“Treatment is a matter of national concern”

The expert for digitalization of the medical system, Jochen A. Werner, is an otolaryngologist who specializes in cancers of the oral cavity, pharynx and larynx. Since 2015, the 63-year-old has been medical director and president of the Essen University Hospital; even before that he was medical director of the university hospital Gießen and Marburg GmbH.

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Mr. Werner, how is your hospital? What is the current situation?

Professor Jochen A Werner: Of course, we are still struggling with the pandemic. As of April 26, we had a total of 61 hospitalized patients who tested positive for Sars CoV2, 16 of them in intensive care units. Of these, perhaps 35 to 40 percent are manifestly sick with Covid 19. The remaining diagnoses are incidental findings or secondary diagnoses in patients who come to us for a completely different disease. However, we must take special care of them, as they pose a potential risk of infection for other patients and for employees.

The other story is that in the current situation we also have patients from Ukraine. These are, for example, children and young people who come to us for cancer therapy that they cannot receive in their country of origin, or victims of isolated wars. For the most part, however, we naturally have a very active patient care operation, which is actually functioning undisturbed at the moment. At the moment we have enough employees on board again and we don’t have to close down entire areas.

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How do the Ukrainians get to you? Are there still medical flights ordered, for example for children in need of cancer treatment? How do the wounded reach them? Do you have to imagine it in such a way that people have a hard time? Or is there still regular medical traffic?

It is very organized at the moment. classic medical transport, by bus, train or plane. In Germany, we regularly treat the vast majority of patients with certain eye cancers, especially children. That is why Ukrainian patients come here specifically, through organizations or sometimes on their own initiative. And the war wounded arrive through aid initiatives or directly through the so-called four-leaf clover system. This will be announced in advance. We have a contact person here, or even two, for adults and children. If in doubt, we will be asked quickly and patients will be transported here in a targeted manner.

How many patients from Ukraine do you currently have? And how many of them are oncology or seriously injured in the war?

We currently care for 31 children, 27 of whom have a clinical oncological picture, two mine victims and two children with other diseases. There are also about 20 adults with various diseases without a particular focus.

In addition to the bleak state of digitalization, you particularly lamented the lack of nursing staff and beds during the pandemic. Have you noticed any improvements following the measures taken by the new federal government?

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The whole topic of the cure is a huge topic in itself. And it’s something that has really been on our mind for a long, long time. So even now. We try to compensate for this every day. But you have to be realistic: the shortage of nurses has accumulated and consolidated in Germany over a long period of time. It will also take many years to solve this great challenge. At the same time, it must be stressed again and again that cure is not just cure. You simply cannot equate geriatric therapy with intensive care, nor with the neonatal nurse. In addition to the all-encompassing “health emergency”, we also have our absolutely central digital issue, where everything is exactly the same as before. I myself am curious to see where the journey with the new government will lead.

Professor Jochen A. Werner, Medical Director of the University Hospital of Essen.

Healthcare is in a transition phase.

Health insurance companies are actually a very good indicator of the ability to finance a health care system. In 2018, there was still a surplus of € 2 billion. In 2021, just three years later, this turned into a deficit of € 5.8 billion. We still have this huge number of hospitals. This is the only point. Funding for all of these hospitals will reach us. We have addressed the shortage of nurses. In too many hospitals we do not employ nurses efficiently because the facility is too fragmented and we cannot use economies of scale. And on the subject of sustainability: every single hospital also has a negative impact on the environment. This is one of the reasons why it cannot be left as it is now. And that is why there is no doubt in my mind that we need fundamental structural change. Delayed closures of hospitals must be pursued, but not the responsibility of the district administrator with his 140-bed clinic. We need concepts at the national level, we need a strategy because we cannot remain in this current state.

There is no reason for all of us to celebrate again the fact that a fax or two were turned off during the pandemic.

Are you worried that after the serious situation of Covid and the focus on Ukraine, the health reform will be rejected?

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I am very worried about this. The fact is that even during the pandemic some hospitals survived thanks to allowances or other benefits. We are now gradually returning to normal operation. And now we need to make sure that this reform, especially digitization, does not completely subside. The pandemic hasn’t done much good. In any case, there is no reason to celebrate all of us again that one or the other fax was turned off during the pandemic or that the DIVI registry is working. These are the right first steps on a very long road. When it comes to reforms, we need an active control process, not coincidences caused by arbitrary cash flows. I’m not that optimistic when I think about the consequences of the war.

Is there some kind of priority list?

The fact remains that we must significantly develop the issue of digitization as a basis for modern and affordable medicine. We need to question and optimize our processes. And if possible, we need to support them digitally. The second problem is the staff. We are talking about a shortage of skilled workers and we need to be careful not to mention a general shortage of workers at some point. There is also the very complex issue of cure. This is a matter of national concern. This also includes developments such as temporary workers or nursing staff from abroad. Once again we talk about the consequences we have to endure due to too late reactions to a shortage that has been looming on the horizon for decades.

This bottleneck situation hits university hospitals particularly hard, but not because they have less efficient staff than many non-university hospitals. The reverse is the case. As University Medicine Essen, we rely on the PbUGV (Nursing Staff Lower Limit Ordinance, Red.) better than many other hospitals. The problem is that university hospitals have to deal with a portfolio of tasks that does not tolerate interruptions. University clinics are not only training centers for doctors, they are not only the institution from which many primary doctors come, they are not only beacons of every federal state, but they are also engines of innovation of German medicine, the custodian of the most complex medicine ( eg transplant medicine) and for many seriously ill patients the last hope of saving their lives. When funds are scarce, the university hospital system is also put under pressure, with the severe effects mentioned.

You once said that we put data protection above health protection and that data protection is a kind of sacred cow in the country. But now, in these times of war, it is evident that sacred cows can apparently be slaughtered after all, if you look at the topic of arms deliveries, for example. Under pressure, reforms suddenly become realistic.

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Right. We just didn’t do it during the pandemic. The Corona alert app was a defining moment and also a symbol of mis-prioritization. Warnapp was unable to develop its potential for various reasons, but also due to exaggerated data protection. Data protection was not relaxed, although it was discussed at the time. But this showed how high the data protection hurdle in Germany is. That is why I am quite skeptical of if and when this relaxation will come. I have heard from politicians who have recognized the problem and are considering what consumer and patient-friendly data protection could be. But it’s not just a story for the Ministry of Health, the Ministry of Justice is also involved. With that in mind, I’m thrilled to see if that happens. It is clear to me that it must be about ensuring that patients have the right to use their data. Because if their data cannot be used properly, then it could be that people have to suffer, possibly even premature death.

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