The number of hospitals that have to temporarily close the Emergency Department (A&E) is increasing. That is the view of the Dutch Association of Emergency Medicine Doctors (NVSHA). There is a shortage of qualified staff and the number of patients with complex problems is increasing.

“The last year has been unprecedented,” said David Baden, president of the NVSHA. “We see that hospitals that have never had to declare a closure are now having patient stops.”

There is no national record of the number of emergency room closures, but Baden is seeing crowds increase across the country. “We hear from all our colleagues that there is enormous pressure, which makes it just not fun anymore. You just want to be able to provide good care and not have the feeling that you have your back against the wall.”

Short of staff

A&E doctor Joris Holkenborg of the Rijnstate hospital in Arnhem also sees it getting busier in his department. “We often have thirty to forty patients on the floor at the same time around 5 pm. Then you can get full. Sometimes we still have beds, but no nurses to provide the heavy care.”

The emergency room in Rijnstate had to close five times in the past year. Due to the shortage of mainly specialized nurses, it is difficult to complete the schedule. Meanwhile, the flow of patients with increasingly complex problems is growing.

They fear a new corona wave and flu epidemic in the hospital. “I am especially concerned about the nursing team,” says doctor Holkenborg. “There are already shortages and they work under great pressure. If more nurses are lost, for example due to illness, I wonder what it will look like.”

Healthcare staff have gone to extremes in the corona crisis, but the pressure on healthcare is not decreasing. In fact, it will only increase. It is even untenable to continue to provide the same care in the future, says the Scientific Council for Government Policy (WRR).

It is becoming too expensive and too few staff are available. By 2060, one in three employees will have to work in healthcare, according to the WRR. Now that’s one in seven.

It is already very difficult to find well-qualified personnel. There is a shortage of staff everywhere in healthcare. In hospitals, mental health care, home care, youth care and general practitioners are faced with personnel problems.

General practitioner Paul Prinsen Geerligs keeps the practice in Amsterdam Nieuw West running with acting general practitioners. Three of the six GPs are permanently employed. The rest of the services are filled with observers. “It creates uncertainty for patients. They often see a different doctor,” says the GP.

The shortage of staff also leads to closures in general practice: on some days there was no consultation hour recently. “On those days, the practice was only open for emergency care. The other care had to be postponed until the next day, because we did not have enough capacity.”

Make choices

It is time to make choices together with politicians and society, says Baden of the NVSHA, with the central question: which care makes sense and which does not?

“We like to take care of people and that’s why we provide a lot of care. But we have to look at what improves people’s lives,” says Baden. “We do a lot of diagnostics in the ER, for example. Sometimes I want to rule out something. Afterwards I think: why did I do this now? I would like to be supported in this by society and politics. You have to take the risk now that sometimes something is missed.”

General practitioner Prinsen Geerligs: “I also think it is possible. If we look at the corona epidemic: when there was a shortage of vaccines, the government decided who gets a shot and when. This happened with the participation of experts. government can weigh that well and that this is the best way to democratically decide what care we can provide.”

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