Health Ministry discouraged hospitals from expanding ICUs mid-pandemic

In the middle of the coronavirus crisis, the Ministry of Public Health, Welfare, and Sports discouraged hospitals from putting extra beds in their intensive care units (ICU), NRC reports based on its own research. While the Netherlands was in total lockdown in December 2020, the Ministry and hospitals argued about the reimbursement of extra ICU beds. Some hospitals were even told to "scrap" beds - put down fewer beds than agreed, according to the newspaper.

When the pandemic broke out, too few ICU beds turned out to be the biggest problem for coronavirus care. Therefore, the government and health services tailored the coronavirus policy to the number of ICU beds available and started planning expansion. In June 2020, the sector made a plan for extra beds. The Ministry made 500 million euros available through a subsidy scheme intended to gradually increase the number of beds from 1,000 to 1,700.

This culminated in the "scaling up list" in October 2020. According to NRC, this list took on a life of its own, with civil servants so fixated on the agreed-upon numbers that hospitals that could or needed to expand more were blocked from doing so. In Amsterdam, two hospitals had to increase their ICU beds because of an influx of patients but were denied funding because "only hospitals from the upscaling list" were eligible. NRC reports based on an internal memorandum from the Health Ministry.

At least a fifth of hospitals butted heads with the Ministry on this point, according to the newspaper. Six hospitals ended up taking the Ministry to court. The quarrel about the subsidy and conditions attached delayed the ICU expansion, at least one hospital told the MInistry. The department's internal notes show that it knew the money disputes could jeopardize the expansion. At the beginning of November 2020, officials wrote that "there may only be a definitive answer in 2021, as a result of which there may be no scaling up in accordance with the subsidy scheme until then."

At one point, "maximum efforts were made to prevent an increase in the number of beds," officials wrote to the Minister. In December 2020, the Ministry of Public Health advised at least four hospitals to "scrap" beds. This happened two days after Prime Minister Mark Rutte announced a nationwide lockdown, closing all schools, non-essential stores, contact professions, and restaurants. He said it was necessary to keep healthcare accessible. "So that there is a bed for you if you need it," he said. A month later, the government imposed the first curfew since World War II to ease the pressure on the ICUs.

NRC said it asked the Ministry of Public Health to respond "twenty days ago." A spokesperson said that the department was unable to answer the questions at the time "if they can be traced at all."