SPD on health and care

The SPD wants to improve working conditions in nursing care and health care and to push at the federal level for a reform of how they are financed. It should be possible to make collective agreements binding for the whole sector. Health services, medical technology and research are also to be linked more closely through the Gesundheitscampus (health campus).

Very many people work in care and hospitals, mostly women. The SPD wants better pay and better working conditions for them. Union wage agreements should be able to apply to all employers in the sector. The federal government should fund care and health better. Research, technology and hospitals should work together more closely.

According to the program, the sector accounts for more than 68,000 jobs in the state, most of them in nursing homes and hospitals. The SPD wants to support unions, among other things by having collective agreements declared generally binding, meaning they also apply to employers not covered by them. Together with providers, schools and researchers, opportunities for further training and career advancement are to be created. As a second field, the program names innovative health services, in which artificial intelligence and suitable IT solutions are to play a central role.

The SPD wants prisoners to remain in the statutory health insurance system while in custody. This is meant to ease rehabilitation and secure medical care of equal quality. For mentally ill prisoners, it calls for inpatient treatment places.

Prisoners should stay in public health insurance. Federal laws must be changed for this. Mentally ill prisoners should get into a clinic quickly. For this there should be at least one reserved bed outside the prison.

This would require changes to federal law; the platform sees it as in line with the idea of a Bürgerversicherung (universal citizens' insurance). Free choice of doctor remains restricted in custody, but adequate specialist care is to be ensured. Because the prison can hardly care for mentally disturbed inmates in acute situations, at least one reserved bed in an outside facility should be available on call.

The SPD considers the welfare associations' service centers indispensable and wants to examine whether they can be linked with employment projects. Counseling on housing and dementia is to be funded according to need, and the care support centers are to be expanded at the neighborhood level.

More and more people need help in daily life. Service centers provide this help. The SPD wants to check whether job projects can help there too. Advice on housing, dementia and care should get enough money. Care advice should be offered in more neighborhoods.

According to the platform, demand for neighborhood help and everyday assistance is growing. Linking the centers with employment projects is meant to help meet that demand. The platform names the housing advice service kom.fort and the dementia advice service DIKS, which are to be adequately funded. The SPD wants to expand the care support centers in the neighborhoods. All providers are also to adapt to older people with a migration background.

The SPD wants to extend the municipal coverage of costs for prescribed contraceptives to additional low-income groups. In the party's view, family planning should not depend on how much money someone has.

Bremen pays for birth control for some people. So far this applies to people on welfare, for example. The SPD wants to include more people. These include students with state aid and people who get housing benefits.

Since 2016 the voluntary benefit has applied to Bremen residents receiving social assistance, ALG II (basic unemployment benefit) or asylum seeker benefits. Students receiving BAföG (student aid), trainees receiving vocational training assistance, and recipients of the child supplement or housing benefit are to be added. The SPD argues that decisions about family planning should be self-determined.

The SPD wants to draw lessons from the COVID-19 pandemic and prepare Bremen for future crises. Protective equipment is to be kept in stock, vaccination infrastructure maintained, and a crisis team kept ready for rapid deployment.

The SPD wants to prepare Bremen for new pandemics. Masks and protective clothing should be kept in storage. There should still be staff and places for vaccination. A crisis team should be able to start quickly. A crisis team is a group that decides in an emergency.

For crisis-relevant products such as protective gear, tests, disinfectants, vaccines and medicines, the program calls for secure supply chains and coordinated stockpiling. Culturally sensitive health workers in neighborhoods, funded so far until the end of 2023, are to continue their work. The crisis team is to report directly to the Senate, have clear responsibilities, and include practitioners, especially from nursing care. More broadly, the SPD regards health as a public service the state must provide and considers the market unsuited to it.

The SPD wants enough rehab places and interdisciplinary outpatient clinics for people with long Covid. For children and adolescents, it plans to expand school psychology, creative therapy and physical activity programs, because the platform says they suffered especially during the pandemic.

Some people stay sick for a long time after Covid. This is called long Covid. The SPD wants enough rehab places and clinics for them. Children and teenagers should get more help at school. There should also be more programs for exercise.

The platform notes that more children are suffering from depression. School psychology and creative therapy services are meant to help them work through their lockdown experiences. Because physical activity programs declined, the SPD plans targeted offerings for children and adolescents. For people with long Covid, enough rehab places and interdisciplinary outpatient clinics are to be available.

The SPD wants reliable working hours, less overtime and higher wages in nursing care. The aim is to keep care workers in the profession or bring them back, since the platform sees sufficient staff as the key condition for good care.

The SPD wants better jobs in nursing care. Care workers should be able to go home on time. They should work less overtime. They should also earn more money. Then more people will stay in the job.

In home care, a system giving care workers more time and flexibility is to be tested together with the health insurers, and the payers are to cover the higher needs. The platform counts regular breaks, few split shifts and no call-ins on days off as part of reliable hours, supported by providers' own float pools. Pilot projects and onboarding support such as mentoring are to be funded for returners, newly hired trainees and staff recruited from abroad. Dealing with psychological strain is to become a fixed part of workplace health management. The SPD will seek labor market funds for career paths and staff development.

The SPD wants to attract more people to nursing training and reduce dropouts. Training for care aides and assistants is to be structured so that the path to becoming a registered nurse is open, with credit for prior training.

The SPD wants to train more people in nursing care. People who are about to quit training should get help. Care aides should be able to become nurses more easily. What they have already learned should count.

Modeled on the “Bleib dran!” (Stay with it!) program, support is planned for trainees at risk of dropping out. For aide and assistant occupations, which are regulated by the states, the SPD plans a modular structure with credit rules and secure funding, from one-year care aide training through two-year assistant training to registered nurse. At the federal level it advocates a generalist care aide training paid from the training fund, and further qualification under the Qualifizierungschancengesetz (Qualification Opportunities Act). For dropouts, it wants to check whether completed parts are enough for an assistant qualification. Overall, training capacity in all health professions is to rise markedly.

The SPD sees entry-level opportunities for refugees and immigrants as key to getting more nursing staff. It wants to offer language training and recognize foreign qualifications without red tape.

Nursing care lacks many workers. The SPD wants refugees and immigrants to work in care. They should get German classes for the job. Degrees from other countries should count more easily.

The SPD wants to fund a program for learning both general and job-related German. It also intends to use labor market policy programs for this purpose. Recognition of nursing qualifications earned abroad is to move ahead with little bureaucracy, including in residential care facilities in Bremen.

Beyond nursing, the SPD wants to support other health professions: midwives, medical assistants and therapists. It justifies this with the continuing need for staff in these fields.

The SPD also wants to support other health jobs. These include midwives and assistants in doctors' offices. They also include therapists. Doctors' offices should train more people.

For midwives with traditional training, the state government is to present a solution for recognizing their qualifications and for further training, now that midwifery training has moved to universities. Working as a family midwife in the public health offices is to become more attractive so that these posts are again filled by midwives. The new training fund is to create incentives for doctors' offices to train more medical assistants. The SPD wants reliable conditions for therapy professions, including arts therapists. Bremen is to apply for pilot projects in which nurses take on certain medical tasks.

The SPD wants to use state money to support training for so-called Pflege-Guides (care guides), who advise employees with relatives in need of care at their workplaces. It expects the federal government to cover nursing training costs from taxes so that out-of-pocket contributions fall.

Many people care for relatives and also have a job. Care guides advise them at work. The SPD wants more care guides to be trained. The state should give money for this. The federal government should pay for nursing training from taxes.

Care guides help employees balance caring for relatives with their jobs. So far the health and long-term care insurers pay for this; a state subsidy is to be added. The demand addressed to the federal government aims to stop financing the training share through the out-of-pocket contributions of people in care and their families.

The SPD wants women and couples seeking an abortion to get information and fast, good care close to home. Hospital planning is to guarantee this.

Some women want to end a pregnancy. The SPD wants them to get good information. They should find help quickly and close to home. Hospital planning should take this into account.

According to the platform, this applies to both outpatient and inpatient care. Hospital planning is to make sure the services are available. The platform places the demand within its goal of giving women's concerns more weight in health care.

The SPD wants to create more local health centers and health kiosks that bring together advice, prevention and support in the neighborhood. It argues that health risks differ in size by district and population group.

The SPD wants more health centers in the neighborhoods. People can get advice there about illness and care. The centers should be easy to reach. Schools should get more health workers.

In the centers, medical, nursing and preventive services are to work under one roof and be linked with other social services. The platform cites the LIGA health center in Gröpelingen, for which start-up funding and money for a new building have been secured; other districts are to follow. People with different languages and cultural backgrounds are to be recruited for the local work. Health kiosks are to inform people about cancer screening, nutrition and sports; further tasks such as help finding a doctor are being considered, drawing on Hamburg's experience. The use of health professionals in schools is to grow, and urban planning is to factor in medical care from the outset.

The SPD wants to use incentives to bring more family doctors, pediatricians and psychotherapists to districts with too few practices. The state authority is to have a targeted say in how physician slots are filled.

Some neighborhoods lack family doctors and children's doctors. The SPD wants to attract young doctors there. For example, they could get help with rent. The state should have a say in where practices open. More practices should be barrier-free.

Possible incentives named in the platform include rent subsidies, trial practices, attractive premises, scholarships, cooperative practices and municipal care centers; a daycare spot could also tip the balance. The system for assessing need is to be developed further, partly because replacements cannot yet be targeted by medical subspecialty. The different care sectors are to cooperate more closely at the district level. The SPD supports issuing health insurance cards to refugees and volunteer treatment of homeless people; copayments for these patients are to be dropped nationwide. More practices and facilities are to become barrier-free.

The SPD wants to push providers focused mainly on returns out of medical care. In the platform's view, financial investors are increasingly buying up practices and medical care centers and have little interest in care that covers the whole area.

Some companies buy doctors' offices to make a lot of money. The SPD wants to push this back. The cities should set up their own care centers. A register should show who owns the practices.

At the federal level, the SPD intends to advocate for rules to this effect. In Bremen and Bremerhaven, the municipalities are to act themselves by founding and supporting their own medical care centers. The platform considers transparency registers necessary to monitor ownership.

The SPD wants patient counseling that depends neither on health insurers nor on health care companies and is organized regionally. Counseling on dementia is also to be strengthened and expanded.

Patients sometimes need advice, for example after treatment mistakes. The SPD wants independent counseling. It should not depend on insurers or companies. There should also be more counseling about dementia.

The platform notes that a private service provider has run nationwide counseling since 2016 and that the Federal Court of Auditors, among others, has criticized its work. In the upcoming reorganization, a capable regional structure is therefore to be created. The dementia information and coordination office DIKS is to receive more support. An information campaign on available help and more counseling, including in Bremerhaven, are planned.

The SPD calls on the federal government for a new approach to hospital financing and backs the federal government's reform plans. In the state budget, investment in hospitals is to rise every year, and surpluses are to stay in the hospital system.

The SPD wants hospitals to be paid in a different way. Doctors should decide based on what patients need, not on money. The state should put more money into hospitals every year. Profits should stay in the hospital.

The platform regards the planned federal aid for obstetrics and for pediatric and adolescent medicine as a first step; it should not burden other hospital areas and should be funded permanently, independent of case volume. Pediatrics, emergency care and obstetrics are to be adequately funded. Annually rising investment funds are meant to clear the investment backlog, with the federal government contributing substantially. Surpluses from patient care are to be used for investment; the SPD wants to prevent private investors from withdrawing profits.

The SPD wants to keep all sites of the municipal hospital group Gesundheit Nord (GeNo) while establishing a division of labor with clear specializations among Bremen's hospitals. GeNo is to continue its restructuring and reduce its deficits.

The SPD wants to keep all sites of the city-owned hospitals. Each hospital should have its own focus areas. The hospitals should work together better. The city-owned hospitals should lose less money.

From 2025, GeNo is to reach a balanced operating result before interest, taxes and depreciation. Hospital planning is to become cross-sector planning, with more outpatient and day-care services in hospitals and closer cooperation with practices and care providers. Patients are to be discharged only when follow-up care is secured. Alongside specializations, easily reachable basic, standard and emergency care is to be maintained, and quality reports are to be understandable for laypeople. The SPD calls for more palliative and hospice services and for good resourcing of the treatment center for adults with severe disabilities (MZEB), including a directory of barrier-free practices.

The SPD wants to build outpatient emergency care as cooperation on equal terms between hospitals and doctors in private practice. It is to be geared to the needs of the districts and regions in Bremen and Bremerhaven.

In emergencies, hospitals and doctors' offices should work closely together. Both should have an equal say. The help should fit the neighborhoods. First, there should be a careful check of where the problems are.

According to the platform, integrated emergency care involving several professions only works jointly. The SPD expects lawmakers to adopt measures that make this cooperation possible and intends to support them. The basis is to be a data-driven analysis of the problems in each care region.

The SPD wants psychiatric care in Bremen to be organized more on an outpatient and regional basis. Binding community psychiatry networks with regional budgets are meant to coordinate services so that the support system is no longer fragmented.

The SPD wants to change mental health care. More help should take place outside the hospital. Help should be close to where people live. Providers in a district should work together in a fixed way. There should be enough money for this.

The program supports testing a regional budget and involving patients and their relatives. Proven projects such as the night café, patient advocates, and the interpreter pool are to receive permanent funding. Every person affected should have a steady contact person from a therapeutic team, and needs are to be assessed individually. Coercion should be avoided as far as possible, and medication used cautiously. Regionalization in Bremen's western districts is to continue in close cooperation with the hospital group GeNo. The SPD also backs a sufficient psychiatry budget, the use of peer recovery supporters, and a master's program in clinical psychology.

The SPD wants to do more to prevent addiction and to expand counseling. Addiction counseling centers are to get more staff, and self-help groups are to receive support.

The SPD wants to do more against addiction. There should be more prevention. Counseling centers should get more staff. Self-help groups should also get support.

The regular student survey "SCHULBUS" is to be used to develop local prevention and counseling concepts. Self-help groups are to be supported and trained, for example in going digital. Outpatient addiction counseling is to get more staff, also in view of newer addictions such as gambling and early help for young people. The psychosocial counseling that accompanies substitution treatment is also to be adequately staffed.

The SPD wants low-threshold drug services to be easier to reach, including in the evening. Drug consumption rooms are to be equipped according to need.

The SPD wants better help for people who use drugs. The help should also be open in the evening. There are rooms where people can use drugs under supervision. These rooms should be well equipped.

Drug services are to offer counseling and a daily structure and be available for longer hours. The program sees these services as a bridge: they are to be used actively to refer people to further treatment. The equipment of consumption rooms is to follow actual need.

The SPD wants a comprehensive reform of the public health service (ÖGD) and a new definition of its tasks. According to the program, budget cuts and unattractive jobs led to staff losses, so staff are to be recruited across all medical professions.

The SPD wants to strengthen the public health offices. The SPD says they lack staff. Too much was cut in the past. The offices should hire more experts. Working there should become more attractive.

Recruitment is to go beyond doctors, and funding is to be secured for the long term. Pay supplements for positions where the service competes with hospitals, for example, are to stay. The plan also includes better staff development, a better working climate, and easier balancing of work and family. The tasks of the public health service are to be included in the curricula of health and social professions. Working as a family midwife is to become more attractive, and more midwife centers are to be set up in the districts. The service is to play a larger role in public services beyond its sovereign duties and draw on Bremen's public health research.

The SPD wants the public health offices to inspect hygiene in medical practices, nursing homes, and hospitals more often. Prevention and health promotion in neighborhoods, schools, and daycare centers are to be strengthened, and a permanent vaccination infrastructure is to be built.

The health offices should take on more tasks. They should check hygiene in practices, care homes, and hospitals more often. Neighborhoods, schools, and daycare centers should have more health workers. There should be permanent places to get vaccinated.

The more frequent hygiene inspections are meant to protect patients and people in need of care from infections. Health professionals and health guides are to work in neighborhoods, schools, and daycare centers. The vaccination infrastructure is to be permanent.

The SPD wants to secure staffing for health reporting (GBE) and expand it so that health policy rests on evidence. The public health service is also to get better technical and digital equipment.

The SPD wants to collect more data on the health of people in Bremen. There should be enough staff for this. Politicians should decide based on this data. The health offices should get better digital technology.

The program sums up the goal with the motto "Daten für Taten" (data for action) and wants to provide the necessary funds. It wants to examine how health reporting and the care reporting done by the social affairs department can complement each other. For digitalization, common standards are to be developed with other health offices. Findings from the Leibniz ScienceCampus "Digital Public Health" are to help make sure hard-to-reach groups can take part in digital services.

The SPD wants to organize care so that people can grow old in familiar surroundings. All care services are to focus on their neighborhood, cooperate on a binding basis, and close gaps; the start will be pilot projects in selected neighborhoods.

Many people want to stay at home when they are old. So the SPD wants to organize care in each neighborhood. Providers there should work together in a fixed way. First there will be trials in some neighborhoods. Later this should apply in all of Bremen and Bremerhaven.

The plan includes a fund for small neighborhood projects and a neighborhood care coordinator under municipal responsibility, with the long-term care insurers involved in design and funding. Self-help, courses, and respite services for family caregivers, including young carers, are to be supported; contact offices for relatives are to be examined. A trial is to show whether home care services can concentrate on defined catchment areas. Talks with day care providers are to aim at services close to where people live. The concept will be discussed with care insurers, welfare associations, and advocacy groups, and lessons from the pilot neighborhoods are to be applied across Bremen and Bremerhaven.

The Bremen SPD calls for a federal reform of long-term care. Statutory and private care insurance are to be merged into a single Bürgerversicherung (citizens' insurance), benefits are to rise, and the co-payments of people in need of care are to be capped.

The SPD wants to change care insurance across Germany. There should be just one insurance for everyone. This is called citizens' insurance. The state should add more money. People who need care should pay less themselves.

The reform includes higher tax subsidies, having health insurance cover medical nursing care in homes, and a relief budget that bundles existing individual benefits. Care workers are to be paid under collective agreements and get better working conditions. The program also names the "Sockel-Spitze-Tausch," under which people in need of care pay a fixed amount and the insurance covers the rest. The SPD considers the graduated relief for nursing home residents in force since 2021 insufficient, saying insurance benefits have lagged behind prices.

The SPD wants to expand the Pflegestützpunkte (care support centers) so that counseling is available right in the district. People in need of care should also be able to have a personal care adviser who draws up an individual care plan.

The SPD wants more advice on care in the districts. The care support centers should offer consultation hours there. People who need care should be able to have a personal adviser. This person makes a plan for their help.

Counseling is to be available at least in the pilot neighborhoods, for example as consultation hours. Personal care advisers are to be attached to care support centers or service centers, follow up on how the care plan is carried out, and give advice at home on request. For Bremen's 17 service centers, the SPD wants to examine whether they can provide more advice, referrals, household help, and everyday assistance; their resources are to be reviewed and improved where necessary.

The SPD wants to expand care services in Bremen, especially day, night, short-term, and respite care that support care at home. Regular care reporting is to track demand, and higher subsidies for investment costs are to encourage new services.

The SPD says Bremen has too few care services. There should be more day care and short-term care. Shared care apartments should also get support. The state should give money for new places. Regular reports should show what is needed.

The reporting is to cover existing infrastructure as well as the needs and wishes of the population and assess them together with those involved. The SPD wants to examine whether full-time nursing home places will be sufficient in the future. Alternatives to the classic nursing home such as shared care apartments are to be supported, along with specialized settings, for example for younger people needing care or people with mental illness or intellectual disabilities. Services should also reflect the situations of migrants and of queer, trans, and intersex people. The expanded subsidies and pilot projects are also meant to lower residents' share of investment costs, and all facilities are to open up to their neighborhood.

The SPD wants to create more training places for registered nurses and care assistants to address staff shortages. At the federal level, Bremen is to push for collective bargaining coverage in the care sector.

Care lacks staff. So the SPD wants to create more training places. Fewer people should drop out of training. Care workers should be paid under collective agreements everywhere. Bremen wants to push for this at the federal level.

Projects to prevent dropouts are to be developed with the nursing schools. Assistant training is to get considerably more places and make it easier to move on to full nursing training; the SPD wants to examine whether dropouts can have parts of their training recognized to start as assistants or aides. Training for nursing educators is also to grow. Staffing in nursing homes is to be assessed beyond the legal minimum. The staffing regulation under Bremen's housing and care law is to be adjusted and allow family-friendly, flexible working time models.

The SPD wants to ease the burden on nursing home residents by having the state of Bremen cover investment costs, for example through a needs-based Pflegewohngeld (care housing allowance). The state is also to monitor investment costs more closely.

People in nursing homes also pay for the building. These are called investment costs. The SPD wants the state of Bremen to cover these costs. One way is a care housing allowance for people with little money. The state should also check these costs more closely.

Besides care and support, residents pay for accommodation, meals, and investment costs. The program names the care housing allowance as one possible way of covering the costs. The SPD also wants to examine how the housing benefit reform of January 1, 2023 affects nursing home residents and take that into account.

The SPD wants federal and EU rules to limit the activity of profit-oriented national care providers, especially private equity firms. In Bremen, the housing and care supervisory authority is to get more staff, and protection standards are to be checked more strictly.

Some large companies want to make high profits with nursing homes. The SPD says problems are more common there. It wants new rules for these companies. The authority that supervises homes should get more staff. It should check the homes more strictly.

According to the program, care deficiencies are more frequent at such providers; private equity firms are said to aim at quick resale of real estate and to shift profits to tax havens. Rules on protection, pay, co-determination, and staffing levels for employees are to be tightened and better enforced, as are standards protecting residents. Audit rights that currently cover employee pay are to be extended to other cost areas. The SPD names public steering, neighborhood-based organization, and strong nonprofit providers as the best protection.

The SPD wants to make Bremen a model region for the digital health industry. To that end, research, industry and health care providers are to work together more closely, and companies in the sector are to be attracted to the state.

The SPD wants a stronger health industry in Bremen. Bremen should be a model for digital medicine. Researchers and companies should work together more closely. New health companies should move to Bremen.

The platform lists four goals: cooperation, digitalization, attracting companies, and networking. Innovation partnerships among science, industry and health care providers are to be expanded so that research feeds more quickly into technologies such as AI, health robotics, telemedicine and e-health. The companies to be attracted include biotech, medical technology and digital health firms as well as makers of medical devices. The Integrated Health Campus Bremen is to be expanded as a network of these players and to establish health as a defining theme for the location.

The SPD wants to sharply limit profit-seeking in health care and nursing care and will push for this at the federal level. In Bremen and Bremerhaven, municipal and nonprofit facilities are to be strengthened. The platform holds that health and care are public services, not commodities.

The SPD wants less profit-seeking in health care and nursing care. It will push for this at the national level. In Bremen it wants to strengthen city-run facilities. Nonprofit facilities should also be strengthened. Nonprofit means they do not work to make a profit.

The platform criticizes the growing takeover of health and care facilities, and now also doctors' practices, by private companies. It says profits there go to investors and private equity firms and are paid for by insured people through contributions and partly through taxes. In its view, this money is then missing for the care of patients and people in need of nursing care. The development of new medical products and digital applications by private firms is explicitly exempt from this criticism. The restriction is to be achieved at the federal level, while locally the SPD relies on municipal and nonprofit providers.

The SPD calls for a climate plan for the state of Bremen and its two cities that links health and climate policy. Hospitals, nursing homes and rehabilitation facilities are to draw up their own climate plans and use fewer resources. The platform argues that climate change makes people sick.

The SPD wants a climate plan for the state of Bremen. Hospitals and nursing homes should make their own climate plans. They should use less energy and material. The SPD says climate change makes people sick.

The departments for environment, health, economy and finance are to work together, and a cross-sector pandemic plan is to be developed. Hospitals are to ensure sustainability; the platform recommends a "Green Team" led by management and paid for by the funding bodies. Hospital planning, renovations and new buildings are to take climate impacts such as heat, flooding and heavy rain into account. Energy-saving medical technology is to be promoted. Climate protection and health are also to become topics in medical and nursing studies, other training programs, schools and daycare centers.

The SPD wants a heat action plan for the state of Bremen. It is to include a warning system for heat events and to protect and care for especially vulnerable people.

The SPD wants a heat plan for Bremen. The plan should warn people about extreme heat. It should protect people who are most at risk. These are old or sick people, for example.

The plan is meant to avert health risks and harm caused by heat. It provides for an effective warning system and for measures to protect and care for vulnerable groups. In addition, public authorities are to provide easy-to-understand information on the link between climate change and health, which the platform says is little known.