The current Dutch Flevoland healthcare landscape has all the ingredients to continue to deliver high-quality and accessible healthcare – now and in the future. That’s the main conclusion from a report by Bas Leerink, explorer of the future and partner at IG&H.

Download the full report here (in Dutch).

In the past few months, Leerink and his team of IG&H consultants have defined a vision of healthcare in the Dutch province Flevoland from 2020 onwards. To this end, they’ve had extensive talks with residents, healthcare providers, health insurers, and the local government. They’ve also made extensive calculations and analyses of all scenarios. Moreover, regulators NZA (Dutch Healthcare Authority) and IGJ (Health and Youth Care Inspectorate) have been actively involved and have responded to the report. They don’t have any objections.

As an explorer of the future, Leerink recommends a step-by-step improvement of the current healthcare provision as the best approach for Flevoland. The province shouldn’t seek to restore the situation that existed before the bankruptcy. Therefore, the emergency room and acute obstetrics will not be reopened in Lelystad.

This is a difficult matter for many parties involved, but restoring the situation that existed before the bankruptcy doesn’t offer a solution for future demand. Furthermore, it’s neither realistic nor feasible in the short term. In the report, Leerink makes several recommendations. If this Agenda for Healthcare is realized, it will turn Flevoland into a leading region in the sector.

Importance of close collaboration

The bankruptcy of the former MC IJsselmeer hospitals has damaged the citizen’s trust in healthcare (parties) and the extent to which they’re able to really put the public interest in available, accessible, and good healthcare first. Now, researchers observe that healthcare (particularly the networks of healthcare professionals) is being restored in terms of content. The trust of citizens – reflected in local governments, the Flevoland Patient Federation (FPF), and Stichting Actie Behoud Ziekenhuis Lelystad (foundation to promote the preservation of a general hospital in Lelystad) – is still fragile.

Therefore, the explorer of the future proposes to keep analyzing and monitoring the situation carefully, and to continue consulting with all parties involved through Zorgtafel Flevoland (healthcare table Flevoland) in the coming year. The latter is supported by a progress meeting, chaired by the Ministry of Health, Welfare, and Sport. It also offers the option of addressing bottlenecks and escalating progress-related problems. The Ministry of Health, Welfare, and Sport can use the outcomes of the meeting to inform the Dutch Lower House of Parliament.

Acute healthcare

One of the issues that damaged trust encompasses concerns about accessible emergency care. Before the bankruptcy, patients with an acute, life-threatening condition, such as a heart attack, were sent to the Zwolle-based hospital. This procedure will be maintained. Because of the emergency outpatient department in Lelystad and the local emergency room in Emmeloord, it’s possible to provide care in the area in the case of low-complex emergency conditions.

To relieve pressure on these surrounding hospitals, it’s important to set up an acute care data science team in Flevoland. The team can contribute to the improvement of processes, which can increase the availability and effectiveness of emergency rooms. Currently, the St Jansdal hospital provides the emergency outpatient department at the Lelystad location and the emergency room at the Harderwijk location, which means it’s logical to start with this hospital.

By deploying data and new technology in the right way, ambulance care in Flevoland can take the lead in data-driven process improvement in the short term. This may serve as an example for other regional ambulance facilities in the Netherlands in the long term.

Obstetric care

The disappearance of acute obstetrics in Lelystad means that part of the people in Flevoland need to travel a longer distance in acute obstetric situations. The increase in travel distance means it’s easier to use an ambulance.

A new type of collaboration is needed to keep providing good birth care. Carefully organizing the unchanged demand for care within the context of the altered care provision – both primary and secondary care – is a priority. Recently, new partnerships have already been established between all care providers involved. They have given tremendous effort to reach additional agreements, which has strengthened cooperation and mutual trust.The explorer of the future also recommends that birth care in Lelystad is supported for one year.

The starting point is to offer birth care in the pregnant woman’s area if possible, and to provide it in a clinical setting as quickly as possible if the case in question so requires. Birth care providers are obstetricians or obstetrically active primary care physicians, secondary and tertiary care obstetricians and gynecologists, the regional ambulance facility (only in the case of acute obstetrics), and maternity care.

Care and support for vulnerable groups of people

The growing number of vulnerable elderly people with a complex, often cross-domain demand for care and the increasing health differences between socio-economic groups require far-reaching cooperation between care and welfare organizations and municipalities.

An adapted form of the neighborhood clinic in Amsterdam would be an interesting initiative for Lelystad. This clinic’s target group consists of patients with a combination of geriatric problems and, for example, pneumonia, COPD, heart failure, a bladder infection, or neurological symptoms. The results are positive – patients experience less loss of function, and the number of readmissions and emergency room visits is reduced, among other things. Several parties have now entered into discussions, and the first plans for such an initiative in Lelystad are being developed.

There is also a demand for primary care plus in the Noordoostpolder. Chain partners have signed a letter of intent for the new health plaza to be built in Emmeloord. This care concept will offer room for day treatments, convalescence, and observation beds, among other things. The various parties’ involvement enables far-reaching cooperation.

Furthermore, the number of residents with a chronic condition, which is already relatively high in Lelystad, is expected to increase sharply. One of the numerous action points that should be implemented according to the explorer of the future is the deployment of e-health initiatives. However, it is essential to pay attention to the limited digital and health literacy among part of the population. Finally, it is important for health insurers to support these initiatives – that is, if they don’t already.

Vision for the future of healthcare in Flevoland

In January, after the sudden bankruptcy of the IJsselmeer hospitals last fall, minister Bruno Bruins appointed Leerink. The disappearance of the emergency room and obstetric care caused much unrest in Flevoland. As an explorer of the future, it was Leerink’s job to make a thorough inventory of the healthcare market in Flevoland and to subsequently outline both short-term and long-term needs.

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