Emergency departments in smaller hospitals in Latvia’s regions must definitely be preserved so that they are always accessible to people and function in reality, Health Minister Hosams Abu Meri (New Unity) said in an interview with Latvian Television’s program Rīta panorāma.
At the same time, specialist positions that in smaller hospitals are currently filled only “on paper” may be eliminated so as not to mislead patients, according to the minister’s remarks.
“Sometimes patients write on social networks that they were at a certain hospital but could not receive the service when they needed it,” Abu Meri admitted, referring to the problem of doctor positions that sometimes exist only “on paper.”
He pointed out that hospitals must not create a situation in which patients are given the impression that a service is available when, in fact, it is not. However, the most important thing, he said, is that every hospital must have accessible emergency and urgent medical assistance.
The minister emphasized that it is very important to maintain the accessibility of hospitals
for all residents of Latvia. As examples, he mentioned Balvi, Gulbene, and Alūksne. Moreover, when planning the hospital network, it is also necessary to take into account factors that are harder to notice from the outside, such as the military’s plans and the proximity of military bases.
As reported, the Ministry of Health (MoH) plans to submit for public consultation this month an informative report on the planned changes to the hospital network, said Sanita Janka, Director of the Health Care Department at the MoH, during a meeting of the Health and Social Affairs Committee of the Latvian Association of Local and Regional Governments (LPS).
She emphasized that the MoH does not plan to close any hospitals and that no decision has yet been made regarding any particular hospital. The ministry is evaluating which mandatory profiles each hospital will be able to provide. The network of emergency medical and patient admission departments, as well as inpatient health care service profiles, is being reviewed. It is planned to establish requirements for inpatient health care services. Possible models of cooperation networks between hospitals are being assessed, and the financing model is being revised.
Janka said that, at present,
the MoH has made the most progress in defining requirements for maternity departments.
The ministry has held joint meetings with hospitals and reached agreements on the requirements. It is planned to set requirements for two types of maternity departments — those for normal deliveries and those for premature births, where perinatal care centers are necessary.
Speaking about possible models of hospital cooperation networks, Janka stressed that they would be in the interests of patients. A patient who has received highly qualified assistance could continue recovery at another hospital closer to their place of residence.
Janka explained that the MoH is strictly analyzing both the human resources available in hospitals and their technical equipment, as well as data on patient flow. It is planned that an emergency medical service (EMS) brigade should be able to reach a hospital within one hour.
Since last year, a pilot project on patient transportation has been implemented.
Its main objectives were to ensure that patients receive help closer to their place of residence — for example, that a patient from Limbaži would not have to be taken to Riga just to have an X-ray and find out that they only have a head bruise, Janka noted.
As a result, the distances and travel times for EMS brigades to medical institutions would be reduced. In addition, by taking patients to first-level hospitals, higher-level medical institutions would not be overloaded.
However, the practice of the pilot project revealed that EMS brigades have to deal with situations where examinations or specialists are unavailable. The highest number of refusals to admit EMS patients was received from lower-level hospitals. In 47.3% of cases, patients were transferred to fourth-level hospitals, and in 31.9% of cases to fifth-level hospitals. There have even been cases when a patient is not admitted to the emergency department but is redirected to another hospital, Janka pointed out.
The pilot project concluded that, on average,
an EMS brigade delivers one patient every five days to a first-level hospital.
Speaking about this pilot project, Janka admitted that the idea was good, but in practice it did not materialize as the MoH had hoped. There were several aspects that the ministry could not foresee, as every year the flow of so-called “walk-in” patients in hospitals has increased. In Riga, this happens more often in the evenings and at night, while in the regions it is up to around 10 p.m. These “walk-ins” are mostly primary health care patients, who overload large university hospitals.
The results of the pilot project are one of the reasons why the MoH must evaluate and determine where to maintain emergency departments, where to have urgent care points where assistance can be provided 24 hours a day, where there will be a doctor and medical staff available, and where examinations, X-rays, laboratory tests, electrocardiograms, and ultrasounds will be accessible.
According to the MoH’s plans, an informative report will be submitted to the government for public consultation in October of this year. In June of next year, the inpatient service profiles and their requirements are to be reviewed and established. Hospitals will be given one year to implement the requirements. In January 2027, the established requirements for hospitals are expected to come into force. In 2028, the inpatient health care service profiles will be evaluated and refined. From January 2029, the inpatient service profiles and changes to the hospital network will be reassessed.
Representatives of municipalities expressed concern about
how patients who will be taken to more distant hospitals will be able to return home,
since these plans are not coordinated with the availability of public transport services. The Ministry of Health expressed hope that municipalities could provide transport for residents to return home from hospitals.
As reported earlier, at the beginning of October, during a meeting of the Saeima’s Social and Labour Affairs Committee, the MoH presented a plan to merge hospitals of various profiles and levels into ecosystems.
Members of parliament and sector specialists discussed the State Audit Office’s audit of inpatient health care entitled “Is Inpatient Health Care Planned and Organized Effectively?”
The MoH also informed that its vision for health care management foresees the creation of hospital ecosystems.
In the mental health ecosystem, there would be the National Mental Health Center, Daugavpils Psychoneurological Hospital, Ģintermuiža Hospital, Piejūra Hospital, and Strenči Psychoneurological Hospital.
In the children’s health system,
it would be possible to unite the Children’s Clinical University Hospital, Adolescent Resource Centers,
and the Ainaži Children’s Psychoneurological Hospital.
The ecosystem of Pauls Stradiņš Clinical University Hospital would include traumatology, chronic patient care, and a repurposed Riga 2nd Hospital. This ecosystem would also include the hospitals of Liepāja, Ventspils, and Jelgava, as well as third-level hospitals.
The ecosystem of Riga East Clinical University Hospital would include maternity care, traumatology, and home care services. It would also include hospitals in Daugavpils, Rēzekne, Jēkabpils, Vidzeme, and other third-level hospitals.
Meanwhile, the specialization of second- and first-level hospitals would include trauma care points, day hospital services, and palliative care.
The MoH plan stipulates that
emergency assistance, palliative care, and outpatient care should be available closest to one’s place of residence.
Therapy and nursing services should also be provided nearby, while specialized assistance should be received further away.
No specific changes to the hospital network or the range of services were mentioned by the MoH at the meeting.
At the same time, deputies were informed that the MoH plans to review the network of emergency and patient admission departments and to reassess the inpatient health care service profiles. It is also planned to establish requirements for inpatient health care services and to review the financing model.
State Auditor Edgars Korčagins stated at the meeting that the State Audit Office does not recommend where specific services should be provided, as that is determined by policymakers. However, he urged the evaluation of the hospital network so that in five years it will not again turn out that services are available “only on paper” and in visions.
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