agenda:
As part of marking the due date in the Knesset - a follow-up meeting for:
1. Failure to meet the needs of premature infants in Israel.
2. Critical shortage of pediatricians in the neonatal wards in Israel

were present:
Committee members:
Merav Ben Ari - the Chairman's Mm

Members of the Knesset:
Yitzhak Herzog
Orly Levy Abacsis

invited:
Dr. Siegel Libernet Taub - Head of General Medicine Division, Medical Administration, Ministry of Health
Hadar Yardani - Director of the Department for Child Development and Rehabilitation, Ministry of Health
Dr. Lisa Rubin - Director of the Mother and Child Department, Ministry of Health
Miri Cohen - Director of Rescue Services, Ministry of Health
Moavia Kabaha - Senior Center, Control of Intervention Programs, Ministry of Health
Oren Perlsman - planning field referent, Ministry of Health
Dr. Orli Luz - Nursing Administration, Ministry of Health
Dr. Hila Figel - Nursing Administration, Ministry of Health
Miriam Brashi Cohen - Assistant to the Deputy Director General of the Ministry of Health
Elad Massasa - Health Referent, Budget Division, Ministry of Finance
Aliza Berelzon - Director of the Family Pensions Division, National Insurance Institute
Ester Nimrodi - director of maternity, National Insurance Institute
Sharon Asiskovits - Research and Planning Administration, National Insurance Institute
Prof. Binyamin Bar-Oz - Director of the Department of Newborns and Premature Babies, Hadassah Hospital, Ein Kerem
Prof. Michael Shimel - Director of Pediatric Intensive Care, Shaare Zedek Hospital
Dr. Aganta Golan - Director of the Neonatal and Premature Department, Soroka Hospital
Dr. Israel Eilig - Chairman of the board of doctors of Soroka Hospital
Nurit Baruch - Director of Nursing, Schneider Hospital
Esther Kazmirski - Deputy Director of Nursing, Schneider Hospital
Naomi Alkaoui - director of labor, Schneider Hospital
Dr. Omri Hossam - director of labor, the French Hospital, Nazareth
Abed Masalha - Head of Department, French Hospital, Nazareth
Keren Makdesh - responsible nurse, preemies department, Sheba Hospital, Tel Hashomer
Prof. Yosef Meyrowitz - Coordinator of Pediatrics, Klalit Health Services
Dr. Shmuel Tsangan - Chairman of the Israeli Neonatology Association
Dr. Vared Fleischer Shaffer - Director of the Prematurity Department, Galilee Medical Center, Israel Association for Neonatology
Rumi Shouri - Executive Director of the Israel Association for Premature Infants in Israel
Tali Binyamin - Lehab association, for premature babies in Israel
Shelly Burns - Lehab association, for premature infants in Israel
Giti Meirovitz - Lehab association, for premature babies in Israel
Zahvit Dvash - Lehab association, for premature babies in Israel
Shoshana Budinstein - Lehab association, for premature babies in Israel
Rinat Farber Malomed - Lehab association, for premature babies in Israel
Shlomit Harel - audit committee, LHB association, for premature babies in Israel
Dr. Sharon Hermati - the association for the Mother's Milk Bank, the Lehab Association, for premature infants in Israel
Dr. Ravid Schechter Hospital - the Association for the Mother's Milk Bank, the Lehab Association, for premature babies in Israel
Leslie Wolff - Lactation Consultant, Ichilov Hospital, Lehab Association, for premature babies in Israel
Michal Kabara
Tali Tesler -
- Lehab association, for premature infants in Israel
Mother of a premature baby and parliamentary advisor to Knesset member Tamar Zandberg
Meira Basuk - Attorney at Law, Legal Chamber, Namat
Galia Niv - welcome
Tal Ben Ari - invited
Yehoshua Shlomo Zohar - lobbyist (Goren Amir Consultants Ltd.), representing Klalit Health Services
Avishag Shaham Hadad - lobbyist (Giladi government relations and lobbying), representing the Israel Medical Association (additional regular clients that the topic of the meeting directly affects: Meuhedat)

Director of the committee:
Anat Cohen Shmuel

Parliamentary Register:
Ahuva Sharon, translation friend

As part of the observance of Prematurity Day in the Knesset - a follow-up meeting on: 1. Failure to respond to the needs of premature infants in Israel. 2. Critical shortage of pediatricians in the neonatal wards in Israel

Chairman Merav Ben Ari:

Good Morning. I am replacing Knesset member Eli Alalof. We are opening the Labor, Welfare and Health Committee meeting. Today is the 14th of November 2017, 25 in Hashon of the year 2018. The issue is part of the celebration of Prematurity Day in the Knesset - a follow-up meeting on the failure to respond to the needs of premature babies in Israel and a critical shortage of pediatricians in the neonatal wards in Israel.

This day is part of a special day to mark the overdue day initiated by Knesset member Orly Levy Abacsis who will join us after she finishes another debate she is in. We will start because we are limited in time and I want to hear from everyone who came.

We were joined by Knesset member Orly Levy Abacsis.

Orly Levy Abacsis:

I will give a short introduction since a large part of the invitees are still in the committee for the rights of the child. This is such an important topic. When we talk about premature babies in the State of Israel, year after year we point out here in the Knesset and at the same time we also continue to operate throughout the year and do our tests. On this special day we present what we managed to achieve and what we didn't. Over the course of these six years, together with the Lehab association, together with the organization of neonatologists and the managers of premature births and the unimaginable collaborations between all these groups, brought about a real change. In the first place, to reach premature births, which the Ministry of Finance did not want to let us do. Therefore, the hospital managers were sovereign in deciding what they do with the money that the state transfers for each low birth weight, premature birth, and the funds would have gone elsewhere.

There could have been a situation where the state paid for a premature birth and the money would have gone to the public relations of the hospital, to pay for electricity, to another department that is in need. We could not divert the funds to save these children.

Even from an economic point of view, that child who does not receive the proper treatment in time, will develop deficiencies that will accompany him all his life and he will be on the fringes of society or there will really be a Sisyphean struggle for the parents and the children how to exist within the daily routine.

We were able to channel some of the funds, we were able to bring in additional regulations and we are still lagging behind the rest of the world in terms of personnel standards in pre-schools and especially in the community. If somehow we were able to create an incentive model that comes and gives grades, which prematurity in some hospital invested more money, where they improved, where the level of infections decreased and as a result receive hypocritical funds, we were not able to do this completely in the community.

My friend Moli Tsangan, who is the chairman of the neonatologists, together with other neonatologists created some kind of work program in the community. Still, even though a circular from the Director General of the Ministry of Health came out, when we look to see what is happening on the ground - not much. Apparently the cash registers are also waiting for some kind of incentive. The CEO repeats, we need to understand that apart from the financial matter that goes through, the funds do accept, they don't accept, what do the insured get, the child who won't be scheduled with a pediatrician on time, the nutritionist who needs to adjust the right diet for his development, the neonatologist who will examine him in the community , the physiotherapy, occupational therapy treatment and the like, we will not be able to minimize the damages that these children will carry with them for the rest of their lives.

Those parents are often forced to leave their workplace. We somehow managed to deal with this and I can tell you that in the previous Knesset I was able to pass the law that says for every hospitalization of a newborn, whether it is premature or due to another illness, the mothers, the parents will continue to receive and have their maternity leave extended, including all the accompanying payments, when in the past women had to leave their place of work because the maternity leave is over and this is still while the child is hospitalized. It was corrected and I think it is the only paid maternity leave extension in the State of Israel and I am proud of it.

But there is still a long way to go, if we still discover that, for example, in the whole issue of intracerebral hemorrhages in premature infants in the State of Israel, it is far above the average in the OECD, above the average in all developing countries, which means that these children will later suffer from problems. It can be about a wide spectrum of problems and it can also be minor things.

I just spoke with the manager of the maternity hospital in Shaare Zedek and he told me about an amazing program that is already being carried out in other parts of the world. They showed that with a certain treatment of brain stimulation - and he will probably give the explanation better than me - they were able to make these premature babies develop a kind of bypass roads to their problems. I ask why it doesn't work in Israel. They gave me a very simple answer: because it costs money. How much does a child's life cost? How much is his life expectancy and quality of life worth? Maybe we should just talk financially? So let's ask the insurance companies how they calculate a person's life expectancy and quality of life. What about the family that needs to be mobilized for this story because God forbid there is a disabled child at home? Everyone pays the price and we have to come and say that with all the progress we've had on the subject of premature babies, the road ahead is still long.

I will try not to extend any more and just say that I would be very happy if next year we meet here and say that the funds also learned something and the funds started investing in their premature babies. Maybe we should come and publish, as we do with the premature babies in the star model, the same registers, how long it takes to wait in line for a pediatrician for a premature baby in the community and find out how long it takes to wait for occupational therapy, a speech therapist, physical therapy, a thousand and one things that these children need in order to develop into adults norms.

I just met a hospital manager who was born prematurely weighing one kilo and fifty grams. think about it. You can say a bag of sugar. My niece was also born prematurely and I remember always saying it's like a kilo of sugar we hold in our hand. It's unbelievable. There is a real miracle here, but if we don't know how to invest the same budgets that are required, this miracle will not be perfect.

Our job is to ensure normal development and if we have to fight for it, we know how to fight. If it can be done well, what good. Thanks.

Chairman Merav Ben Ari:

Thank you. We will move to the Ministry of Health.

Siegel Libernet Taub:

Good morning everyone. I am the head of the General Medicine Division, Medical Administration, Ministry of Health. In the next few minutes I would like to present what the Ministry of Health has done for premature infants in the State of Israel. Of course, we still have a lot to do, but I think that on this day it is important to emphasize the situation of premature babies and premature babies in the State of Israel.

Some general background on what is happening in the State of Israel. We have about 183 thousand babies born every year. The number of premature babies who weigh less than a kilo, 750 grams, has remained fairly stable over the years and is between 2,600 and 2,800 premature babies. In Israel there are thirty preemies including Asuta Ashdod which opened this month with 870 cribs. Of course, the maternity hospitals have freedom of choice.

what happened four years ago I would like to preface by saying that the issue of treating premature babies and in newborn care units is on the agenda of the Ministry of Health and the program to promote premature babies has become our flagship program. This year we are celebrating four years of activity with an investment of about two hundred million shekels which were distributed among all preemies in the State of Israel. The situation four years ago was very bad. We have reached a situation where premature births in the State of Israel definitely - I agree with Knesset member Orli Levy Abacsis - were the backyard of the hospitals. It was not in the center of interest of the hospital administrators. Publications from various publications, including the State Comptroller's report, pointed to the dismal situation of premature babies in the State of Israel. There was overcrowding, there was congestion, there was not enough infrastructure, there was infrastructure damaged by premature babies, there was not enough personnel, neither doctors nor nurses, there were very high infection rates.

So we set off. The first thing we did was establish a ministerial committee that decided to settle the matter. The regulation of the issue was in the form of a medical administration circular that established the recommended standard in terms of infrastructure, personnel and quality of premature babies in the State of Israel. We defined the subject of neonatology as a profession in need and thereby increased the number of doctors who came to this profession.

Orly Levy Abacsis:

Still, how many doctors are missing?

Siegel Libernet Taub:

Many doctors are missing.

Orly Levy Abacsis:

About a hundred doctors. No?

Siegel Libernet Taub:

Not exactly a hundred.

Orly Levy Abacsis:

Close.

Siegel Libernet Taub:

According to our calculation, a little less. We defined this profession as a profession in need in order to bring more doctors to it. We also defined the specialist nurse in premature infants. The thing that really changed the essence and the state and the quality of premature care was our model. We implemented a dedicated incentive model that measured the inputs and the results according to the standard recommended in the medical administration circular in all areas - as I said, in infrastructure, manpower and quality - when this model stimulates the activity of premature babies and thereby actually directs the hospital's resources towards premature babies and ultimately improves the quality of premature care.

This model is a dynamic model. We update over the years and between 2014 and 2017 we updated every year according to the needs in the field, according to the hardening of the required standard, the insights that emerge from the field and of course the consultation with the professionals.

This model rates the preemies. Every year we do a check on every preemie, we check all the parameters we defined every year and we reward the preemies that get the highest marks.

Chairman Merav Ben Ari:

How do you get a high score in prematurity?

Siegel Libernet Taub:

All the ingredients must be met.

Chairman Merav Ben Ari:

Give me an example of something that gives honor to prematurity.

Siegel Libernet Taub:

You have to meet the standards.

Chairman Merav Ben Ari:

Give an example of two or three indicators that you check for premature birth.

Siegel Libernet Taub:

The number of personnel, the number of nurses who have passed a basic course, the presence of a breastfeeding room, the presence of a medicine room, the distance between cribs, the presence of incubators.

Orly Levy Abacsis:

A reduction in the rate of infections.

Siegel Libernet Taub:

A reduction in the rate of infections. Later on I will mention all the things that we are checking and that have led to improvement.

Chairman Merav Ben Ari:

We were joined by the chairman of the opposition, Knesset member Yitzhak Herzog.

Siegel Libernet Taub:

We also reward the preemies not only according to their highest score but also the improvement over the years. We can say that so far all 29 premature babies during these four years have received some kind of incentive because they have shown some kind of improvement and of course an improvement in the quality of treatment of the premature baby.

Every year we improve our incentive model and this year we did two new things. One, we took some of our model's money and divided it horizontally among the preemies. Each preemie received a million shekels in order to comply with the list of equipment that we thought was necessary for each and every preemie. In fact, we created some kind of standardization for all preemies regarding the quality equipment that we think every preemie should have.

In addition, we divided the premature babies this year into three houses - for large hospitals, medium hospitals and small hospitals - again, listening to the field. We saw that there is a problem in comparing a large hospital that treats patients whose mix of diseases is a little different than in small preemies. That's why we decided to compare the big hospitals with the big ones, the medium ones with the medium ones and the small ones with the small ones.

results Despite all the announcements this morning, I think that the Ministry of Health has come a very, very good way in the last four years in several indicators. Yes, I wanted in the few minutes I had left to present the results as we check them.

The control score in preterm infants. We started with an average of 33 percent in 2014. There is no doubt that this is very bad. At the end of 2017 we reach an average score of 85 percent and this 85 percent is much more significant because year after year we have tightened the standard and added things. There is no doubt that the improvement in the system is very, very significant.

When we started the model we were told that premature babies in the periphery would probably be harmed by the subject of our incentive and that we would probably incentivize only the big hospitals and the periphery would be damaged. We see from the beginning of the model to the end that the preterm scores in the periphery are not only average but above the national average, so that the periphery is also able to make a significant change and benefit from the funds.

Orly Levy Abacsis:

Of course she can. When there are budgets, she knows how to meet the goal. The whole story is narrowing the gaps. Put the budgets where they are missing, believe me the results will come. Here, factually.

Siegel Libernet Taub:

Right. Another thing that I think is the most significant is that we checked, and we are checking, the rates of the acquired blood parasite in all premature babies. We check the blood platelet acquired in prematurity for a thousand days of hospitalization. We started in 2014 with a very high rate of these infections. Towards 2017, we reduced by seventy percent the incidents of contamination in premature babies. We have come a long way. That doesn't mean we can't download more. We will do more but this is a very, very significant improvement.

Likewise when we compare the periphery with the national average. The rate of improvement there is much higher.

During these four years we have improved the whole issue of human resources in early childhood. We have added 293 nurse standards, 121 of whom have gone through a basic course in premature intensive care. We added 16 nurses specializing in neonatology. We added about fifty neonatologists, ten specialists and forty interns. We have added sixty standards of health professions and for the first time there is a dedicated standard of a nurse to prevent infections in every preterm birth in the State of Israel.

I will emphasize and say again that we have improved the infrastructure in preemies in the State of Israel and created some kind of standard that is the same for each and every preemie. I can tell you that in the State of Israel today, in November 2017, there are thirty digital X-ray machines in thirty preemies throughout the State of Israel.

Yitzhak Herzog (the Zionist camp):

Regarding the infection prevention nurse. There is such a thing. Is this a full time job in prematurity?

Siegel Libernet Taub:

Yes. prematurely

We added 110 new beds in preemies. We added parents' rooms, nursing rooms, milk kitchens, medicine rooms, 11 new isolation rooms, of course some of them were in the system, but we added them. There is no doubt that we brought the preemies today, after four years of the Timrutz model, to a completely different place than it was. There is no doubt that more can be done. We do not ignore the challenges that exist, both in terms of personnel and in terms of infrastructure, but it is important to note just like the headlines that appear in the press today.

Regarding the rating of the model in 2017. As we said, we divided the centers according to super, medium and small centers. It is important to note that the excellent ones are rewarded and the good ones are rewarded, and also those who improved beyond the average of their house, they also received funds from our incentive model.

Again I want to emphasize the periphery. 24 percent of births in 2017 were in the periphery. 27 percent of our budgets of the incentive model went to the periphery and there is no doubt that we are seeing the improvement.

A little about the construction in the field. It is important to note that our model made the hospital managers put the premature babies in the center. It may be that the money, the incentive model, is not hypocritical, but there is no doubt that today's hospital managers invest and sometimes even more than what the incentive model gives them. We see new preemies built in Carmel Hospital, Rambam, Hadassah Ein Kerem, Assuta and San Joseph. We see preemies that these days are being protected in Nahariya, Laniado, Schneider, and next year construction will also begin in Hillel Yaffe, Ziv, Barzilai, Soroka and Zarfati in Nazareth .

I would like to thank my friends in the budget department, the nursing administration and the medical administration, and of course the neonatological association, which is the one that outlines the professional path for us. The Ministry of Health is doing its best as a ministry, as a regulator, as someone who promotes things, budgets and processes, but the professional aspect is led by the Association of Neonatologists. Thank you very much.

Chairman Merav Ben Ari:

Thank you. I have to tell you that it is very impressive. I've been on the committee for two and a half years and I often replace Knesset member Alalof and all the time officials come here and twist. Presenting a very impressive presentation and also an important activity. should be praised. strength You took the issue, raised awareness. In the end, wherever there are resources, there are successes. Once you put in resources and knowledge, it doesn't matter where in the country you are.

Knesset member Herzog, do you want to comment?

Yitzhak Herzog (the Zionist camp):

I would like to thank Member of Knesset Orly Levy Abacsis for this day's initiative. We will participate in some more discussions. I want to thank you too, Madam Chairperson. It looks impressive. There are many issues that come to us concerning premature babies and preemies.

I have an intriguing question and it is what was the smallest prematurity you had in the system. I came across a premature baby that weighed 650 grams.

reading:

It's a big miss.

Yitzhak Herzog (the Zionist camp):

This Pega is now serving in the IDF. Not from my family but I know her closely.

reading:

Is 440 grams low enough?

Yitzhak Herzog (the Zionist camp):

And what about the global test?

reading:

Do not know.

Rose Fleischer Schaffer:

The question is what is the quality of life afterwards. He went home - as far as I'm concerned, he has a chance to be a healthy child.

Michael Schimmel:

He who was Peg, today is my colleague. He was born in the 30th week, weighed a kilo and a half and today he is one of the neonatologists in my department.

Chairman Merav Ben Ari:

I would like to hear from Rumi Shouri, who is the CEO of the Lehab Association, for premature babies in Israel.

Black Rumi:

Peace. Thank you. Thank you for the stage and for dealing with this very important issue. Every year I say it, but I will come back and say it. You talk about premature babies, but with us these are our children. I am the mother of Liya, born at week 29, 768 grams. Today she is eight years old and we have a very, very extensive history.

The theme of the star model has made a far-reaching change in preemies and we welcome it. There is another way. The Lehab Association is a small association that is based on donations, and we still hear from preemies that there are needs for the well-being of the parents and the preemies themselves. The association donates equipment throughout the year according to our ability, whether these are milk pumps, incubator covers, noise meters, equipment for parents' rooms, anything that arises from the field If the association has money, it donates.

I would like to see in the model more funds allocated for the purpose of purchasing this equipment for premature babies so that the association can invest the donations more in the parents. Thank you.

Chairman Merav Ben Ari:

Thank you. The chairman of the Israeli Association for Neonatology, Dr. Shmuel Tsangan.

Shmuel Tsangan:

Hello and good morning. Thank you to Merev and Knesset member Herzog for choosing to come and participate in such an important committee. Thanks.

In the State of Israel, about 13,000 premature babies were born this year, of which 1,600 had a very low birth weight, that is, under one and a half kilos. 630 premature babies are born with a tiny weight of less than a kilo, between the 24th and 28th weeks and they really represent the most significant challenge in terms of treatment, life expectancy and quality of life afterwards.

I am aware of the responsibility, the duty and the privilege to be here for these premature babies on this festive day, on behalf of the dedicated nurses and doctors along with the parents, with Romi from the Hebrew Association and all the parents, and of course Knesset member Orli Levy Abaksis who for years has been working and leading with determination and dedication the movements for premature babies in Israel.

I would like, with your permission, to note the achievements on the side of the challenges. The achievements include recognition by the State of Israel of the need to add nurses to care for premature babies. Not only to staff the standards but to add dedicated standards for intensive care nurses. I have every hope that the agreement signed in initials between the Ministries of Finance and Health and the Chairwoman of the Histadrut Nurses Ilana Cohen - which I am sorry she is not here to confirm but the representative of the Treasury Elad is here - I hope to hear from him that this agreement, which until now has been in some kind of secrecy, will indeed be signed. This is a welcome step in the right direction.

Additional congratulations, of course, to the topic of the incentive model that Siegel described so well. It is the fruit of labor that should be noted for the first ones who conceived it together with Orli Levy Abacsis and Professor Roni Gamzo who was then the Director General of the Ministry of Health and Oren who is here. We sat and built the model and we never dreamed that this model, which brings so much blessing to preemies, is going to be a role model for other projects in other sectors .

I want to fix. The incentive model, it's not special money.

Orly Levy Abacsis:

This is not new money.

Shmuel Tsangan:

It's actually the silver of the preemies that we created and dyed, the closest to what you can call the coloring of the silver to return it to the preemie. This is a blessed thing and we should say a big blessing.

Another achievement that should be noted and celebrated is the news that a breast milk bank is about to be established in the State of Israel. First Bank. This will be discussed in more detail in another committee today. It will be in MDA and I wish success to MDA. We are of course very excited about this.

Along with the achievements, the challenges should also be mentioned. On the side of the challenges, there is still a significant gap in the high mortality and morbidity rates of the tiny premature babies in Israel compared to developed countries. Thanks to our program, a quality improvement program called Touching Zero, to lower the rate of blood-acquired infections in preterm infants, as noted, a significant fifty percent decrease in the rate of infections in preterm infants under one and a half kilos was recorded. It is important to note that these rates are still three times more than what is customary or what exists in the western world. We dropped from six to three infections in central catheters per thousand catheter days, while the average in developed countries is between 0.5 and one per thousand catheter days. We have indeed made great progress, but there is still a way to go. Soon I will detail what I propose to do to really align and even lead in this aspect.

Even on the issue presented in the media, it may be exaggerated but it is a fact that cannot be denied, the issue of intracerebral hemorrhages in premature infants with a tiny birth weight. Unfortunately in the State of Israel twenty percent of them, one out of five of those prematures who are 630 prematures this year, have significant intracerebral bleeding that can cause death and severe disability. We need to know this figure in order to present a work plan in front of this thing.
Orly Levy Abacsis:

How do you reduce it in the world?

Shmuel Tsangan:

That's exactly what I'm going to talk about. These are the same steps that I propose and call upon the State of Israel to adopt, not necessarily the Ministry of Health, but the Ministry of Health as the professional ministry is of course a guide. I must point out that the office is aware of these issues and we are working together to promote things.

In order to close the gap, the state must formulate a plan that will bridge a decades-long delay and upgrade the pre-term infants in Israel and adjust to the standards of the 2000s. A circular was published in 2013 which is one of the pillars of the incentive model. You just have to take this circular, develop it and place our preemies in the program so that they will be the preemies of the 2000s. When I say two-thousand-year preemies, I mean spacious preemies that give the mother room to be as close to the preemie as she wants, giving all the required envelope, the availability of the additional medical professions to be on the care team. The concept of family-oriented prematurity or single rooms for prematures, this concept that already exists in the Western world, does not yet exist in Israel.

Benjamin Bar-Oz:

exists in Ein Kerem.

Shmuel Tsangan:

Right. It existed in Ein Kerem when a few months ago it entered and received eight single rooms which, let's face it, were also rooms that belonged to intensive care for children and in their design are not the most suitable for treating premature babies. But this is the first swallow and as Siegel said, there are mishaps along the way but it should be something more structured.

The State of Israel lacks over a hundred doctors and this also appears in our incentive model. To add to this problem, doctors have not yet been arranged to treat the mature babies. I must mention this phenomenon here. Beyond the lack of neonatologists, which is indeed defined as a profession in need, in the State of Israel the issue of who takes care of the mature babies has not yet been settled. The responsibility of taking care of the mature babies, talking to the parents, releasing them, the responsibility of caring for those 183 thousand mature babies, rests with us as well. Dr. Adi Golan, who is the director of the preterm and neonatal department in Soroka, which is one of the largest hospitals, will soon describe the great distress.

Orly Levy Abacsis:

I think that at least the non-professional factors can miss here. explain When you talk about the term newborns, you mean babies born at the normative time.

Shmuel Tsangan:

Yes.

Orly Levy Abacsis:

But what happens is that doctors, who are also in short supply of premature babies, are being asked to take care of the other newborns.

Shmuel Tsangan:

exactly.

Orly Levy Abacsis:

It turns out that the shortage of doctors is becoming much greater than it was in the first place. This needs to be taken care of.

reading:

It's not lending. It's part of our job.

Orly Levy Abacsis:

It's part of the job. That's why the shortage is greater because there are no doctors for children and the neonatologists have to treat both the tiny prematures and the big ones.

Shmuel Tsangan:

exactly. Here you have to think creatively. In many developed countries, the care of full-term newborns is done in the form of reaching out. The communities are already entering the wards, taking care of the children, making contact and there is the whole issue of continuity of care. There is definitely something here that needs to be developed and done. This issue is known to the Medical Association, as well as to the Ministry of Health, and in this matter we need to move forward, to provide a solution for the mature newborns to allow the neonatologists to treat premature babies properly.

In the preemies of Klalit's medical centers, only 23 intensive care beds for preemies are registered out of the required eighty.

Orly Levy Abacsis:

And this is the biggest jackpot.

Shmuel Tsangan:

And this is the biggest jackpot. What further worsens the situation is that the preemies of the government hospitals have a sufficient and satisfactory amount of intensive care beds. For some reason there is a shortage of intensive care beds in the general hospital and only thirty percent of the beds are staffed.

There is also a shortage of nurses and Siegel pointed that out. Hundreds of nurses are missing. I very much hope, if Elad gives confirmation, that the agreement was indeed signed and published, that the addition of the nurses - this is an insufficient but nice addition - will be. If we are informed that this agreement has been signed, I will of course thank and congratulate.

I want to end with something that may not be the most important, but it is very important that it does not necessarily refer to the issue of infrastructure and that is the issue of promoting national programs to improve the quality of care for premature babies. It should be understood that this issue of lowering the incidence of acquired infections as well as lowering the rate of intracerebral hemorrhages, is a national project that requires us to be given quality improvement tools. Managerial leadership should be fostered and knowledge sharing should be encouraged between preemies. A database should be established in order to know what needs to be improved and what indicators should be followed. You need to specialize in accurate and high-quality execution of the treatments through high-quality training for teams, observations, conducting investigations and extracting lessons for every event.

In conclusion. I am sure that carrying out these recommendations will close the gap between us and the West and even place us in a leading position because our nurses and doctors have the commitment and knowledge to do it. Thanks.

Chairman Merav Ben Ari:

Thank you. Thank you very much for all your activity. No doubt that is part of the matter.

Reference of the Treasury.

Elad Masasa:

I spoke with Doctor Tsangan this morning as well and told him that the agreement is not a state secret and it has already been signed. Following the leadership of the Ministry of Health, the issue of premature babies is something that is very important to their hearts, they prioritize the issue high in their priorities, in the last year we reached agreements with the Nurses Association regarding a significant addition of nurses to all premature babies in the government hospitals and I understand that in general they are also making progress, an addition of about 120 nurses to the government hospitals - not to mention Klalit - when the first pulse should be as early as January 2018. As we see it, following the needs that have arisen from the field, this will provide a very significant response to the quality of care for premature babies.

Oren Perlsman:

Ministry of Health. The issue of beds is in the process of being arranged within the office. We call on the hospitals to apply separately and regulate the registration.

Chairman Merav Ben Ari:

What about the general?

Mu'awiya blacked out:

I will answer you about that. I am from the medical department of the Ministry of Health. Not to mislead the public, it is true that there are records and what is written in general terms is in the records. In practice, Hakhalit hospitals operate a number of intensive care beds in preemies as required. It is simply necessary to settle the registration issue. This does not mean that there is no intensive care within the wards.

I must point out that as someone who has accompanied the model for four years with Dr. Shmuel Tsangan, who did a wonderful job, the preemies passed the so-called TMA 38 in the last four years. I also invite the committee to come and visit the preemies.

To your question about the scoring in preterms. We succeeded in the ingenious model that is common to all of us to create some kind of pathway, to force the hospitals to invest in areas that, according to our mapping over the years, we discovered that there is a serious lack of them. For example, in the regulation of nurses and the regulation of doctors. A hospital that wants to be ranked among the best will have to, and has no other choice, to invest in the areas that are lacking. The model created this competitiveness and I think we are in the right direction. It is true that there is still a shortage, but we must not ignore the huge and tremendous result we achieved in the last four years.

Chairman Merav Ben Ari:

Right. Thank you. The French Hospital in Nazareth, Doctor Omri Hossam, director of the department.

Omri Hossam:

Good Morning. I will not repeat Dr. Tsangan's words. I'm from the outskirts and I'm also a private public hospital, so I'm neither from the general nor from the government. The first thing I want to introduce is the sisters. You talk about the addition of nurses, I think all our preemies are excellent.

Chairman Merav Ben Ari:

How many premature babies do you have in your department?

Omri Hossam:

We have almost 3,000 births a year and we have five intensive care beds and we admit almost ten and 12 premature and unhealthy full-term babies into our prematurity. Next year we are going to build a new prematurity and I hope it comes to fruition. There is talk of perhaps uniting or collaborating between the maternity hospitals of the hospitals when the maternity will be in the French hospital.

I want to talk about the sisters. You are talking about nurses and I think that when talking about standards and reinforcement of nurses in the hospitals, do not forget that there are hospitals that are non-governmental and not of the general government. In my opinion, there should be a national deployment with budgetary funding also in relation to nurses. It is impossible to come to nurses in the model of 2017 when there were 1.4 nurses for intensive care and today you increased in 2018 to 2.5 nurses for intensive care. When I'm going to bring in 15 more nurses, that's a huge budget. Therefore, in my opinion, the Ministry of Health should know that there are premature babies and that there are hospitals that are not general and non-governmental, and in my opinion, funding should be done for all premature babies equally.

Strengthening hospitals. Next year we are going to build a new hatch that I hope will come to fruition. In my opinion, there should be help and funding for the hospital so that it can establish it because it involves millions of shekels and it's not easy to build a hospital or renovate a hospital without help.

Regarding the fake money you talked about. Bless you for the hypothecated money which is 800 thousand shekels and two hundred thousand shekels from the hospital. I think the Ministry of Health should control this money. You provide the quality indicators that provide funds that reach millions of shekels, there should be control here as well. The throne, this hypocrite, should be raised so that it is equal to all preemies and even reaches the amount of two million shekels. It is blessed money. It's money that goes to premature babies because it's money you're criticizing. I know from my friends in other preemies that you don't have control over the money and it's hard to control it. Therefore, in my opinion, to take out of the money you give it, to increase the borrowed money. I think it's for the benefit of premature babies.

Chairman Merav Ben Ari:

Thank you. I'm sorry, we have a lot of speakers.

Omri Hossam:

last sentence I am from the French hospital in Greater Nazareth which includes Afula and the valley. Since the circular of the Ministry of Health came out in 2016, I went to the district director of Nazareth but no such move was established in Nazareth or the northern region. There is no existence of the circular. I have been working on this since last year for a whole year with the district. Now Dr. Efrat Shabaa Schneider understands that this matter is very important and is going to establish an institute or a clinic for premature babies in the community in the Nazareth-Afula area.

Chairman Merav Ben Ari:

Thank you. We want to hear from Tali Tesler, who is the mother of a premature baby and also the parliamentary advisor to Knesset member Tamar Zandberg.

Tali Tesler:

Thank you for the right to speak. I gave birth nine months ago at the 26th week, 823 grams, at the Ichilov Hospital. I want to say a few things from a parent's perspective. In my experience in prematurity I had the feeling that there was some kind of lack of support or mental assistance for parents during the stay in prematurity. Being premature is a very complex thing. At least with us in Ichilov there are no separate rooms and Pegeia is a place where many miracles happen but also many very difficult things. The parents are there for each other and talk about perhaps the most difficult things that they go through without knowing basic things about each other, but I really felt that there was some kind of lack of such an answer.

Mu'awiya blacked out:

Before you continue, I want to address this point. After mapping, understanding what you are saying, we are considering - and this is already in an updated draft of the medical administration circular - to introduce the profession of psychologist, which is both intended for teams and parents in preemies. It will probably enter in 2018 and this is a welcome step.

Tali Tesler:

Thanks. In general, thanks to the Ministry of Health for everything it does for us and for premature babies.

Regarding the community. I say something personally. The child development institute that my baby is being treated at, her physiotherapist was about to give birth. Giving birth is something for which there is a lot to prepare for, yet after she gave birth I had no answer and for almost two months I did not come to physical therapy with my baby. When I called Nandan every time, I was told that they have a lot of traffic because parents are more aware today and therefore they want to come more. It is important for me to emphasize this because it was said both in the morning in the committee and here.

reading:

don't give up

Tali Tesler:

True, but if you are not a bullying parent, not an aware parent, do not know the CEO's circular and do not work in the Knesset, it is difficult. You are right, do not give up.

After the release, it is important for me to say that all the follow-ups are working hours and these things are worth the money. A lot of parents are afraid to put a premature baby in kindergarten in the first year and doctors don't recommend it, so they have to hire a nanny, which means very, very high costs.

An opportunity to thank from the bottom of my heart to Knesset member Orli Levy Abacsis for everything you do all these years, for many years I've seen you do it, and also for the maternity leave that when I left the delivery room, the first thing I checked was because I said there's no way I'm spending my leave now My birth is premature. I was shocked by what the law provides. Thank you very much for this.

Yes, it is important for me to say that there are mothers who are more than twenty weeks premature. These are not many mothers.

Orly Levy Abacsis:

We are trying to expand it for a day. I mean, as long as it takes. Here, the finance representative is here. It is not about many mothers who remain premature.

Chairman Merav Ben Ari:

He was talking while you were out. I want to give to more people.

Tali Tesler:

i finish It was important for me to say these things. One last thing is a reference to all the activities that are being done because I just heard the Ministry of Health. Thank you for all you do, but all the frustration and headlines in the media, the media talked about a report on the condition of premature babies published by the LB Association and the Association of Neonatologists. Without these organizations, parents like us would not receive intensive care for children, no sitting area for premature babies, no pumps. That is, the activity of the civil society also includes headlines in the media, it is important.

Orly Levy Abacsis:

If we didn't put out these reports every year, we probably wouldn't have started the star model in 2014.

reading:

The balance is important. I'm not saying it shouldn't be published, but the balance is important.

Tali Tesler:

Thanks to the Ministry of Health for everything it does, but thanks also to the LB and the Association of Neonatologists.

Chairman Merav Ben Ari:

Thank you. Professor Meyrowitz, Coordinator of Pediatrics, General Health Services.

Yosef Meirovitz:

I wanted to point out that there is a welcome activity here that is done in the hospitals, but premature babies, as the whole forum here understands, need close and close monitoring for many years. A very, very meticulous procedure came out that defines what the child needed later.

Due to the shortness of time I will only say that we did a very detailed mapping of the needs. There is an example brought up, for example, from the North District. We sat down all the factors because these are also factors some of which are in general and some of which are not in general and examined what is required to really realize it. I say by and large that most premature babies get what is required, but there are quite a few gaps. The gap that I think is important and should be closed is a gap related to information. Knesset member Orli Levy Abkasis brought it up. We understand that some premature babies are born in government and private hospitals and transfer to the general and other funds, and some prematures born in general hospitals transfer to other funds. That's why a national move is required here, to create this foundation.

Orly Levy Abacsis:

This requires information sharing.

Yosef Meirovitz:

Information sharing. I think it is essential. Once you have a database, you can really track things well. We have done this in many subjects in the past and I can say that we are advanced in many areas, including the training of all the professions that need to be trained specifically for monitoring premature babies. Some of these moves with us have been carried out and some will continue to be carried out in the future. I think that in terms of the opening we are in a situation that promises a significant improvement.

Chairman Merav Ben Ari:

Thank you. Dr. Aganta Golan from Soroka Hospital.

Aganta Golan:

Thank you. I want to congratulate the work of all the people involved in the model. I still have only one statement in this regard, and that is that there is a great need for a regulator to look at the equal medicine between the hospitals of the General Health Fund and the Histadrut. Still, the model in some form is not implemented in the field in an equal way in all hospitals and this requires testing.

The topic I wanted to refer to is precisely the topic of the healthy newborn. The very fact that this day is called prematurity day, it only shows the distortion when no one takes into account that prematurity is only ten percent of all births in the State of Israel, depending on the different hospitals. Fifty to seventy percent of the neonatologist's time, one hundred of which is missing, instead of engaging in promoting projects such as lowering infections, lowering intracerebral blood and other quality improvements that will improve our results in relation to the world, we are engaged in determining health, which is no less important. The Ministry of Health issues more and more instructions about the obligation to record the things, that a hearing test was done and all. There is no standard for the healthy baby. The Goldberg document referring to the healthy newborn was never implemented.

I will give you a live example. When a new maternity ward was opened, it means that they recognized the need for more midwives, more gynecologists, more nurses, a nurse in charge, a gynecologist and zero standard for a doctor to examine this baby. It falls on my shoulders and the shoulders of my team and we are busy - instead of the super professional work we have, and there are a handful of lone people who deal with the sick newborn - in the great mass of the healthy newborn. This requires immediate correction.

This thing also brings about a very great distress in turns. Some of this work does not require super expertise in neonatology. This means that even in shifts there is a violation of the interns' law when they don't get to nap because they run to the delivery rooms and there is no one to replace them and there are no more standards. They do the maximum number of shifts they are allowed and every morning we see a violation of the law because our doctors are unable to rest. All as a result of the fact that there is no standard for the doctor for the healthy baby and this is something that requires immediate correction before the wards collapse. The infections, instead of seeing a decrease, will increase and we will not be able to lower the intracerebral bleeding.

The union sets up improvement projects at a super professional level, but we have to be free for that. We spend fifty to seventy percent of our time with the healthy newborn and that requires correction, if by anything you want but it can't go on like this.

Chairman Merav Ben Ari:

Thanks. Professor Michael Schimel, director of pre-school education at Shaare Zedek.

Michael Schimmel:

We call it a premature day but we have ninety percent of the children who are born on time, a significant percentage are born with problems. This morning at Shaare Tzedek we did two resuscitations for children born on time and these resuscitations, with everything that is going to be around, the two resuscitations. It neutralizes a huge number of manpower. There are certain populations today who will not terminate pregnancies even though they know there are severe birth defects. These children, with all the modern equipment we have, we are able to take care of them and they are not premature, but it requires a lot of manpower.

Chairman Merav Ben Ari:

Thank you. Knesset member Orli Levy, we need to conclude. We have already surfed in time. Please, briefly, your summary before I conclude.

Orly Levy Abacsis:

Yes, very briefly. First, to the representatives of the Ministry of Health. For a moment we do not want to reduce, and believe me mine has no interest in reducing the achievements of everything related to the care of premature babies, both in premature babies and in the community. We've come a crazy long way since the day I entered this topic. I think we were at the bottom of the scale and babies paid with their lives or their quality of life. When I entered the subject together with Molly Tsangan and the LHB association, the data were catastrophic, both in terms of infections, both in terms of mortality, and in terms of disabilities, the children continued on and the terrible shortage in everything related to routine care and control.

I ask and say that even on the issue of the breast milk bank that I have been running for several years, it probably won't be in the legislation so as not to give credit, but that's fine. I also strongly support the area where the Ministry of Health says there is a problem with how to issue a tender and we will try to do it through someone who already knows because he owns the blood bank there. We are talking about MDA for example. So that's fine. We need to come and demand that these things be real and at regular times because this issue has led to the fact that today there is a black market in everything related to breast milk and you know it. We all woke up one day to the shocking headlines in the newspaper about it who were confused about the pumped milk in Schneider and one baby received milk from another mother who is infected with AIDS. This should be prevented. These things, we are here and even if the headlines in the newspaper sometimes do not flatter the Ministry of Health, it is our job to flood it so that we can solve the problems.

I am glad that this issue will also be resolved and the sooner the better. But do an audit of the cash registers and check that they comply with the CEO's circular that you issued because otherwise what is the power and what is the ability of a CEO's circular to change things? If there is no stick and carrot, there will be no results. Criticize, encourage or punish those who do not comply. Thanks.

Chairman Merav Ben Ari:

Thank you. I want to summarize the discussion. I would like to thank Member of Knesset Orly Levy Abacsis for all her activities for premature babies and putting this day on the public agenda. It is very important that every day there is a discussion on this issue in the committees as well as in the plenary. It is important that a Knesset member takes on an issue and mobilizes with all his might.

I want to summarize in three things. First, to thank the Ministry of Health for the activity. You missed it because you were outside, but Muawia Kebaha said something very nice. He said that the preemies passed TMA 38 and that was very important. We saw the move, presenting them in a commendable presentation, nice work. There are of course more things to improve.

I would of course like to thank the social organizations. There is no doubt that both the LAB Association, which does excellent work, and the organization of the neonatologists. I want to thank you for your work, Doctor Tsangan. I praise the activity. Of course, there are still things to improve on. I really think that perhaps some kind of follow-up should be done here on the topic of premature babies with intracerebral bleeding and not only in a year but throughout the year and to see the improvement.

I also want to thank Tali. As someone who recently gave birth, eight months ago, and God willing, I gave birth to a baby weighing 3,900 kilos, but I kept turning around and looking at the premature birth because you can't help but look. You're a new mother, you can't help but look at the prematurity. I was in Ichilov. I relate so much to what you say about the matter of the escort, by the way, not necessarily psychological but also a social worker. I told Anat here that there are mothers who cry because of an injection their baby receives for jaundice in the foot. You see mothers falling apart there. I tell myself what the mother is going through. I kept peeking at the premature baby to see and asked myself what the premature mothers go through. I admit that I too when she was in the grill of jaundice - that also took a toll on my soul because suddenly I see my daughter there. Mentally it killed me and I ask myself what happens to mothers whose babies are premature. It was so hard for me. Therefore, I very much hope that we will take this psychological treatment to accompany those parents.

I thank you all. Those who are here from medical teams, at 1:30 there is a lobby here against violence against medical teams in the Jerusalem Hall, you are welcome to stay.

Thank you and goodbye.

The meeting closed at 11:10.

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