SPD on health and care

The SPD wants binding staffing levels in maternity care and aims for every woman in labor to have her own midwife. Care before and after birth should be available close to home everywhere in the state.

At every birth, one midwife should care for just one woman. Help before and after birth should be nearby. Maternity wards in hospitals should stay open. The state should help midwives with costly insurance.

The plans include midwife emergency lines on the islands and in other underserved areas, coverage of liability insurance premiums for midwives who attend births, and keeping hospital maternity wards open. Support is also to be provided during and after miscarriages and stillbirths. The dual degree program in midwifery is to be strengthened through better pay and practical placements and complemented by a master's program. Advice and financial aid are meant to help freelance midwives settle in rural areas and set up midwife-led facilities.

State civil servants would be able to choose between the individual Beihilfe (state reimbursement of medical costs) and a flat-rate employer contribution to full health insurance. In the long run, the SPD continues to back a single citizens' insurance for everyone.

State civil servants should get a choice in health insurance. They can keep the current system. Or the state pays a fixed share of their premiums. Later, the SPD wants one insurance for everyone.

The model is Hamburg's flat-rate Beihilfe. Under it, the employer pays a fixed share of premiums for full health coverage instead of reimbursing individual medical costs. Civil servants decide for themselves which of the two options to use. The platform names a Bürgerversicherung (citizens' insurance) as the long-term goal.

The SPD wants to make rural practice more attractive for young doctors and to connect medical services better. People should be able to stay in their familiar surroundings even as their need for care grows.

The SPD wants good doctors in rural areas too. Young doctors should like working there. Doctors and care services should work together in centers. Video appointments should also help.

The platform expects many regions to have fewer family doctor practices in the future. In care centers, family doctors, home care services and household support services are therefore to work together. Nursing is to play a larger role in primary care. E-health and telemedicine are meant to add security. A so-called Vor-Ort-für-dich-Kraft (a local support worker) is to help develop neighborhoods and villages.

The SPD wants every county to have care centers offering comprehensive general medicine by 2030. Smaller hospitals are to be able to develop into regional health centers. This is to rest on a care and prevention strategy drawn up with all stakeholders, because in the party's view health must not be organized by profit and loss.

The SPD wants a center with doctors in every county by 2030. People get general medical help there. Small hospitals should be able to become health centers. The SPD says: health is not a product for sale.

The platform favors regionally varied models such as health centers or physician cooperatives; frequently consulted specialists should also be able to set up there. In the health centers formed from smaller hospitals, basic inpatient care, outpatient treatment and nursing are to be linked. Model regions are planned for this, especially where hospital sites are closing. Hospitals are to be networked more closely with each other and with the University Medical Center Schleswig-Holstein (UKSH), whose modernization in Kiel and Lübeck the SPD wants to keep supporting. Regional and statewide health and care conferences with public participation are meant to improve planning.

The SPD wants to expand digital services in health care more quickly, such as phone and video consultations and electronic patient records. In the platform's view, such services can complement and improve local care but cannot fully replace it.

The SPD wants more digital technology in medicine. For example, people should be able to talk to a doctor by video. Patient records should be electronic. The local doctor's office still stays important.

The platform lists telephone and video consultations, electronic patient records and electronic vaccination certificates. In emergencies, paramedics are to receive remote support from physicians. The SPD also backs the first responder concept, meaning trained first aiders, as an addition to the emergency rescue chain.

The SPD wants to set aside medical school places for applicants without top grades who commit to working as rural doctors for ten years. It also wants to create additional places in human medicine. The background is that many practices will need new doctors in the coming years.

Rural areas will soon lack doctors. So the SPD wants to reserve places in medical school. People without top grades can get these places. In return they must work in the countryside for ten years. There should also be more places overall.

The quota is to follow a rule used in Bavaria. For the additional places, the SPD wants to examine awarding them through a repeatable aptitude test that does not depend on high school grades, as Austria uses. If that test does not come, these places are also to be awarded through the rural doctor quota. The party also wants to implement the Masterplan Medizinstudium 2020 (a reform plan for medical studies) and points to the demand for modern working-time models among doctors.

The SPD wants to change billing through Fallpauschalen (flat rates per treatment case) so that it reflects actual costs. Hospital investments in buildings and equipment are to continue to be paid from public funds. Rural hospitals are to receive base funding for keeping their services available.

Today hospitals get fixed amounts per treatment. The SPD wants to change that. The money should match the real costs. Rural hospitals should get money just for being there. The state should keep paying for buildings and equipment.

According to the platform, the current system disadvantages hospitals that are essential for care in rural areas. Because a reform takes a long time, pilot projects in Schleswig-Holstein are to be made legally and financially possible in the short term. These would combine outpatient, day-clinic and inpatient treatment under one roof, especially in pediatric and adolescent medicine. The SPD expects the federal government to permit such pilots for pediatric medicine and child and adolescent psychiatry as early as 2022.

The SPD wants more hospitals to be run by public or municipal operators again. Municipalities that want to take hospitals back under their own responsibility are to receive support from the state.

Many hospitals belong to private companies. The SPD wants more hospitals to belong to the state or to cities again. Cities and counties should get help with this.

For the coming legislative term, the platform announces a review of whether the state should take back the former state hospitals for psychiatry and forensic psychiatry. As its main reason it cites that private operators are currently responsible for the Maßregelvollzug, meaning the secure placement of offenders with mental illness or addiction.

The SPD wants to push for contraceptives to be free for everyone. Couples who are involuntarily childless are to receive financial help for treatment through a federal program, explicitly including unmarried and same-sex couples as well as single people. For abortions, the party wants to secure information, counseling and care close to home.

The SPD wants contraceptives to be free for everyone. People who cannot have children should get money for treatment. This should also apply to unmarried couples, same-sex couples and single people. Women should find good help nearby for an abortion.

Schleswig-Holstein is to join the federal initiative supporting people with involuntary childlessness, because health insurers pay only part of the costly treatments. The platform points out that nearly one in ten couples between 25 and 59 is affected. Women who decide to have an abortion are to have access to information, objective pregnancy-conflict counseling and medical care both in outpatient settings and in all inpatient facilities.

The SPD wants to keep maternity wards in both urban and rural areas and expand care before and after birth close to home. Midwife-led delivery rooms, practices and outpatient clinics are to be supported. Parents should remain free to choose where their child is born.

The SPD wants to keep maternity wards in cities and in the countryside. Midwives should get more support. There should be more training places for midwives. Parents should choose where their child is born.

Support is also planned for freelance midwives setting up practice and for additional birth centers that complement but do not replace hospital obstetrics. Training capacity for midwives is to increase. For the islands and the Halligen (small tidal islands), the SPD wants to develop dedicated solutions that take patient transport into account. Accommodation for pregnant women before birth is to be expanded as needed, and the "Frühe Hilfen" (early support) network is to be kept and enlarged.

The SPD wants to improve access to therapy for people with mental illness, especially children and teenagers. Public education is meant to counter stigma, including in schools. Preventing and fighting addiction is to be given more weight.

People with mental illness should get therapy more easily. This applies especially to children and teenagers. School psychologists should visit classes. The SPD also wants to do more against addiction.

The regional budget model is to be extended to child and adolescent psychiatry. In schools, the plan includes regular class visits by school psychologists, appointments open to all students and project days. Psychotherapy training is to improve; through the Blankoverordnung (a prescription that leaves treatment choices to the therapist), therapists are to work more independently. On addiction, the platform names alcohol, drugs, gambling and the internet. Because online gambling has been legalized, the SPD wants to draw up a plan for player protection and help for gambling addicts.

The SPD wants to raise the number of hospice places in the state to 160 and support hospice work, which is largely done by volunteers. Day hospices are to be funded as pilot projects at first in order to close gaps in care.

A hospice cares for people who are dying. The SPD wants 160 hospice places in the state. Many helpers there work without pay. The SPD wants to support them. There should also be hospices for daytime only.

The party wants to examine how the state can cover training costs for volunteers. Day hospices are meant to close gaps in care between inpatient facilities. Funding for outpatient, day-care and inpatient hospice services is to be secured.

The SPD wants to restructure long-term care close to home and prioritize home-based services over nursing homes. Short-term, day and night care are to grow in order to relieve family caregivers. People aged 75 and over are to be offered a preventive home visit with advice.

The SPD wants better care close to home. Care at home should come before a nursing home. There should be more places for day care, night care and short stays. People aged 75 and over should get a visit and advice at home. This should help them stay in their homes longer.

The home visit is to be introduced with municipalities and long-term care insurers, cover topics such as age-appropriate home fittings and support services, and be part of the Vor-Ort-für-dich-Kraft program. Plans include more care support centers, an expanded and accessible care emergency hotline, and an updated dementia strategy with contact points. The KIWA coordination office for new forms of housing and care in old age is to keep receiving funding. For aging people with disabilities, the SPD wants to work out solutions in residential integration assistance together with providers. Older people's needs are to be considered across public infrastructure and reviewed regularly with senior citizens' councils; volunteers are to get rooms and digital equipment.

The SPD advocates training programs without tuition and with pay that is subject to social insurance, especially in occupations mostly chosen by women. Nurses are also to be trained at vocational schools, and there are to be more university places for nursing. The platform justifies this with the shortage of skilled workers and rising demands in nursing care.

Some training programs charge tuition and pay no wage. This often affects jobs that many women choose. The SPD wants to change that. Trainees should pay no tuition and get a wage. There should also be more places for nursing training and nursing degrees.

The platform names early childhood education as an example of unpaid training. Trainees in all health professions are to be able to take the extra classes for the university of applied sciences entrance qualification at vocational schools. More nursing degree programs are to be set up at universities and universities of applied sciences. The SPD points to recommendations by professional associations that about 20 percent of nursing staff should have an academic degree.