The difficult farewell to far too many beds

The report on the hospital landscape in Saxony-Anhalt was presented to the state's health cabinet at the beginning of April this year in the form of an interim status report, which is intended to determine the long-term investment needs in hospitals, the supply structures with emergency care and the emerging need for skilled workers up to the year 2035. The Partnership Germany (PD) - a consulting company for federal, state, municipal and other public bodies and institutions and 100 percent publicly owned - was commissioned to prepare the report on July 1, 2022, after the coalition committee met on July 3. May 2022 agreed on the key points to be assessed. The report should actually have been completed by the end of the year in order to be able to use the money from the Corona special fund in a targeted manner for hospital planning. The report, which will be completed in the coming weeks, is intended to be the basis for further planning in the state, taking into account the federal hospital reform.

>> Partnership Germany (PD) – consultant to the public sector GmbH based in Berlin and Düsseldorf – is familiar with such reports. She had previously worked with Lohfert & Lohfert AG and the Department of Healthcare Management at the Technical University of Berlin to prepare a hospital report for the state of North Rhine-Westphalia with a comparable objective, but on a much larger scale. The main focus here should be to analyze the connection between outpatient and inpatient areas and to make statements about the investments required. In an extensive process, the experts analyzed the hospital treatments carried out in Saxony-Anhalt over the last few years (2017 to 2021), surveyed all hospital operators and interviewed numerous players from the health sector. They were also able to rely on data from the outpatient sector and thus get a comprehensive picture of the provision of health services in Saxony-Anhalt.
Saxony-Anhalt's Health Minister Petra Grimm-Benne said when presenting the interim report: "The faster the results are available, the faster we can make decisions for targeted investments." The health minister named the central result of the study as the result that the supply of inpatients Overall, hospital services from the 54 hospital locations are well positioned, although she knows full well that the report also says that in the long term almost a third of the hospital beds available in the country could be dispensed with.
The experts justify this by saying that a total of 14,600 (2019: 15,050) fully inpatient hospital beds were available in Saxony-Anhalt in 2021, which is significantly above the national average. In the same year, bed occupancy was only 63%, which was the lowest level of occupancy in a federal state comparison. This situation has existed in Saxony-Anhalt for many years and has only been exacerbated by the corona pandemic. And for the future, according to the report, a further decline in the number of cases from -6 to -21% is expected by 2035. This includes a significantly greater decline in elective cases compared to emergencies during the pandemic. Be like that
• the number of inpatient cases fell by around 17% from 2019 to 2021,
• the number of fully inpatient cases with the admission reason “emergency” decreased by approximately 9% from 2019 to 2021 and
• Elective fully inpatient cases fell significantly more (-22 %) during the Covid-19 pandemic.

For the experts, the stated number of 2,000 to 4,000 hospital beds to be added can only represent a lower limit, as they link the statement to the condition that a utilization rate of 80% is necessary for this.
The bed reduction is essentially made up of three effects:
• Dismantling beds that have not yet been used to increase occupancy.
• Demographic change and the associated decline in the number of cases.
• Outpatient treatment of previously inpatient cases. In order for this to be successful, the outpatient care structures, including at existing hospitals, must be expanded.
Nevertheless, Grimm-Benne explained that it is not about closing individual hospitals, but rather about ensuring good medical care in the country, which must be set up for the future. “With the report we have a good basis with detailed data and findings that will help us to ensure inpatient medical care of the best possible quality in the state in the future,” said the Health Minister of Saxony-Anhalt: “One thing is clear: the locations in the area must be preserved.” Nevertheless, the problems arising from a shortage of skilled workers and demographic developments in the country are unlikely to endanger medical care. Petra Grimm-Benne: “For this we need smart, sustainable structures such as the combination and integration of outpatient and inpatient services in the area of child and adolescent medicine.”
The study also uses a survey to show how hospitals assess the skilled workers situation and the economic situation. In an online survey, 85% hospitals reported a shortage of skilled workers in nursing. 43% of the hospitals surveyed declared a negative annual result and almost all hospitals expected a permanently reduced number of cases. In the area of obstetric care, the experts also found that although obstetric care can be reached in less than 30 minutes in most areas, some maternity clinics do not even have 300 births per year and half of the maternity clinics in Saxony-Anhalt usually do so 600 births did not reach the economic lower limit. Nevertheless, almost all maternity hospitals are considered necessary for acceptable care in the country.
According to the study, care in the area of child and adolescent medicine in Saxony-Anhalt is currently comparatively good. 97% of the population can reach a hospital with pediatric care in less than 40 minutes. However, from 2017 to 2021 there was also a sharp decline in the number of cases. In 2021, 22 locations provided services in the pediatric care area, but five of them had fewer than 500 cases in the age group of children and adolescents. More than 1,000 inpatient cases were treated at just six locations. The experts therefore see the sustainability of small departments in particular as being at risk due to the population decline in conjunction with the often inadequate financing of pediatric services.
According to the report, there is good, comprehensive care in basic emergency care, and in general there is a good, albeit small-scale and heterogeneous, care landscape in rescue services. In the higher levels of emergency care, however, there are sometimes significant gaps and the resulting long travel times. The experts explained that air rescue, which in Saxony-Anhalt is only spread across two locations in Halle and Magdeburg, can only achieve its goals through cross-state care.
According to the report, many special services can only be accessed by a small part of the population with travel times of over 45 minutes. This also applies to the availability of extended emergency care (so-called G-BA level 2), which is only available in Stendal. The experts also find that in the area of life-threatening illnesses (e.g. stroke) the distances are too long and the time to treatment is too long and provide information on how this can be counteracted.
All in all, the PD good
Eighth: inside it is absolutely necessary to use all possibilities of cross-sector care. Already established models of collaboration between practicing doctors and hospitals could be expanded. This also included outpatient services (MVZ) provided by hospitals or municipalities. However, new models are also necessary in which hospital doctors can fill gaps and take action in the area of outpatient treatment. The state is already promoting closer integration of outpatient and inpatient services in Gardelegen, and a project is also planned in Genthin. The experts recommend that the country adopt a tiered system of hospital care. Basic care with internal and surgical services should be possible close to home. Children’s and maternity clinics should also be available regionally. The more specialized medical services become, the more services are concentrated at large specialist providers, maximum providers and university hospitals. <<
from:
MVF editor-in-chief Peter Stegmaier