Spital Uster and Affoltern do not have to close

The Zurich Health Department had put the knife to the neck of three hospitals. That was six months ago. The government council has now made its final decision on the Zurich hospital list. In two cases he has relieved the pressure, in one case he remains firm.

It was a real shock for the hospitals concerned when the health department announced its decision in mid-March: The Uster hospital only receives provisional performance orders, and in three years it has to prove, among other things, that it can get its finances back on track. She was even stricter with the Affoltern hospital and the Dielsdorf Adus clinic. The Health Directorate wanted to finally withdraw the service contracts from both of them, Affoltern for three years, and the Adus Clinic even at the end of the year.

For a hospital, not receiving any more service orders from the canton is tantamount to closing it. Because without state contributions it is not possible.

Uster and Affoltern «sustainable»

So the situation for the three hospitals was serious, but not yet hopeless. Because the government council decides on the hospital list. First of all, a consultation took place, in which the hospitals themselves as well as politicians and the population could have their say. The cantonal government has now made its decision based on this feedback. And this is gratifying for Uster and Affoltern.

As Health Director Natalie Rickli told the media on Thursday, Uster Hospital will now definitely receive the performance mandates for the next ten years. However, they are only granted on condition that the hospital proves sustainable cost efficiency and economic stability by May 31, 2025.

Rickli explained that those responsible at the Uster hospital had dealt intensively with the future direction and had in the meantime submitted a new care concept. The government council supports the planned future conversion of hospital structures to more outpatient and medium-term reduced inpatient services as well as a focus on basic and emergency care in the region and integrated care in the field of geriatric medicine. «In addition, those responsible for the hospital are working with great commitment to improve cost efficiency. The 2022 half-year results show some improvements compared to previous figures.”

The Affoltern hospital developed a “sustainable” concept in close coordination with the health department, as Rickli said. In the future, the hospital will focus on the areas of geriatric and palliative medicine, in which it has been very successful in recent years. In return, it dispenses with comprehensive basic inpatient care. In concrete terms, this means that the surgical offer will be discontinued at the end of the year. The field of internal medicine will continue to be inpatient until the end of 2025 and then primarily on an outpatient basis. For the new focus areas, the hospital now receives the service orders definitively, for the others provisionally.

Things are not looking so good for the operators of the Adus Clinic. The small hospital definitely no longer receives the performance orders. According to Rickli, the consultation did not bring any new facts to light. The clinic in Dielsdorf does not achieve a role that is relevant to the care of the canton’s population in any of the service areas offered.

Those responsible for the hospital and local politicians had argued that the hospital met the requirements in all important points, for example in terms of quality and cost-effectiveness. Nevertheless, the government council removes the clinic from the hospital list because the surrounding clinics can also offer the selective offer. In order to be able to complete ongoing treatments and find a follow-up solution for the 40 employees, the Adus-Klinik will now receive provisional performance orders until the end of 2023. After that, it will be over in Dielsdorf.

Rehabilitation Clinic Wald will remain for the time being

As Rickli said at the beginning, a ten-year hospital plan must also take future developments into account. This would not only include the rising costs of healthcare, but also demographic change – “that is the gratifying fact that we are all getting older”. However, this means that older people would often suffer from several diseases at the same time.

In terms of a holistic view of health care, according to Rickli, the goal is to shift from the inpatient to the outpatient area. The focus is on integrated care. This includes the structured and binding cooperation of various service providers and professions throughout the treatment path.

Supply at one location serves this goal, Rickli continued. The physical proximity simplifies medical cooperation and is also advantageous for patients and their relatives. In the field of rehabilitation in particular, in which the health department expects a particularly significant increase in demand, it considers physical proximity to be particularly relevant. The expansion of the range of care close to home was also welcomed by the majority in the consultation, said the Zurich health director.

The Wald Clinic of the Zurich Rehabilitation Centers is given the service contracts for an indefinite period. In the short to medium term, however, the clinic management sees opportunities to relocate the services provided in Wald to locations close to home that are close to acute hospitals. Specifically, the Zurich rehabilitation centers are planning to move neurorehabilitation to the Wetzikon hospital with mandatory monitoring. In the medium term, there are plans to relocate further services to central locations in the Zurich Oberland, for example to Uster. According to Rickli, it is not possible to say at this point in time whether the Wald rehabilitation clinic will one day be given up.

According to the hospital list 2023, the Zurich City Hospital can now definitely expand the offers at Waid and Triemli in favor of rehabilitation close to home. The Limmattal rehabilitation clinic will be able to start operating neurological rehabilitation in the course of 2023. However, the Winterthur rehabilitation clinic no longer receives any service contracts. And the Kilchberg rehabilitation clinic has to stop operating. The rehabilitation clinic is granted a transitional period so that it can be properly shut down and the staff transferred to the Limmattal site. She will receive individual performance orders up to the end of 2023 at the latest.

Adus Clinic plans complaint

The private clinic Hohenegg now has a place on the list for selected services in the field of adult psychiatry. According to Rickli, the awarding of service contracts to Clienia Littenheid AG for a new location in the field of child and adolescent psychiatry in Oetwil am See also ensures that inpatient care is tailored to the needs of this age group.

Based on the realignment of the Affoltern Hospital, the Affoltern Center for Psychiatry and Psychotherapy has adjusted its application and received the corresponding performance mandates. To complete the offer, the service provider will in future also offer gerontopsychiatric services including the treatment of dementia and delirium.

The two hospitals in Uster and Affoltern reacted with great pleasure to the definitive list of hospitals on Thursday. The Adus Clinic was disappointed but not surprised. Their specialized offers in the fields of orthopedics are effective, appropriate and economical. You will therefore proceed with a complaint against the decision, according to a press release.