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Kommissionsdrucksache 7/46 7 Landtag Mecklenburg-Vorpommern Kommissionsdrucksache 7/46 7. Wahlperiode Enquete-Kommission „Zukunft der medizinischen Versorgung in Mecklenburg-Vorpommern“ Kommissionsdrucksache (12.05.2021) Inhalt: Stellungnahmen zur 7. Sitzung am 14.10.2020 zu den Themen Aktueller Stand der medizinischen Versorgung aus Sicht des Rettungsdienstes und des Krankentransports und der Kommunen - DRK-Landesverband M-V e. V. - Landkreis Vorpommern-Greifswald - Laura Isabelle Marisken, Bürgermeisterin Heringsdorf - Lars Prahler, Bürgermeister Grevesmühlen - Prof. Dr. Klaus Hahnenkamp, Universitätsmedizin Greifswald - Landkreistag M-V e. V. - Städte- und Gemeindetag M-V e. V. - Artikel Prof. Dr. Fleßa DRK -Landesverband DRK-Landesverband Mecklenburg-Vorpommern e.V. Wismarsche Str. 298 19055 Schwerin Mecklenburg-Vor- pommern e.V. Landtag Mecklenburg-Vorpommern Enquete-Kommission Vorstand z. Hd. Herrn Heydorn Lennéstraße 1 Wismarsche Str. 298 19053 Schwerin 19055 Schwerin Tel. 0385 59147-0 Fax 0385 59147-98 www.drk-mv.de [email protected] per E-Mail: [email protected] Ihre Nachricht vom Ihr Zeichen Schwerin, 09.10.2020 ÖfFentliche Anhörung der Enquete-Kommission „ZukunFt der medizini- schen Versorgung in Mecklenburg-Vorpommern" am 14.10.2020 Sehr geehrter Herr Heydorn, sehr geehrte Mitglieder der Enquete-Kommission, uns erreichte Ihre Einladung zur öffentlichen Anhörung der Enquete-Kommis- sion am 14.10.2020 in Schwerin. Zur Vorbereitung der Thematik haben Sie Sparkasse Mecklenburg-Schwerin uns einen umfangreichen Fragebogen übersandt und die Bitte formuliert, Geschäftskonto: Ihnen unsere Beantwortung bis spätestens 09.10.2020 zurückzusenden. IBAN DE84140520000300034008 In unserem Verband ist es bei derlei bedeutenden Stellungnahmeverfahren BIC: NOLADE21LWL nicht unüblich einen innerverbandlichen Prozess vorzuschalten. Dies bedarf Spendenkonto: aber einer gewissen Zeit und war daher mit der gesetzten Frist kaum umfang- IBAN: DE49140520000350036004 reich durchzuführen. Daher erlauben wir uns eine ausführliche Beantwortung BIC: NOLADE21LWL des Fragenkatalogs nur zum Kapitel „Rettungsdienst“ abzugeben. Die übrigen Kapitel werden von uns mit einer zusammengefassten, thematischen Ein- VR 211 Amtsgericht Schwerin Steuer-Nr. 090/141/01095 schätzung beantwortet. USt-IdNr. DE 156890235 In der Anlage übersenden wir Ihnen den bearbeiteten Fragenkatalog des DRK-Landesverbandes Mecklenburg-Vorpommerns e. V. zur weiteren Ver- Ihre DRK-Service- wendung. Nummer … an 365 Tagen im Jahr In der öffentlichen Anhörung am 14.10.2020 wird der DRK-Landesverband für Sie da … Mecklenburg-Vorpommern e. V. durch meine Person vertreten. * 08000 365 000 Mit freundlichen Grüßen 24 Stunden täglich *(bundesweit gebührenFrei) Jan-Hendrik Hartlöhner Landesgeschäftsführer Landesverband Mecklenburg-Vorpommern e. V. Stellungnahme des Deutschen Roten Kreuzes zur öffentlichen Anhörung der Enquete-Kommission „Zukunft der medizinischen Versorgung in Mecklenburg-Vorpommern“ am 14.10.2020 Inhalt A.1 Grundsatzfragen .............................................................................................................. 1 A.2 Detailfragen ..................................................................................................................... 3 I. Stationäre Versorgung .................................................................................................... 3 II. Ambulante Versorgung .................................................................................................. 4 III. Rettungsdienst .............................................................................................................. 5 IV. Rehabilitation / Krankenhausnachversorgung.............................................................. 14 V. Fachkräfte/ Personalressourcen ................................................................................... 14 VI. Patientenorientierung .................................................................................................. 15 VII. Finanzierung / Vergütung ........................................................................................... 15 VIII. Telemedizin / Datenschutz ....................................................................................... 17 IX. Öffentlicher Gesundheitsdienst ................................................................................... 17 X. Pandemie und Folgerungen ......................................................................................... 17 B. Gesamteinschätzung/ Bewertung .................................................................................... 18 C. Zukunftsansätze .............................................................................................................. 18 A.1 Grundsatzfragen Das Deutsche Rote Kreuz wirkt sowohl als Leistungserbringer im stationären Bereich und auch als Leistungserbringer im öffentlichen Rettungsdienst in Mecklenburg- Vorpommern mit. Viele Herausforderungen, wie die sich wandelnden Anforderungen an die präklinische Versorgungsstruktur, gestiegene Einsatzzahlen oder auch der Fachkräftebedarf fordern die Akteure im Rettungsdienst. Die traditionelle Trias der medizinischen Versorgung ist in den letzten Jahren durch Veränderungen der Finanzierungsgestaltung, der Versorgungsstruktur, verändertem Inanspruchnahmeverhalten sowie teilweise ausgereizten Ressourcen der medizinischen Versorgung an quantitative und qualitative Grenzen gestoßen. 1 Landesverband Mecklenburg-Vorpommern e. V. Die medizinische Versorgungsqualität ist für die meisten zu versorgenden Patientengruppen als gut zu bewerten. Jedoch limitiert ein derzeitiges System der Über-, Unter- und Fehlversorgung der Patienten eine effektivere Umsetzung der vorhandenen Kapazitäten. Dies liegt nicht unbedingt daran, dass zu viele Behandlungseinrichtungen im ambulanten sowie stationären Bereich existieren, sondern dass deren zielgerichtete Auslastungssteuerung nicht immer optimal ist. Denn beispielsweise die enorme Auslastung der Notaufnahmen der stationären Versorgungseinrichtungen wird durch lange Wartezeiten bei ambulanten Fachärzten mit verursacht. Die langen Wartezeiten sind auch in der Notfallrettung zu thematisieren, denn beispielsweise führen lange Anfahrtswege zu stationären Versorgungseinrichtungen zu verlängerter Abwesenheit der Rettungsmittel im jeweiligen Rettungsdienstbereich und zu Herausforderungen in der Rettungsmittelvorhaltung und führen somit zu Schwierigkeiten bei der Sicherstellung der Hilfsfrist. Die zukünftige medizinische Qualität wird hingegen deutlich negativer bewertet, denn der Fachkräftemangel im ärztlichen und nichtärztlichen Bereich wird unser Bundesland noch intensiv fordern, wenn in den kommenden Jahren beispielsweise nochmals deutliche Kapazitäten der hausärztlichen Versorgung aus Altersgründen nicht mehr aufrecht erhalten werden können und ein Mangel in den betreffenden Bedarfsplanungen damit absehbar ist. Dies führt zu reduzierten Versorgungskapazitäten durch weniger Arztsitze, welche durch ein Überangebot in den Ballungsgebieten verschärft wird. Das heißt, neben der fehlenden Nachbesetzungsproblematik von Arztsitzen, addiert sich noch eine ungleiche Besetzung der Arztsitze mit haus- sowie fachärztlichem Tätigkeitsschwerpunkt hinzu. Aus Sicht des Deutschen Roten Kreuzes ist es für die medizinische Versorgung der Bevölkerung von enormer Bedeutung eine flächendeckende Versorgung im ambulanten sowie stationären Versorgungspfad sicherzustellen, welche einen Mindeststandard der krankenhäuslichen Grund- und Regelversorgung garantieren und durch flächendeckende Spezialisierungszentren ergänzt werden. Dies hat diverse Gründe, denn beispielsweise der demografische Wandel, medizinische Versorgungskapazitäten mit adäquater Erreichbarkeit oder generelle Kapazitätsproblematiken in Krisenlagen erfordern eine durchdachte dezentrale Planung und Umsetzung der ambulanten und stationären Versorgung. Eine solche Versorgungsstruktur hat unter einem DRG-Finanzierungssystem schnell seine Grenzen erreicht und daher ist die Einführung einer auskömmlichen und betriebssichernden Finanzierungsgrundlage über ein Kostendeckungsprinzip eine Option, um mangelfinanzierte Bereiche der stationären und ambulanten Versorgung leistungsfähig zu halten. Eine Finanzierungsproblematik trifft aus unserer Sicht auch auf den Bereich der Notfallrettung: Die derzeit geltenden gesetzlichen Vorgaben dämpfen perspektivisch die Aufrechterhaltung eines leistungsfähigen Rettungsdienstes, welcher in allen medizinischen (Krisen-)Lagen an der Spitze der nichtpolizeilichen Gefahrenabwehr 2 Landesverband Mecklenburg-Vorpommern e. V. steht und durch einen leistungsfähigen Katastrophenschutz im Bedarfsfall unterstützt werden kann. Die herausfordernden Ereignisse der letzten Jahre haben gezeigt, dass Institutionen wie die anerkannten Hilfsorganisationen sich an der Abarbeitung von (Krisen-)Lagen erfolgreich beteiligen. Dies muss aufrechterhalten werden. Im bisherigen System der rettungsdienstlichen Versorgung spielen Empfehlungen des Gemeinsamen Bundesausschuss für die Notfallmedizin eine untergeordnete Rolle. Dies zeigt sich an der Einordnung des Rettungsdienstes im Sozialrecht als Fahrtkosten. Mit den Reformvorstellungen der Notfallversorgung des Bundesgesundheits- ministeriums kann sich dies aber ändern, wonach dem Gemeinsamen Bundesausschuss eine deutliche Mitwirkung bei der Rahmengestaltung eingeräumt werden soll. Unserer Auffassung ist dieser Vorstoß zu mindest in Teilbereichen kritisch zu bewerten, da der Rettungsdienst als Teil der nichtpolizeilichen Gefahrenabwehr Ländersache
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