The letter from the Executive Council of Saba about dissatisfaction among the population about the functioning of the VWS branch in the Caribbean Netherlands ZJCN does not seem to have been well received in The Hague. State Secretary Maarten van Ooijen apparently finds it important to recall in a letter to the House of Representatives that a delegation from Executive and Island Councils indicated in a conversation with him that “their letter was perhaps too sharply formulated.”

Saba previously desired an independent investigation into ZJCN, but now the problem seems to have been reduced to the category of misunderstandings: “Saba and VWS agree that better communication, also about the aforementioned improvements, is necessary. We also agree that this is a responsibility of all parties involved.” according to Van Ooijen.

Van Ooijen’s letter to the Second Chamber reads:

During the Committee debate of 15 November 2022 on social domain and administrative agreement BES, your Chamber asked the State Secretary for Kingdom Relations and Digitisation to be informed of the outcome of the conversation that the Deputy Secretary-General and the Director of Care and Youth Caribbean Netherlands (ZJCN) of the Ministry of Health, Welfare and Sport will have with a delegation from the Executive Council (EC) and the Island Council of Saba. By means of this letter, I want to give substance to this commitment.

The reason for the conversation was the letter that the EC of Saba sent me on 27 October 2022. In this letter, which was also sent to your Chamber by the EC, the EC expresses its concerns about the functioning of the ZJCN program directorate. I sent my reply to the EC on 15 November. I have also sent you this letter at the request of your Chamber.

The meeting with the EC delegation and the Island Council took place on 17 November. During the meeting, the Saba delegation explained the contents of the EC’s letter in more detail. Saba is particularly concerned about the process surrounding the medical referrals and the access times that exist for obtaining specialist care. In Saba’s opinion, this is too slow and it leads to unrest among the population. This unrest has led to the demonstration of 26 October 2022. Saba has also pointed out that the charters hired by ZJCN for patient transport are too small and that patients experience getting in and out as problematic. Some patients do not feel safe in these aircraft. Saba’s delegation indicated that it would be preferable to make more use of Winair’s regular flights. Finally, the Delegation of Saba indicated that their letter was perhaps too sharply formulated, but that there must be understanding at VWS for the growing unrest among the population about the medical broadcasts.

In response, the Ministry of Health, Welfare and Sport indicated that the ministry realizes that improvements are needed in the process surrounding the medical broadcasts. In May, agreements were made with all parties involved (the hospitals on Saba, St Eustatius and St Maarten and ZJCN) about the necessary improvements to this process. An important part of these appointments is the “pilot direct medical referrals” that started last Monday, November 21, 2022. The core of this pilot is that the general practitioners of Saba and Statia can now refer patients to the Sint Maarten Medical Center (SMMC) without the intervention of the medical advisors of ZJCN. It is expected that with the help of this pilot, the process around the medical broadcasts will be accelerated. In addition to this pilot, agreements have been made about improving communication with patients; the protocol of the Medevac has been clarified and the referral portfolio will be updated. During the meeting, VWS indicated that the realization of these agreements takes time and that all parties involved are working hard to make this possible. Saba’s delegation understands that this takes time and agrees that these agreements can lead to improvements. At the same time, ZJCN is asked to pay attention to the here and now and that it is important that results are quickly visible. Saba and VWS agree that better communication, also about the aforementioned improvements, is necessary. We also agree that this is the responsibility of all parties involved.

In response to Saba’s concerns about patient transport, VWS indicates that the reliability of this transport is the first priority for VWS. The experiences with Winair in this have not been good in recent years. In the past, there were many complaints about this from patients and from the EC of Saba. The Ministry of Infrastructure and Water Management is conducting an exploration of a public service for air transport of passengers to Saba and St Eustatius. VWS will examine to what extent (part of) patient transport can connect to this. In anticipation of this, vws will look in the coming months at how more patients can be transported with the help of Winair’s regular flights. But the use of the charters will remain necessary for some patients. The solution will be to determine the right mix. Saba has indicated that it thinks this is a good approach.

Regarding the access times at the hospitals for specialist care, VWS indicates that it cannot easily solve this, which is also not possible in the European Netherlands. With SMMC, ZJCN tries to make agreements about what reasonable access times are (comparable to the Dutch standards). Saba appreciates this approach and once again points out the importance of good communication with the patient. VWS agrees with this. Essential is the important role that the doctors of the hospitals on Saba and Statia have in this. After all, they have the daily contacts with the patients. ZJCN can of course help with this.

The conversation was constructive. It has been agreed that VWS will look at what is possible to use Winair more in patient transport. In addition, the pilot of the free referral will start as soon as possible and monitoring and evaluation will also be organized. Furthermore, communication will have to be improved by all parties involved.

Finally, I intend to visit Saba in the third week of December. I will then discuss the progress of the improvements in the medical broadcasts and the improvement of communication with all those involved on Saba.

State Secretary Maarten van Ooijen

Thanks to Dossier Koninkrijkrelaties.