The petitioner shall: Ministry of Health of the Slovak Republic
Name of the petition:
–Petition for maintaining and categorizing Liptovský Mikuláš Hospital in level II in the framework of optimisation of the hospital network–
Text:
We, inhabitants of the Liptov region and citizens of the Slovak Republic ask the Ministry of Health of the Slovak Republic.

  1. Maintain the hospital Liptovský Mikuláš with the provision of healthcare within the optimisation of the network of hospitals in category II.
  2. To amend Law 540/2021, extend the deadline until 31.12.2023 Paragraph 45 paragraph 7 of the submission of the list of classifications of hospitals, for reasons of approval of Law 540/2021, without processing a quality analysis of the economic and social impacts of the planned optimisation of the hospital network for the development of the regions, taking into account the less accessible regions.
  3. We strongly disagree with the inclusion of our Liptov Hospital in Level 1 for these reasons.

It's quare: No.
Number of persons supporting the petition: 14 639 persons on 312 signing sheets in documentary form and 517 sheets in electronic form
Date of delivery: 21.12.2022
Date of equipment: 31.01.2023
Equipment: § 5 (6) of Law No 85/1990 Coll. on petition law as amended
Reason for equipment:
On 21.12.2022, a submission was delivered to the mailing office of the Ministry of Health of the Slovak Republic (hereinafter referred to as "MZ SR") in the subject marked as –Petition for maintaining and categorizing Liptovský Mikuláš Hospital in level II in the framework of optimisation of the hospital networkThe President and, at the same time, the person appointed to represent him in contact with a public authority (hereinafter referred to as "the representative') submitted the same text with the accompanying letter of 16.12.2022 as the petition committee. In a letter dated 16.12.2022, it was stated that the petition in question was sent with annexes of 312 signature sheets in documentary form and 517 sheets in electronic form and supported by more than 14 000 persons. The Office of the Minister for Health referred the documentation to the further proceedings of the Unit of Control, Supervision and Complaints (hereinafter referred to as "ÚKDaS') in cooperation with the Institute of Health Analysis.

The ÚKDaS as an organizational unit of the MZ SR in the meaning of the order of organisation of the MZ SR in the current version materially competent for the handling of petitions within the meaning of the Act on petition law also in conjunction with the factually relevant organizational units of MZ SR received the accompanying letter together with the annexes. After assessing the material and formalities of the documentation required by the Act on petition law, the ÚKDaS found that the submission, marked as "Petition for the maintenance of the hospital Liptovský Mikuláš and its categorisation in level II, in the framework of the optimisation of the hospital network" and with 829 pieces of signature sheets in both documentary and electronic form, with a list of more than 14 000 persons supporting the petition in question, is a petition according to the feeling of the Act registered by the ÚKDaS in the Special Registry Report in 2022 as a petition under sp. zn. Pet 9/2022, which was renumbered at Pet 1/2023 in 2023.
In view of the fact that the petition had the nature of the request, the Ministry of the Slovak Republic was obliged to make a petition within the meaning of § 5 (6) of the Law on Petitions, according to which, if the contents of the petition indicate that the petition cannot be dealt with under paragraph 5, the public authority competent to handle the petition containing the request or proposal will assess its content and send a written reply together with the statement of reasons to the representative within the period referred to in paragraph 5. Taking into account also the fact that the petition was supported by more than 10 000 persons, the MZ SR was obliged to proceed with its settlement within the meaning of Article 5d (1) of the Law on Petitions, according to which, if the petition is supported by more than 10 000 persons, it will be discussed by the competent public authority with responsibility for the whole territory of the Slovak Republic with a representative and a petition committee. According to the above provision of the law on petition law, employees of the Slovak Republic discussed the petition with the representative and two other accompanying persons on 19.01.2023 in the Slovak Republic.
In accordance with the provisions of § 5 (6) of the Act on petition law MZ SR submitted written notification to the representative of the outcome of the petition, which was mentioned.

The petition committee requests:

  1. Maintain Liptovský Mikuláš Hospital with the provision of healthcare within the optimisation of the network of hospitals in category II. level.

MZ SR proceeded within the meaning of § 45 paragraph 7 of Act No. 540/2021 Coll. on the categorisation of institutional health care (hereinafter referred to as Act No. 540/2021) In the case of the IRIS-H, the IRIS-H and the IRIS-H do not have the right to provide hospital services. This is the first sub-phase of the classification of hospitals, which means that hospitals are included in the basic level and that compulsory programmes are established for individual hospitals. The second phase will cover supplementary programmes which the hospital may provide in addition to compulsory programmes. MZ SR will issue decisions on the provision of complementary programmes and will publish a list of complementary programmes by the end of March 2023. Decisions on additional hospital programmes will be preceded by evaluation and discussion with hospitals. Supplementary programmes are approved by the Ministry of Health of the Slovak Republic, the contracting of optional programmes is on the agreement of the insurance company and hospital.
Details of the hospital evaluation and the inclusion of the hospital in Liptovský Mikuláš I. level:
MZ SR in the creation of a network of categorised hospitals proceeded according to § 10 (2) of Law No 540/2021 Z. z. z. and MZ SR conditionally assigns hospitals to the network if they are fulfilled

  1. conditions for networking, which are the geographical availability of institutional care, the number of insured persons in the catchment area of the hospital
  2. the preconditions for the provision of mandatory programmes under the programme profile, which are:
    • - the hospital operator is authorised to operate a general hospital or a specialised hospital,
    • - the hospital operator has special staffing arrangements related to the programme profile to be carried out by the hospital,
    • - the hospital operator has special material and technical equipment related to the programme profile that the hospital will perform.

From the point of view of meeting individual criteria in the hospital in Liptovský Mikuláš, today there are not all compulsory level II programmes. In particular, there is a lack of a program of haematology and transfusiology, a program of paediatric endocrinology, diabetes and birth defects of metabolism, a program of paediatric immunology and allergology. This means that in these programmes, neither 20% of the level II average cases in the medical services falling under the programme level are reached. Both 2019 and 2021 have been evaluated to take into account, as far as possible, time fluctuations caused by COVID. The hospital in several programmes does not even reach the minimum limits for selected medical services. In particular, this concerns the Gynaecological Programme, the Musculoskeletal Programme, the Neurological Programme and the Neonatology Programme. Hospital in Liptovský Nicholas also has shortcomings in the minimum personnel requirements for programmes. Doctors with the following specialties are missing from the hospital's portfolio: pneumoftiseologist, endocrinologist, diabetesologist, clinical logoped, paediatric endocrinologist, paediatric nephrologist, FBLR physician. In the requirements of the neonatological program are two tested neonatologists, the hospital has currently employed a doctor in the specialization of neonatology on a part-time 0.7. The Musculoskeletal programme is built on one doctor from the specialization of orthopedics, level II programme has an obligation to provide 60 medical services that do not have the limits, i.e., acute care that the hospital must provide without waiting. It is necessary to provide a more generous staff subsidy for the programme to run. The hospital itself has declared that it completes less than half of the compulsory level II programmes: From 34 compulsory programmes, our hospital currently meets 14 programmes and from 4 additional programmes, the Liptov Hospital claims (source: https://www.sanitarydenik.cz/2022/12/inthe country of Zilina-fight-of-Liptov-hospital-reforma-ma-change-its-kategorie/).

As far as accessibility is concerned, compliance with the availability conditions for the level II network of hospitals is comparable in the Žilina region to that of the nationwide network. For the entire network, 93% of residents have hospital II. level available up to 30 min. from their residence, in Žilina region it is 92 percent. Within Slovakia, 0.6% of the residents have a hospital II. level in running time exceeding 45 min.. In Žilina region, effective accessibility according to the transport model nearest hospital II. level is below 45 min for all residents. Average running time for the whole network is 13.30 min.. The average time in Žilina region is 12.48 min.
According to Section 2 (12) of Law No 540/2021 Coll., geographical availability means the distance from the place of temporary residence of the insured person and, if the insured person does not have it, from the place of permanent residence, to the nearest hospital of the relevant level expressed by the time of commuting. For the purposes of this Act, the time taken to arrive shall be the time in minutes rounded to two decimal places corresponding to the effective availability of the place of provision of institutional care for at least 90% of the population in the catchment area of a motor vehicle at a speed that is appropriate to the type of ground communication and complies with specific regulations. In view of the above mentioned MZ SR decided to include the hospital in Level I.
We take the petition of the citizens of the region around Liptovský Mikuláš with full seriousness, the incentives mentioned in the petition and the suggestions made during the negotiations. At the same time we actively communicate with the hospital management in Liptovský Mikulas. The aim of MZ SR is to increase the quality and accessibility of healthcare provision to citizens throughout Slovakia. The I. level hospital and therefore the hospital in Liptovský Mikuláš has the possibility to provide programmes from a range of 32 additional programmes and 18 optional programmes. The hospital declared an interest in providing 22 programmes. All these programmes, e.g. psychiatric programme, emergency medicine programme, neurological or obstetric program, etc., can be provided at first level, whether in the form of an additional or optional programme.
Law 540/2021 The Z. z. leaves to hospitals I. levels the greatest flexibility in providing care in the width and spectrum according to the needs of the region in which they operate and the ambitions of hospital management. The hospital can thus profile in specific specialties beyond extensive outpatient care or overnight health care. MZ SR plans a meeting at the hospital in Liptovský Mikuláš during February or March, which will discuss supplementary programmes. When approving complementary programmes, MZ SR will also take into account several other factors such as the geography of the region, tourism, the organisation of sports events and the working industry in the region of Liptovský Mikuláš. At the same time, MZ SR will take into account the presence of high health school in order not to jeopardize teaching. After discussion with the hospital MZ SR by the end of March 2023, he will publish a list of additional programmes to be provided by the hospital in Liptovský Mikuláš.
The petition committee requests:
  1. To amend Law 540/2021, extend the deadline until 31.12.2023 Paragraph 45 paragraph 7 of the submission of the list of classifications of hospitals, for reasons of approval of Law 540/2021, without processing a quality analysis of the economic and social impacts of the planned optimisation of the hospital network for the development of the regions, taking into account the less accessible regions.

MZ SR to the above requirement states that the amendment to paragraph 45 of paragraph 7 of Law No 540/2021 It is not possible on account of the expiry of that transitional provision. MZ SR issued a list of categorised hospitals within the time limit specified by law, in accordance with the transitional provision, until 31.12.2022. At the same time, we would like to draw attention to the milestones of the Recovery and Resilience Plan, which are linked to the release of funds for the Slovak Republic. The delay in submitting the list of hospitals would jeopardise the achievement of milestone No 105 of the Recovery and Resilience Plan - 40% of reprofiled hospitals within the new hospital network by the end of 2025.
By sending a written reply to the representative of MZ SR, he considers the petition to be equipped in accordance with the provisions of § 5 (6) of the Act on Petitions.

Place: In Bratislava– Date:3 February 2023