Critical situation
Emergency in children’s hospitals: Why free beds are often in short supply
According to experts, the situation at many children’s hospitals is critical: a shortage of doctors, a shortage of skilled workers, a lack of money and the reduction in beds are putting the facilities under increasing pressure.
© Rolf Vennenbernd / DPA
In Germany, more and more children are suffering from chronic illnesses. But the children’s hospitals lack money and staff. Doctors therefore have to make sometimes difficult decisions every day.
Every day Ursula Felderhoff-Müser and her team have to decide how many Children can be cared for safely in their children’s hospital. Because it is not a given that there is a free bed for every sick child at the Essen University Hospital. “We have big problems accommodating all the children,” says Felderhoff-Müser, who heads Children’s Clinic I in Essen, about the current situation at the end of February. The clinic includes the areas of early and newborn medicine, pediatric intensive care and child neurology.
“We in the children’s clinics do everything we can to ensure that children are not put at risk. We do not turn away sick children without initial care,” says the pediatrician. However, due to the lack of beds, it does happen that children have to be sent to another hospital for further treatment – which may well be further away. It is important to understand that a lack of beds does not necessarily mean that there are not enough beds in the clinic, but also that there are not enough staff to look after the beds.
A shortage of skilled workers jeopardizes supply
The situation at Children’s Hospital I in Essen is by no means an isolated case. A survey by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) in February showed that only 65 percent of intensive care beds for children were in use on the survey date. 145 pediatric intensive care units were contacted for the survey, of which 91 responded. The reason for the bottlenecks in the care of critically ill children is the “glaring lack of care” and “acute illness absence”. The managing director of the Society of Children’s Hospitals
and children’s departments in Germany (GKIND), Bernhard Hoch, there are therefore more and more shaky candidates. By this he means children who, for capacity reasons, will continue to be cared for at home for the time being.
There is a shortage of skilled workers everywhere in Germany. But in hardly any other area is the shortage as great as in nursing. According to the Federal Employment Agency, vacant nursing positions remained unfilled for an average of 191 days last year. “We could definitely operate two or three more beds a day if we had the nursing staff,” says Felderhoff-Müser, referring to the two intensive care units at her clinic.
Pediatric nurse training abolished
For Hoch, the new nursing training is also to blame for the problem. In 2020, the previous vocational training in geriatric care, health and nursing and health and child nursing were merged. Since then there has only been generalist training, which makes it possible to work in all areas of care.
Since then, anyone who wants to specialize in the field of pediatrics can only do so by deepening their skills in the third year of training. “But this is offered far too little,” criticizes the pediatrician. The area of child and adolescent medicine actually requires more staff than other areas. Felderhoff-Müser also confirms this. To take blood from a three-year-old, three employees would be needed, says the doctor. It could happen that a five-year-old refuses to take off his sweater to listen to his chest. This requires significantly more time and patience than with adults.
The number of children’s hospitals is shrinking
According to Hoch, the shrinking number of facilities is another problem. According to him, in 2022 there were 326 departments or clinics for child and adolescent medicine in Germany. A good 30 years ago there were around 440. At the same time, the need is increasing: “We have many more chronic diseases and rare diseases,” says the GKIND managing director. In addition, the number of births in Germany has increased on average over the last ten years.
Only a few children’s hospitals manage to run the facility to cover their costs, says Hoch. The clinics would be paid based on performance. Due to the season, this means that the houses sometimes earn significantly less money in the summer than in the winter, when many children are sick. “We have great fear that some children’s hospitals will have to close or go bankrupt or that the hospital authorities will close departments,” says Hoch. That’s why he and Felderhoff-Müser are calling for basic financing security.
Emergency aid is intended to support children’s hospitals
Federal Health Minister Karl Lauterbach (SPD) has implemented several regulations that are intended to stabilize the care of children. A law passed at the end of 2022 stipulated that 300 million euros more would flow to children’s hospitals in 2023 and 2024. This is intended to guarantee the revenue volume of the pre-Corona period of 2019, even if clinics only achieve 80 percent of it. Financing should also become more independent of performance-oriented logic. According to a key points paper from the federal and state governments, the planned hospital reform should include the areas of pediatrics and obstetrics, among others, receive an “additional security surcharge”.
Highly criticized for the fact that, according to him, the emergency aid would benefit all clinics that had once cared for a child. This leaves less for the pure children’s departments. According to pediatrician Felderhoff-Müser, it also happens that the money is used to compensate for deficits instead of being used to create new positions or equipment.
Both doctors are convinced that society can no longer afford to endanger the care of children and young people. They are the future, says Felderhoff-Müser.