The Covid-19 crisis. Need I say more even actually. We all have seen on how fragile the healthcare systems are around us. In this post I will only write about how the Dutch system is failing at the moment. Because that is what it is, an unsustainable situation

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The beginning

This all seemed to have started when the healthcare system turned over the DBC system (diagnoses treatment combination) which was brought in years back to bring in the competition between hospitals getting as low a possible costs for a treatment. The market would define the prices. Meaning if in hospital A you could get your galbladder removed for an all-in price of $500 and in hospital B for $600, hospital B would get less patients because health insurances would send their customers to hospital A. This would make hospital B redefining their price and trying to cut down their costs to get back into the market.

The idea is good in general (all costs should always be as low as possible, health care is expensive enough) but reality is that often was saved on the wrong ideas. Buying products cheaper on the other side of the world (globilisation) not always investing enough in education of existent staff and not training enough new staff. Short term visions. Also how the beds are used is always on the boundaries of what is possible. Say if you have 40 ICU beds they will always be used to the fullest. Meaning when bed 38,39,and 40 will be empty tomorrow surgeries are scheduled to fill them up again. Also in general this is good, because empty beds means costs, but there has to be a level of flexibility. For staff to take their vacation, and also for unknown disasters (like the one we are having now)

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For as long as I can remember (and I have been in the business for a while now) the problem was never the willingness of staff but more the boundaries from the amount of staff. There has always and I mean always been a shortage and we always deal with that. Working a bit extra shifts, doing more with less staff, the boundaries were already long time fading.

Current situation

Now Covid-19 came and we all see how fragile the system is. Dutch government is pushing to upscale the amount of ICU beds from 1150 (currently when everything is FULL FULL FULL) to at least 1700. A good thing naturally, but the way to achieve this doesn't make any sense. Upscaling comes with long term investment and without any willingness to do this, this will never work.

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Applause

On the 17th of March 2020 there was a call for applaud 3 minutes long for healthcare workers dealing with the Covid-19 situation. Super sweet and it felt like support, but with just support you aren't winning the game. You need trained players who are in shape to win the match in the end.

So in this same week a motion was filed into government to get a bonus for healthcare workers or a structural salary increase. I don't believe in bonusses personally, because you forget them as fast as they came. And they do not take out the reason why working in healthcare is unattractive.

It is underpayed under a ridiculous amount of pressure. You work when your loved ones are off. And now with this new crisis it is even so that when someone in your household has Covid-19 symptoms and should home quarantine with the whole household healthcare workers are still required to go to work.

Let that sink in for a second. So the whole world should stay home not to infect others but healthcare workers have to go to work to take care of the sickest of the sick people. That just feels wrong in the biggest meaning of the word.

I get it. When healthcare workers stop going to work the whole system will collapse even more. But taking care of sick patients (and I don't mean hospital alone, in elderly homes this is even a lot worse and they have a lot less protective materials than in hospitals) while Covid-19 lives in your house just feels like a really bad idea. And when after two weeks an X amount of your patients die, and you feel responsibel in the back of your mind for this (luckily this wasn't me but a friend) that presses a lot on you.

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Government

So back to the motion that was filed in goverment in March to get healthcare workers more salary. It was declined this week. Yes, declined.

I wasn't surprised about this at all, because when the iron is hot the topc is hot. When when getting to the nitty gritty all is gone and forgotten. But how on earth should health care work be promoted then if you want structurally more staff? Let us be realistic, I know a lot of people from healthcare who took a different direction because there was more money to make for a lot less stress and risks. This is how the world works.

Healthcare work at the moment is still seen as a calling, and not as a serious career path. And as long as that idea will remain, those 1700 beds remain a dream in the matchmakers books.

Yes, I am concerned.