The petitioner shall: Ministry of Health of the Slovak Republic
Name of the petition:
– Petitions for conservation of NsP, n.o. It is roaring throughout its range of medical activities provided so far under the supplementary Level II programmes by which NsP, n.o. Revúca requested and was not approved by the MZ SR
It's quare: No.
Number of persons supporting the petition: 9 321
Date of delivery: 04.05.2023
Date of equipment: 21.06.2023
Equipment: § 5 (6) of Law No 85/1990 Coll. on petition law as amended - not evaluated
Reason for equipment:
On 04.05.2023 a petition entitled MZ SR was delivered to the mail office without a cover letter on the signature sheets in the documentary form – Petitions for conservation of NsP, n.o. It is roaring throughout its range of medical activities provided so far under the supplementary Level II programmes by which NsP, n.o. Revúca requested and was not approved by MZ SR. The documents were submitted by the submitter and by a person appointed to represent him in contact with the public authority (hereinafter referred to as "the representative') but without signature, without indicating the number of signatures and without indicating the number of persons who supported the petition in question, either in documentary or electronic form. The MZ SR accepted the documentation received and after considering the material and formal requirements required by Act No 85/1990 Coll. on petition law as amended (hereinafter referred to as the Act on petition law) registered as petition under the. zn. Pet 5/2023, but with certain shortcomings. MZ SR, within the meaning of § 5 (4) of the Act on petition law, by letter dated 15.05.2023, called on the submitter to remedy the identified deficiencies of the petition within the legal deadline and with instruction. The deficiencies of the petition by the petitioner were eliminated by letter received from the Slovak Republic on 09.06.2023, stating that the petition was supported by a total of 9 321 persons, of which 7 823 persons on 539 sheets in documentary form and 1498 persons in electronic form.

Since the petition received has the character of a request for the maintenance of NsP, n.o. It is roaring throughout its range of medical activities provided so far under the supplementary Level II programmes by which NsP, n.o. Revúca requested and was not approved by MZ SR, MZ SR as a public authority responsible for its execution is obliged to arrange the petition in question pursuant to § 5 (6) of the Law on Petitions, according to which, if it appears from the contents of the petition that the petition cannot be dealt with pursuant to § 5 (5) of the Law on Petitions, the public authority responsible for the execution of 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 under § 5 (5) of the Law on Petitions.
In accordance with the above provisions of the law on petition law of the Slovak Republic, as a public authority competent to deal with the petition submitted, he submitted the following reply to the representative.
MZ SR proceeded within the meaning of § 45 paragraph 7 of Act No. 540/2021 Coll. on the categorisation of institutional health care and on the amendment of certain laws as amended (hereinafter the Act No. 540/2021 Coll. on the categorisation of institutional health care) decided to conditionally include hospitals in the network and issued the first list of categorised hospitals. It also allocated so-called supplementary programmes to hospitals, i.e. programmes in addition to the compulsory programmes requested by the hospital.
The goal of the Ministry and the optimisation of the hospital network is to increase the quality and accessibility of healthcare provision to citizens throughout Slovakia. The new hospital network introduces new requirements for:

Compliance with these requirements will be checked. The hospital will only be able to provide specific performances if it meets the required standards. This will ensure a higher quality of healthcare provided to patients, but also better working conditions for doctors, nurses, midwives and all health professionals. NsP Hospital Revúca was included in Level I, and at the same time 15 programmes were approved from the required 26 complementary II programmes.
Detail for the evaluation of hospitals and the inclusion of hospital in Revúca level I:

The Ministry, when creating a network of categorised hospitals, proceeded according to § 10 (2) of Act No. 540/2021 Coll. on the categorisation of institutional health care and the Ministry conditionally assigns hospitals to the network if they are met
  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:

From the point of view of meeting individual criteria, in the case of the criterion of existence of medical programmes NsP Revúca hospital does not provide a full range of compulsory level II programmes, the hospital does not provide the following level II programmes or to 20% of the average hospitalisation cases for the programme and given level of the programme: the program of paediatric endocrinology, diabetes and congenital errors of metabolism, the program of paediatric immunology and allergology.
From the point of view of fulfilling the criterion for the creation of a network, which is the fulfilment of the limits on the number of performances for selected medical services, the hospital fulfils only 43% for level II programmes. Both 2019 and 2021 have been evaluated to take into account, as far as possible, time fluctuations caused by COVID. From the point of view of the criterion of special staffing, the hospital meets this criterion at 44%. Which means the hospital has no experts.

Evaluation of specific programmes required:

In the case of the obstetrics programme and the neonatological programme, or for the obstetrics, experts have set a limit of 800 births per year in categorising it as a necessary minimum in terms of patient safety. NsP Revúca had 263 births for 2019 and 294 births for 2021. There is inevitably a percentage of complications within births. The less experience a hospital has with providing obstetric care, the less frequent the staff encounters complications, and the less experienced it is then prepared to solve these complications. At the same time, ensuring the presence of anesthetist 24/7, outside serious complications (such as caesarean section), makes it difficult for women to access epidural anaesthesia during classical vaginal delivery. At the same time, in order to launch the optimisation of the hospital network, all maternity services will be equipped with an intensive care unit for newborns (JISN). Today NsP Revúca only has a physiological department for newborns and therefore all more complicated conditions must be transported to other hospitals, which threatens not only the patient but also the newborn.
The Gynaecological programme, within the meaning of Annex 1 to Decree No 316/2022 Coll., cannot be provided at level I hospital. Gynecologists set this condition.
In the case of a traumatic programme, the hospital does not fulfil the required condition for staffing within the meaning of Annex 15 to Decree No. 316/2022 Coll. in that programme, there is a special staffing provision of at least four traumatists or orthopedists or surgeons experienced in the treatment of injuries. And the hospital has no urgent reception.
In view of the above, the Ministry decided to include the hospital in Level I, but with the possibility to provide up to 15 programmes from Level II.
All level II hospitals are obliged to meet the full range of programmes of this level as well as the limits (performance numbers), personnel and material technical conditions. The compliance rate (number of performances, special personnel, material-technical requirements and quality) will be evaluated annually. In the event of under-compliance with the above conditions, a sanctioning mechanism (from a warning through a level reduction, to a reduction in payments from health insurance companies) is established. This is why, as a level I hospital, the management of NsP Revúca can use this status as an advantage and pursue programmes where, as a hospital, they are strong, which the inhabitants of the region need to build excellence in specific areas.
The goal of the Ministry and the optimisation of the hospital network is to increase the quality and accessibility of healthcare provision to citizens throughout Slovakia. MZ SR communicates with the hospital management NsP Revúca, and twice in the past weeks visited the hospital. We take the petitions of the citizens of the region around Revúca with full seriousness. We also see problematic accessibility due to terrain and mountain area. This is why level I hospitals and therefore also the hospital in Revúca have the possibility to provide programmes from a range of 32 supplementary programmes and 18 optional programmes to ensure that healthcare is available to citizens. And the hospital was approved up to 15 programs.
The law leaves hospital 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. At the same time, according to the Act 540/2021 Coll. on the categorization of institutional care, hospitals have the possibility to apply for a transfer to a higher level or to provide additional programmes.
By sending a letter to the MZ SR informing the representative of the outcome of the execution of the petition entitled "Petition for the maintenance of NsP, n.o. It roars throughout its entire range of provided health activities falling under the supplementary Level II programmes by which NsP, n.o. Revúca requested and was not approved by the MZ SR, it considers the MZ SR petition to be equipped in accordance with the provisions of § 5 (6) of the Law on Petitions.

Place: In Bratislava– Date:26 June 2023