Proposition 52K0482

Proposition de résolution relative à un plan d'action en faveur de l'enfant hospitalisé.

General information ¶

Authors

Open Vld Yolande Avontroodt, Maggie De Block, Geert Versnick, Katia della Faille de Leverghem

Submission date

Nov. 29, 2007

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

child resolution of parliament paediatrics medical institution

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA LDD MR FN VB

Contact form ¶

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Discussion ¶

June 18, 2009 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, the Committee on Public Health has discussed this proposal by Mr. Avontroodt during its meetings on 3 and 31 March, 5 and 26 May and finally on 2 June.

Colleague Avontroodt explains her proposal. She points out that the problem of children in hospitals during the previous legislature became more interested by the publication of the report-Cannoodt-Casaer.

As early as 1986, the European Parliament adopted a resolution calling on Member States to implement the Charter that provided for specific standards for the care of children in hospitals.

As for our country, the Belgian pediatricians are pulling the alarm bell: there are too few pediatricians in our country. UNICEF also calls for special attention to the care of children in hospitals. In addition to adapted care, children need adequate social and educational guidance.

During the general discussion, Mr Otlet asks whether the healthcare budget can bear the costs of the proposals in the resolution. Colleague Lambert would like to know what efforts the government has already undertaken in this regard. Collega Schiltz asks how far it stands with the implementation of the Royal Decree of 13 June 2006 on the child care program.

The representative of the Minister of Social Affairs says that the problem of children in hospitals is one of the priority points of attention of the Minister. It summarizes a series of measures that have already been taken.

After these interventions, five amendments are submitted. The amendments are intended primarily to update the draft resolution and do not affect the essence of the text.

Collega Gerkens supports the proposal and also points out that the rights of a child in a hospital still deserve special attention.

The Minister points out the research that the FOD Public Health ordered during the previous legislature at the ULB and the University Hospital of Gent. The study focuses on hospital pediatrics and follows the publication of the recognition criteria of the child care program. The report provides numerous possible solutions to the problems faced by hospital practitioners. The proposed possibilities will be examined.

Finally, the Minister also lists the measures the government has already taken to address the shortage of hospital practitioners.

During the meeting of 26 May, the report will be presented by Professor Alain De Wever. The following aspects are addressed during his presentation: the financial impact of the measures, a comparison of hospital practitioners with other hospital specialties, the demographic situation with regard to pediatricians, the subspecialities and the recommendations and conclusions.

Then there will be an exchange of views with the members.

Collega Flahaux points out the feminization of the profession. Collega Avontroodt wants an update of the Cannoodt-Casaer study. Such an update could enable us to better evaluate the standards and criteria for the recognition of pediatric services.

She also points out that the study was mainly at the request of pediatricians and that the needs of the child are not central to the study. Collega Avontroodt would have preferred that these needs were part of the research. Mr Otlet agrees with this last observation. Collega Gerkens states that it is noticeable how much the pediatricians evolve into doctors with general competences.

Following this, colleague Avontroodt believes that family doctors should receive a better education in pediatrics. It therefore also asks whether there is no need for a specific RIZIV nomenclature for pediatric care provided by general practitioners.

Professor De Wever points out that indeed a lot of female pediatricians choose a more limited activity that focuses primarily on outpatient care. In fact, pediatricians also take over a portion of the clientele of the family doctor.

Many international scientific studies show that female doctors spend more time with their patients, and especially with children. That time is used to solve psychosocial problems.

The speaker thus considers that an update of the report may be useful. He also points out that the income of pediatricians in Belgium is too low. When asked by colleague Avontroodt whether there is a comparison with wages in other countries, he answers negatively.

Collega Goutry argues that the standards proposed in the report are not adapted to an area such as West Flanders. After all, in this densely populated area, it is possible that the department of pediatric medicine does not meet those standards. However, the speaker believes that childcare is a basic service of a hospital.

Together with colleague Otlet, he therefore asks for an estimate of the gross annual income that the pediatricians would find fair. According to Professor De Wever, this is a gross annual income of 200,000 euros.

Several amendments are then discussed and adopted unanimously. The whole amended draft resolution is therefore unanimously adopted by the committee.

Mrs. Speaker, I thank you for your report. I give the word to M. Otlet in the general discussion.

Mr. Speaker, dear colleagues, the draft resolution that is submitted to us today, calling for an action plan in favour of the hospitalized child, is intended to complement the text presented two weeks ago by our colleague Florence Reuter on pediatric care at home.

Both texts find their origin in the Charter of the Hospitalized Child. Without referring here to all the points contained in this Charter, it seems to me essential to highlight a few of them:

Children have the right to have their parents with them.

Children and their parents have the right to be informed.

Children have the right to be cared for with children of the same age group.

Children have the right to have the opportunity to play, to have fun and to enjoy normal education.

Children have the right to be cared for by staff specially trained for this purpose.

During our work and our hearings, it has become clear that the Charter of the Hospitalized Child is not applied in the same way everywhere in our hospitals and that the means available to do so are still clearly insufficient. A precise assessment of the application of this Charter in Belgian hospitals is therefore necessary and must be carried out with the collaboration of the federal entities.

Furthermore, the study conducted by Professor De Wever and his team on the specialty in pediatrics and its future clearly demonstrated that pediatric doctors were the specialized practitioners with the lowest incomes and that their benefits must imperatively be revalued, both in the hospital, through surveillance fees, consultations and in particular in the day hospital and emergency room.

Without such consideration of this medical specialty, we will continue to experience great difficulties in recruiting pediatricians in our hospitals.

While it is rich in teachings relating to the vision of the medical body and pediatricians in particular, this study was not intended to parallelly analyze the needs for pediatric hospital care. Also, in order to objectively complement our observation on this medical discipline, we ask the Government to update the Cannoodt-Casaer study, conducted at the KUL in 2002 on the acceptance of pediatrics from the perspective of patients and their families, the possible adaptation of the standards of approval, the criteria for programming of hospital and pediatric beds as well as on the funding rules adapted to this medical discipline.

First and foremost, I would like to thank our reporter.

Subsequently, in order to please Mr Annemans, we submit another resolution to the Chamber. I remember your words, Mr. Annemans. You said that these are all things that you cannot oppose. That’s why I just asked your colleague if you might vote for the change and he confirmed it to me.

Colleagues, however universal the rights of the child – they have been recognised for a decade – in practice they are still not fully fulfilled. It happens step by step. I ask your attention for the resolution, but I will not repeat everything that colleagues Otlet and della Faille have already said. Children’s rights are not so easy to fulfill. There is each Charter. This is a charter that has been approved by the European Union and which clearly sets out the rights of children in the hospital.

In the resolution, we ask for an evaluation. I think the report will show a lot of gaps if the administration needs to evaluate the rights of the child in hospitals. This is also the case in our country. However, we have a tradition in this area and we are blessed with good health care. We ask for an evaluation. It is up to us, to the Parliament, if the text is approved, to follow up on the dossier, of course. It is up to the Government and the Minister to provide the necessary resources for this.

Many steps have already been taken. Since 2006, there has been the care program pediatrics, which included a number of quality requirements. It was clear, both during the discussion and during the hearing, that some of those elements were not completed at all or cannot be completed. For instance, in the care program pediatrics calls for attention to the pediatric nurses. Those who know the field know that the pediatric nurses today still do not receive full recognition and ⁇ are not yet sufficient in number. Psychological support and educational capabilities are elements that must be completed not only theoretically, but also effectively in practice.

The shortage of pediatricians has already been explained in detail by both colleague della Faille and colleague Otlet, but it will be even more striking if the standards that have been set up until today... I know that some colleagues in our Parliament are also involved and also looking for solutions, on the one hand to be able to meet the quality standards, but on the other hand to keep their department alive and to be able to deploy enough people. Hence, the shortage of hospital pediatricians has absolutely remained in the resolution, although initially it was thought that this would not be necessary because there are more pediatricians. However, that greater number of pediatricians works less, because different pediatricians have fewer than a thousand patient contacts per year.

The listing within the cadastre for the doctors-specialists is therefore absolutely necessary.

Professor Alain De Wever has very clearly demonstrated the relative loss of income by fewer hospitalizations. But, colleagues, if you were to know how much the supervision fee for a pediatrician for a sick child after the fourth day... Well, that’s scary. It is still not 10 euros for a supervision of a sick child.

I think everyone can understand that monitoring a sick child does not happen in two minutes, or even in ten minutes. This is not measured in time. It must be able to generate adequate quality.

The compensation for the reduced supervisory fees could ultimately come solely – and also in the best interests of the child – through the official introduction of the daily hospitalization for children and the provisional hospitalization with additional supervisory fees.

Mr. Speaker, I would like to conclude with what Mrs. della Faille said. No matter how extensive the questioning and questioning of the Belgian pediatricians has been, it is shocking that there has been zero komma zero interest or zero komma zero demand for an increase or for a support of the hospital pediatrics.

There is a resolution ahead of us that we will soon be able to discuss extensively in our committee. This resolution clearly shows the difficulties in child psychiatry.

I have been active in parliament for 14 years. It is exactly fourteen years ago that I, at that time still in the Flemish Parliament, called for attention to child psychiatry. I then asked for broader support as well as for a better alignment of and alignment with the special youth care, then a competence of the Communities.

Curiously, we are now almost daily confronted with new needs and with even longer waiting lists for children and young people who cannot be accommodated. There is an increasing need to understand violence. There are also international networks. However, no one has allocated all the necessary resources for this.

The College of Pediatrics has not actually started yet, although we thought it was already working. This is not the case. Following the advice of the Belgian Academy of Pediatrics on its composition, it is absolutely necessary that there is also a college for child and youth psychiatry.

Mr. Speaker, colleagues, I thank you for your attention. There is only one action item on the agenda of the plenary session today. However, anyone who has ever had to have their child or grandson hospitalized and cared for will remember the positive support that was given to them.

This should be the second or third time we speak in a plenary session on the theme of "health for the benefit of children". There should still be before the holidays, normally, a last session.

Indeed, the Health Commission has become aware of the paradox facing pediatric care, both in the intra and extra-hospital environment. Indeed, on the one hand, there is a willingness to take good care of children, to devote many resources to them, to provide them with the most suitable and competent people and services but, on the other hand, we must be aware of our limits when it comes to realizing these goals given the needs of infrastructure, personnel and structures to be set up internally by hospitals to organize services and address the concerns of those who want to defend the health and rights of these children.

The work we have begun will logically have heavy consequences to assume, but not impossible, requiring a political will regularly expressed by the commission. The committee wishes to affirm the importance of giving each other the means to meet our obligations in terms of rights arising from the ratification of conventions aimed at respecting the rights of patients, therefore also children. We will therefore have to adjust the budgets, but also the practices, even if it might work otherwise.

Another element highlighted during our work is the need to rethink hospital work in connection with what is possible to accomplish at home, in nearby care; it will probably be appropriate to distribute the resources both financial, skills and care providers in a different way.

With regard to this resolution on hospital care for children, I wanted to intervene specifically today to speak, like Ms Avontroodt, of my amazement to have heard Professor De Wever speak about the study on pediatricians, commissioned by pediatricians: although it was carried out in this context, she did not raise the question of whether pediatricians have a recognised additional useful place in all the providers of care in order to present a medical offer that best meets the needs.

We were already aware of the shortage of doctors choosing the specialization of pediatricians. It is mostly visible in hospitals and is the result of the lack of appreciation of the services of pediatricians, and in particular of their obligation to fulfill a custody function in hospitals for the benefit of children. This problem has been identified for a long time, and we know that it needs to be addressed. But it is also related to the development of services of certain offices outside hospitals, in which the pediatrician increasingly imagines himself as a general physician in the service of children.

What is the role of pediatric specialists? Should they intervene to treat pathologies that are ⁇ difficult and that some children are carriers of? Or is it considered that a child patient should automatically use the services of a pediatrician?

The study in question also shows that these pediatricians imagine themselves in the role of the generalist for children, but refuse to assume the unpleasant aspects, that is, to provide guards, so work after 18:00 and during the weekend.

We are facing a larger task that should also start within the committee and which will consist of reviewing the medical offer. It will be a question of what role the policy could play in establishing tools for regulating the supply of medical care that would be more efficient and that would take into account the needs of patients, the evolution of pathologies and an indispensable combination between the intra- and extra-hospital environments, so that these health actors are complementary and not competing.

Finally, I will allow myself to insist on one dimension of this resolution that we will soon deepen in committee and which relates to the services and care of pediatric psychiatry. We know that there is a need to improve services and infrastructure, the skills of staff for children, the intra and extra-hospital, the respect for the rights of patients, children and parents – which are sometimes contradictory in the facts. To this end, we will need to review the regulation of supply and the organization of child care for the benefit of children.

Madame Avontroodt, I wanted to thank you for your resolution that we will support knowing that it is part of a set of resolutions that we address to the government and that will require means and political will.