Hugo de Jonge (CDA) seemed a dream candidate for youth care when he was appointed Minister of Health in 2017

During the last cabinet term, Minister Hugo de Jonge was 'system responsible' for youth care. A headache file, about which he barely informed the House for three years and in which the new decentralized health care system turned out to be indomitable. Silent and inglorious, De Jonge left the portfolio at the end of last year, on which he manifested himself as an alderman in Rotterdam. Youth care is in crisis. 'Thinking that it will all work out on its own, I just don't believe in that anymore.'

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Hugo de Jonge (CDA) seemed a dream candidate for youth care when he was appointed Minister of Health in 2017. As an alderman in Rotterdam, he was responsible for the youth and witnessed the transfer of tasks from central government to municipalities up close. A decentralization that would make youth care cheaper, better and more efficient.

In October 2020, De Jonge silently left the wallet that had brought him to The Hague. Follow the Money listened to twenty sources and analyzed more than three years of parliamentary debates with De Jonge. What legacy does he leave behind?

Politicians, from left to right, are critical of how De Jonge informed the Chamber. Factual information about the functioning of the new system is structurally lacking and he does not keep promises to provide this information. Whether it concerns the number of providers of youth care, the preconditions for the out-of-home placement of children, or the guidance of young adults with a history in youth care, the House is in the dark.

In the meantime, youth care has grown to obese proportions: the number of care providers can no longer be counted and never before have so many young people made use of it. Money is leaking all over the place and children are sometimes even at risk due to the poor quality of care.

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More prevention, less specialist care, happier children and ultimately: a fuller treasury. That is what youth care would look like in a few years, The Hague promised in a parliamentary study in 2010. "Proud about the conclusions and proud about the unanimity with which they have been drawn," wrote MP Madeleine van Toorenburg (CDA) in Trouw . "Never before have all noses turned in the same direction."

Van Toorenburg is referring here to the parliamentary working group on the Future Exploration of Youth Care. The SP, VVD, PvdA, PVV, GroenLinks, ChristenUnie and CDA are in complete agreement: municipalities must be responsible for youth care. 'I am convinced that this will benefit the care for a successful development of children in the Netherlands,' writes chairman Pierre Heijnen (PvdA) in his letter of submission accompanying the final report.

In the summer of 2019, four years after the so-called decentralization from central government to municipalities, there is again consensus in the House: the new system is anything but lean and mean . Youth care has turned into a greedy, many-headed monster: more young people ( almost 13 percent of children up to the age of eighteen) are using it and the costs rose from about 3.6 billion euros in 2015 to about 5.5 billion in 2019 .

'I believe that in healthcare we need less market, more cooperation and more control'

At the same time, the use of the most expensive, most specialized youth care is hardly declining and the quality regularly leaves much to be desired. 'We hoped that by focusing on prevention and light care, the use of serious care would be prevented,' says Member of Parliament René Peters (CDA), former alderman for Youth in Oss, in a parliamentary debate on 13 June 2019. ' boarding schools are just added in other places. '

His conclusions can now count on support in The Hague. For example, another former alderman for Youth wrote to the House at the end of November 2019: 'The promises of the Youth Act have not yet been sufficiently fulfilled.' And on 23 June 2020: 'I believe that in healthcare we need less market, more cooperation and more control.' And: 'Thinking that it will all work out on its own, five years after decentralization, I just don't believe in that anymore.'

"The financial complexity of youth care is so inimitable that there is little else left than basic fact-finding"

These are the words of a politician who has been in a unique position in recent years to uncover the leak: Minister Hugo de Jonge of Public Health. As a former alderman, he was given the rare opportunity to direct nationally the dossier that he already dealt with in municipal politics: youth care.

File tiger

When De Jonge took office as minister in 2017, De Jonge has a great resume: former primary school teacher and alderman for Care, Education and Youth in Rotterdam. A file tiger, who also sat in the front row in one of the most radical system changes that have been implemented in healthcare: the decentralization . As an alderman, De Jonge was in favor of transferring youth care to municipalities. But at the same time he warned early on against possible excesses of more market forces: too much competition would not do the healthcare sector any good.

De Jonge made national news from Rotterdam with his opposition to the strict application of the tendering rules , which oblige municipalities to tender (European) care assignments. He felt that the constant switching of providers undermined the relationship of trust between patient and care provider, he stated in NRC . Municipalities had to be able to work with a limited number of youth care providers for a longer period of time, preferably in collaboration with other municipalities for complex care.

When he was just a minister, De Jonge shifted his frustration to the so-called 'open house model', a purchasing structure in which a municipality outlines in advance the conditions under which providers can register but does not select a provider itself. 'This can lead to hundreds of contracts, especially in large municipalities, which makes good contract management difficult and entails a risk of fragmentation,' he wrote to the House in the summer of 2018.

'I don't want to postpone anything, I'm from Rotterdam'

"I don't want to postpone anything," De Jonge promised in his first parliamentary debate. 'That is apparently something The Hague, but I'm from Rotterdam.' Three years later, he left the portfolio silently, stopping neither fragmentation nor proliferation.

Municipalities still only work together to a limited extent and the number of new healthcare providers has turned out to be literally countless, it is estimated that there are now around six thousand.

When De Jonge took office, he promised 'factual investigations' into subjects about which it was still unclear when he left. About the causes of the budget deficits of municipalities, for example, about the how and why of the waiting lists, and about the reasons why an increasing number of children need youth care. In short, a minister who achieved disappointingly little with surprisingly good credentials.

Information blockage

Admittedly, since decentralization, the department no longer has all the information about youth care. As a result, it has turned out to be a daunting task to get basic information from this minister, says Lisa Westerveld, spokesperson for Youth Care for GroenLinks. Martin Wörsdörfer, outgoing MP for the VVD and portfolio holder for Youth Care, shares that opinion. He and Westerveld regularly work together on questions, motions and opinion pieces. I have only been a Youth spokesperson since 2019, he says. 'And a former tax advisor, which does not immediately make me an eye-catching colleague for left-wing parties.' But if the financial complexity of youth care is so inimitable that a sharp debate along ideological dividing lines makes little sense, there is little else left than basic factual research. "We know very little about our youth care," says Wörsdörfer. Factual questions often remain unanswered, or receive overly long answers from the minister: "So long that afterwards you almost forgot what you originally asked."

The fact that concrete answers are seldom received has over the years caused a complete information blockage, say both MPs. Whether it concerns the number of providers of youth care, the preconditions for the out-of-home placement of children, or the guidance of young adults with a history in youth care, the House is in the dark.

For example, she has been asking for insight into the waiting lists for years, because young people sometimes do not receive help for months or wander between institutions before they receive the care they need. Moreover, decentralization would actually reduce the waiting lists considerably. But three years later, no one knows exactly how big they are and why. There is the inability to provide the right help to young people with multiple problems. But the lack of money and staff also provides an explanation.

Although the minister acknowledges in debates that waiting lists are a problem, he refuses to map those waiting lists on behalf of the government. The reason? A registration system would lead to a new paperwork and even more bureaucracy. The municipalities should do that themselves, he thinks. After all, they also take care of the contracts with the providers themselves.

Lisa Westerveld: 'Actually, the minister always suggests that the House is part of the problem when we request information about the waiting lists. But without insight into the scale of the problem, we cannot come up with concrete solutions. '

Overhead or profit distributions

And then there is the other seemingly simple question: how do the municipalities spend their budgets? After all, every year municipalities ask the government for extra money for youth care. But it is by no means transparent which part of the current resources goes to care provision, overheads or profit distributions.

Follow the Money has been investigating this for more than a year - with a team of journalists - and there is still no answer from the minister. Nota bene CDA party member René Peters got the hands of the entire House together in the summer of 2019 for a 'Follow the Money investigation', in which 'it is determined very precisely where the money is going'.

LISA WESTERVELD, LEFT GREEN

"Without insight into the extent of the problem with waiting lists, we cannot come up with concrete solutions"

De Jonge had such a study carried out, but when it is finally published, it soon becomes apparent that the findings are not representative to be. "Not good enough," Peters concluded , after which the minister promises a new investigation. But then again not by spending, but by the amount of money that municipalities must receive structurally to get rid of their deficits. 'It is now 2020 and despite the fact that I have been asking for it since 2015, I just still don't know where the money is going,' Peters said last summer in the last parliamentary debate with De Jonge.

The times he does promise something concrete to the House, the execution is so vague that De Jonge gives the impression that he wants to throw a bone in the opposition. Take the amendment by which Lisa Westerveld and Jesse Klaver, both of GroenLinks, argue in September 2019 for the establishment of national centers of expertise. Every year, the cabinet sets aside up to 26 million euros per year for new institutions that have to take care of young people with multiple problems at a regional level. 'Multiple specialisms under one roof, for young people with complex problems who are getting lost in the current system,' says Westerveld.

FILE: YOUTH CARE IN RED

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Almost eighteen months later, the first eleven million euros has been allocated, but there are no expertise centers yet. However, eight municipalities have been selected to 'strengthen the existing structures and add the availability of aid, knowledge and expertise in their region with the help of advisory groups,' De Jonge wrote to the House last year. It is unclear exactly what this means for the care of the most vulnerable young people.

Working visits and photo opportunities

The viscous De Jonge from The Hague is nothing like the jovial minister who wants to pay a working visit several times a month. 'Hugo is an exceptionally charming man who is very gifted to win people over,' says Maaike van der Aar, youth care director at the FNV. She received him several times to trade union events, where for years there has been a plea for a 'drastic simplification' of the current youth care system.

De Jonge's visits have an atmosphere of approach, says Van der Aar. A Rotterdammer who comes to talk to the staff and the children. Who likes to present 'action plans', for example to reduce the number of suicides. Or the number of custodial placements. Or the time when children have to be 'in isolation'.

'Hugo's plans have one thing in common: you can never be against it,' says Van der Aar. If it is about how you realize those plans, how you determine when they are a success and when they are not, then they are a lot less effective. 'Financial paragraphs are actually always missing.'

The danger of working visits is that they give the appearance that De Jonge has his feet in the clay. Van der Aar sees a staged pattern. 'The red carpet is going out, photo opportunities are planned, it is quite a puppet show'. After that, everyone has to get to work quickly, while management has another round table discussion with the dignitary. The most critical voices are thus not heard. 'We have already told him several times that if he really wants to know what's going on, he just has to go into the pub with a youth care worker. But he doesn't want that '.

MAAIKE VAN DER AAR, FNV

"The financial paragraphs are always missing in De Jonge's plans"

De Jonge gives a striking example of his two faces during his working visit to De Hoenderloo Groep on 25 March 2019. He visits De Smaragd, the department for children with complex psychological and / or psychiatric problems. Later that day, he and a few employees presented an action plan for the cameras of RTL Nieuws . 'Fewer closed placements, shorter stays, no separations and better suicide prevention,' De Jonge sums up four days later in his 'Retrospect Vlog # 50' on Twitter. Exactly as they try to realize at De Smaragd. 'We are going to work hard together with those goals,' says an excited minister in the video.

Almost a year later, De Hoenderloo Groep is no longer a shining example of where complex youth care should be headed in the future. Parent organization Pluryn announced in December 2019 that it would close the institution. Pluryn is in dire straits financially and wants to get rid of it, also from De Smaragd department. The remaining real estate in particular makes closure attractive , according to research later from Follow the Money.

In a conversation with concerned parents in February 2020, nothing can be seen anymore of the enthusiasm that the minister still thought worth a vlog during his visit to De Hoenderloo Groep. "Two hundred young people in the woods is outdated," he tells a number of them in a conversation at the ministry.

This is remarkable, because a week earlier the House of Representatives obliged the minister to explore the possibilities of a restart by means of a motion. There will be no, although De Jonge promises that all children will be assigned a new, safe place in time. But in the end, some of that will come to pass much too late. 'The interests of the children were not always paramount,' the Ombudsman for Children concluded in a report on the closure of De Hoenderloo Groep. "We have failed the children," De Jonge admitted in the Chamber.

Flee forward

What De Jonge really cannot ignore at the end of 2019 is an exceptionally critical report from two inspection services. Following the report of the De Winter Committee , earlier that summer, it is now two of their own regulators who sound the alarm. They conclude that the most vulnerable children do not receive enough protection. The responsible care providers, the so-called certified institutions, are 'insufficiently equipped' to perform their core tasks and are faced with an acute staff shortage. Municipalities interfere with the work of the youth protectors and there are long waiting lists. 'A vicious circle is emerging, the question of which is how it can be broken.' And: 'Especially for the children and families with the most complex and serious problems, the necessary help is not available or not available on time.'

"Especially for children with the most complex problems, the necessary help is not available or not available on time"

'The promises of the Youth Act have not yet been sufficiently fulfilled,' write De Jonge and fellow Minister Sander Dekker (VVD) of Legal Protection in a response to the House. The municipalities get a sturdy cat from De Jonge. He argues that they are not spending their money efficiently and have set up unnecessary bureaucracy. 'A large part of the money leaks away and is spent on coordinating care,' he says in an interview with NRC .

He therefore wants to amend the law and 'oblige the municipalities to cooperate' in the tendering of intensive youth care, for example in the purchase of foster care and closed youth care. According to the cabinet, this is now happening too freely. An obligation should result in healthier rates and less bureaucracy.

His flight to the front is going down the wrong way with many of the interest parties, according to the consultation round of the 'Act on the Improvement of Available Care for Young People', which generated 156 responses.

Too weak

The most powerful lobby, that of the Association of Dutch Municipalities (VNG), is opposed to the bill because the government would take too much of the seat of the municipalities. This is where the revenge is that De Jonge never had a clear view of the spending by municipalities, according to the response of VNG director Leonard Geluk. Municipalities are struggling with large financial gaps, but there is no evidence that they are spending their money incorrectly. As long as the shortages at municipalities continue to increase, it is 'unacceptable' for the government to become more involved in the youth care of the municipalities, he believes. 'The bill largely ignores what the role of central government should be: ensuring that the financial and administrative preconditions are in place so that municipalities can fulfill their role within the Youth Act.'

'We know far too little about the current system to implement legislative amendments now'

The trade union FNV Jeugdzorg and the interest group Jeugdzorg Nederland, find De Jonge's proposal to amend the law too weak. And in the House it also leads to furrowed eyebrows, among coalition members: VVD, D66 and ChristenUnie think the bill is a bridge too far.

"I expect it to die in the coming formation negotiations," predicts Martin Wörsdörfer. His VVD is of the opinion that the effects of an amendment to the law are taking far too long. Moreover, it is not clear whether, for example, the waiting lists will be tackled. 'We see the proposal as a horse remedy that combines the disadvantages of the previous system with the uncertainties of the current one. We know far too little about the current system to be able to implement legislative changes now. '

De Jonge will no longer be able to conduct the parliamentary defense of his legislative amendment himself. Due to the corona crisis, the youth care file will fall under State Secretary Paul Blokhuis (ChristenUnie) for the remainder of the cabinet term. For that reason, De Jonge does not want to give an interview for this article: he is no longer about it.

The question is whether he ever talked about it. Shortly after taking office, Hugo de Jonge stated that prior to decentralization 'everyone was somewhat responsible, so that ultimately no one is responsible'. Three years later, the CDA's 111-page election program contains only two paragraphs on youth care. An important objective: 'In situations where several authorities are involved, one person with ultimate responsibility is appointed.'

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