is to be an attractive employer, which means constantly training people and helping them develop their talents.’

In an item on BNR-radio, you reiterated the importance of cooperation between health providers. Only then will we be able to make the healthcare system more efficient and meet increasing demand.

‘We do everything everywhere when sometimes it would be better to concentrate services. For breast cancer care, for example, patients are well served at Alrijne Hospital and for more complicated cancers they can go to the LUMC. But cooperation also means that as a hospital you have to do more in the local community and work together with the municipality, GPs and the Public Health Service to improve the health of the people living there. The LUMC has done this at Stevenshof, a neighbourhood in Leiden with a high demand for health services. But projects like that aren’t completed in a day. They take a lot of time and money and the national healthcare demand increases every year.’

With its Integral Healthcare Agreement from 2022, the Ministry of Health, Welfare and Sport reached agreements with 13 healthcare providers on accessible, high quality and affordable care. Has enough been done so far?

‘The parties are working incredibly hard. They all understand that something has to change in the healthcare system. The Integral Healthcare Agreement also addresses issues such as prevention, remote care, job satisfaction and cooperation within regions and between sectors. The plans for regional cooperation detail how, among other things, GPs, the Public Health Service (GGD), mental health services (GGZ), local hospitals and teaching hospitals should organise patient care as efficiently as possible. The plans haven’t yet been implemented, but I think a lot has been accomplished in a year.’

Healthcare is among the top three issues that the Dutch want the upcoming elections to focus on. What do you think is the biggest challenge for the new government?

‘I understand that voters want healthcare to be high on the political agenda. The increasing demand will mean that by 2040, one in four Dutch workers will be needed in the healthcare system. That’s almost inconceivable, isn’t it? The government should make a structural investment in innovation in healthcare and training for healthcare professionals. At the same time, healthcare institutions need to work in a radically different way and collaborate much more. Only then will we succeed in providing every Dutch person with appropriate care not only now but in the future as well.’

We will post the next article in the From Campus to Cabinet series on 7 November.

Text: Sandra van Egmond
Image: Fien Leeflang

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