The Great Healthcare Debate: Wouter Beke (CD&V) versus John Crombez (Vooruit)

“Too many people – including the elderly and children – do not receive the care they deserve. Flanders really needs to do better.” Today is the Day of Care and so we are organizing a debate about this beautiful, but beleaguered sector. On one side of the table: former minister Wouter Beke (CD&V). On the other hand: John Crombez (Vooruit), once the biggest critic of the policy.

Wouter Beke resigned as Flemish Minister of Welfare in May last year. De Limburger returned to the federal parliament. John Crombez, in turn, left politics for academia three years ago. The West Fleming teaches and conducts research into our health care. Although the two men are of the same generation, they are very different in character. In short: Beke lets the head speak, Crombez the heart. The first is cautious, the second one you-me-and-faultist . They share one thing: a great commitment to our care.

Six years ago you sounded the alarm in this newspaper, Mr Crombez. “Care is failing like never before,” you said. How is the situation today?

Crombez : “Certainly not better. We have seen in corona what achievements our carers are capable of. Phenomenal. But the policy is certainly no better. Look at the numbers. The waiting lists for people with disabilities: sometimes up to twenty years! The same for youth care and other domains: waiting lists everywhere. So I have to sound the alarm again. Too many people – including the elderly and children – do not receive the care they deserve. A rich region like Flanders really needs to do better.”

Is that a reference to CD&V that has been supplying the competent minister for twenty years?

Beke : “Oh, are we going to start like this? ( laughs )”

Crombez : “That is one of those responsible. But it is more general than one party. Too often, when a problem surfaces, our response is either more money or more efficiency. But maybe we should rethink the system? It should be self-evident that people in a rich region receive good care, but Flanders apparently fails to do so. Why is it like that?”

Beke : “Budgets are important. This Flemish government has increased the budget for welfare by 28 percent. The waiting lists for the people with the greatest care needs have therefore virtually been resolved. I do agree that we need to think about a different organization of our care. I think we need to make a shift from care that replaces the family to care that supports the family.”

Crombez : “( nods ) And we have to work much more preventively. In many cases you can prevent people from needing care.”

Beke : “But what I propose requires a different way of thinking and financing.”

What would you call the biggest challenge for our care today, Mr Beke?

Beke : “That ties in with that. As we all get older, care needs will increase. To be ready for this, we must organize our care differently: the focus must be shifted from facilities and institutions to people’s home environment. That is why, as a minister, I have focused so hard on neighbourhood-oriented care and caring neighbourhoods. These must become the starting point of a new model.”

Crombez : “( nods ) Otherwise it becomes priceless. If we want to offer the same care for the next twenty years, the budget would have to be increased by twenty percent. This is evident from research I am doing. Let’s be honest: it won’t work. So we have to change the system.”

Beke : “Today there are people in psychiatry who shouldn’t be there, but meanwhile take the place of people who do belong there. The institutions are therefore still necessary, but they should not always be the only solution.”

Is it not an illusion to think that we will ever get rid of all waiting lists?

Beke : “That is a wrong question. The question is: how do we ensure that as many people as possible receive the right care? That is not to say that everyone should get a personal budget. That would be priceless anyway. Sometimes, for example, better home care or care in a day center can also be solutions.”

Crombez : “But as a wealthy region, we cannot accept these waiting lists, Wouter. ( emphasizes ) Point. We do indeed need a system change and home care is certainly a nice ideal, but what good is that if the carers don’t have five minutes to listen to the people? We ask way too much of them. They haven’t arrived yet, or they have to look at their watch again to get to the next place in time. Then you overshoot your target.”

Beke : “Of course. But the goal must be: getting healthcare closer to the people. Hence: less residential care, more outpatient care. That is the challenge.”

What do you think is the biggest challenge, Mr Crombez?

Crombez : “Obviously there are a lot of them, but I am going to mention something that can make a big profit in the short term. Carers today have to spend 20 to 25 percent of their time on administration. That shouldn’t be. ( on a roll ) Stop that. Dare to finally trust those people. Judge them by the care they provide, not the papers they fill out. If you halve that planning burden, you free up ten percent extra time for care and it won’t cost you a penny.”

Beke : “It’s good that you mention that, but tell that to parliament. As Minister of Welfare you are bombarded with questions about incidents here and there, why don’t you do this, why don’t you do that. As if every incident can be prevented with new rules and procedures. That indeed ensures that the people in the field do not feel confident. ( quiet for a moment ) Those who work in healthcare work with people, and there are risks involved. You have to be able to accept that people sometimes make errors of judgment. Otherwise we will go to American states.”

Crombez : “( picks up ) The legalization of healthcare has gone completely over there. Do you know what that costs them? $55 billion every year. I hope we don’t go that route. If something goes wrong in a youth institution, it is therefore not a bad youth institution. There is simply too much pressure on the people who work there.”

This week, harrowing stories surfaced about abuses in private residential care centers: tying people up, moldy bread, … How is that possible?

Crombez : “That is something else. Do you remember why I was so angry six years ago? Because terrible stories came up from youth services. Today we see these things in the residential care centers. We are of course talking about large private players such as Orpea. They are not dealt with strictly enough by the government.”

Beke : “Who organizes the care should not matter. The government must always and everywhere monitor and enforce quality. That also happens. The fact that some players are under increased surveillance is proof that enforcement works. The reports on our residential care centers have also been made much more transparent. I realized that when I was a minister.”

Crombez : “I don’t agree with that. Those who fail to do so should receive a severe penalty. That happens far too little. Simply placing it under guardianship is far too non-committal. Because what are they risking now? Little or nothing. But in the meantime they do pay out hundreds of millions of euros to their shareholders.”

Mr Beke resigned as minister after abuses in childcare. Did you think that was right, Mr Crombez?

Crombez : “Yes, I am still of that generation that believes that a minister should take responsibility when serious facts happen, even if he is not personally to blame. A baby died then, didn’t it? It doesn’t get much heavier. If he had stayed put, he would have lost a lot of strength.”

Beke : “That is well worded. I would not have enough weight to carry through those things that I wanted to carry through. Note: it was with mixed feelings, mind you. I would have liked to have done a lot more, about the caring neighbourhoods, for example.”

Crombez : “Only: something appears to be fundamentally wrong in childcare, because even after your dismissal, things have come up that cannot be done. Of course it only concerns a small part of childcare, but still. I think the alarm bells should go off much faster.”

Beke : “There has been a committee of inquiry and it has drawn up recommendations. My successor Hilde Crevits is carrying it out.”

Yet you do not let go of the concern, Mr Beke. You recently made a remarkable plea for complete regionalization of health care. Would that be a step forward, Mr Crombez?

Crombez : “No. I do understand why politicians advocate this: it is an easy excuse if something goes wrong. But a smaller scale will not lead to better care.”

Beke : “I tend to disagree. Neighboring countries such as Germany and the Netherlands also organize their health care on a smaller scale. The complex structure of our state prevents good policy. ( delicately ) I will otherwise use an argument from John himself to support my view. A good preventive policy reduces social security expenditure, but why would Flanders spend money on prevention if the benefits are for the federal government?”

Crombez : “( laughs ) That’s the reasoning politicians make, but I don’t approve of that at all. A difficult structure should not stand in the way of good policy. The ministers should make better agreements.”

Beke : “( brighter ) But that also happens. See the preventive screening for SMA, baby Pia’s disease. Flanders and the federal have decided that together. I could give dozens of examples. But it takes a lot of time and in some areas it just doesn’t work. That’s the reality. There are rehabilitation hospitals in Flanders, but not in Wallonia. How can you then jointly implement a policy on this?”

Crombez : “I am not against state reform – I have participated in it in the past – but I too often find it an excuse not to do anything.”

Finally, let’s look at the pennies. Do we as a society spend enough money on our care?

Crombez : “No. Belgium spends about ten percent of its GDP ( gross domestic product, ed. ) to care in a broad sense. That will increase to twelve percent. But again, that won’t solve everything. Above all, we must do better with the existing resources. By the way, did you know that America is the country that spends the most resources on healthcare? No less than seventeen percent of GDP. But in terms of results, America scores very low.”

Beke : “Flanders spends about one third of its budget on Welfare ( 16 billion euros, ed. ). That’s historically a lot. The problem is at Belgian level. If you want to invest more resources in healthcare, you must have a healthy budget. Unfortunately, this week we again received ominous forecasts about the federal budget. This will have consequences for healthcare. For example, the growth rate of health care will drop from 2.5 percent to 2 percent next year. That is also why I say: get this cuckoo egg from the Belgian basket.”

Crombez : “When it comes to spending and returns, Asian countries such as South Korea and Singapore are becoming the best examples. If an apartment block is built there, the center of each floor will be set up as a care unit. At least that is forward-looking policy. That is something I have to take with me to Ostend. ( laughs )”