GP care, exercise and nutrition and the mental health of children and adolescents - 28 randomly selected residents of the Dachau district in Germany thought about these three topics from October 2021 to July 2022. On 14 July 2022, members of the "Citizens' Advisory Council on Health" handed over their recommendations to the Bavarian Minister of Health Klaus Holetschek, District Administrator Stefan Löwl and Member of the State Parliament Bernhard Seidenath (all CSU).
One point of criticism of the citizens' advisory council is the insufficient provision of GPs in its view. The advisory board members recommend the expansion of telemedicine or the use of so-called e-nurses, i.e. nurses who travel around the district and enter into their laptops what information the doctor needs about the patient. In this way, people who can no longer make the sometimes long journeys to a doctor's office could still be cared for. In addition, the advisory board recommends the expansion of the digital infrastructure, for example to make it easier to exchange findings or to offer more digital consultations.
Promotion of joint practices
In addition, the promotion of cooperative forms of practice, such as group practices, is necessary. In addition, there is a need for a coordination centre for transport services. Despite digital services, the goal must be that "the patient comes to the doctor and not the doctor to the patient". In order for doctors to settle in rural areas in the future, the advisory council suggests creating incentives for medical students.
Two topics that the advisory board members have dealt with at monthly meetings are exercise and, above all, nutrition: in order to promote physical activity in all age groups, there is a need to expand cycle paths and footpaths. In addition, "legally binding guidelines" for age-appropriate nutrition in old people's homes are needed, as well as more opportunities for seniors to be active. With kitchen gardens at schools and regular nutrition counselling, children and youths should also be inspired to eat healthier.
"Not a single child and youth psychiatrist"
On the subject of mental health of children and youths, the citizens' advisory council complained that there was not a single child and youth psychiatrist in the entire district. In order to provide a service that is as low-threshold as possible, more networking of the various institutions is needed, as well as inclusion at schools in order to combat bullying, and school educationalists and psychologists throughout the district.
The ombudsman of the Bavarian state government, Michael Hofmann, assured that the trust placed in the government would be handled with care. This is one of the reasons why the current recommendations will be evaluated, feedback will be given and a guideline for further projects of this kind will be developed before the Ombudsman Board is sent back to work.
Project of the Minister of Health and the Ombudsman
The project "Citizen Participation in Health" was initiated jointly by Health Minister Holetschek and Ombudsman Michael Hofmann. The project was funded with 310,000 euros.
The members of the citizens' advisory board were randomly selected from the residents' registers. This procedure has ensured that the composition of the citizens' advisory council is as diverse and colourful as the population in the Dachau district.
Use of practical knowledge
Through the random selection, the practical knowledge of those who, for example, as patients, as relatives or as people who depend on care, was used directly for improvements and innovative ideas. This perspective is still very little represented in the health sector. The members of the citizens' advisory board were not health professionals. Quite deliberately, people were able to contribute experiences from their everyday lives and can thus complement the expert view.
The Citizens' Advisory Council on Health met once a month from October 2021 to June 2022. The eleven meetings took place alternately digitally and in person. Two to three meetings were scheduled for each individual topic.
Citizen participation in topic identification
The citizens' advisory committee on health dealt primarily with the topics of medical care and nursing care in the district of Dachau. In a first step, the citizens of the district of Dachau decided which topics to focus on. There were various opportunities for participation: In an information event for interested parties and stakeholders in the district, initial suggestions were made. On this basis, an online survey open to all citizens took place in summer 2021. Taking the results of the survey into account, the citizens' advisory council participants decided on the topics.
There was only one exception at the start: to ensure that the citizens' advisory council got off to a good start, the first topic had already been decided: The provision of family doctors. It was mentioned as very relevant in all preliminary discussions.
Previous knowledge not necessary
No prior knowledge was needed to participate in the Citizens' Advisory Council on Health. However, in order to be able to make recommendations, a good basis of information was necessary. This was provided in the meetings of the Citizens' Advisory Council. This was done, for example, through an introductory lecture by an expert, or through a video that explained things clearly, or also in the context of a walk-through. In any case, care was taken to ensure that the information was generally understandable and not one-sided.