On the basis of the Paragraph 2 of Article 9 of the Human Rights Ombudsman Act (ZVarCP) [1] the Ombudsperson concluded his investigation of the broader issue of the method of informing patronage services after the discharge of a new mother from a maternity hospital, which he began looking into in 2023. The Ombudsman concluded that due to the non-uniform practice of notifying health care services about the discharge of new mothers from maternity hospitals, the principle of equal protection of rights is violated in accordance with Article 22 of the Constitution of the Republic of Slovenia (URS)[2], therefore he recommended to the Ministry of Health that the practice of informing health care services after the discharge of new mothers from maternity hospitals be unified. At the same time, the Ombudsman also called on the Ministry of Health to strengthen mutual cooperation in order to improve the quality of outpatient care and to coordinate the work between individual institutions, and not to transfer the burden of responsibility for informing the outpatient service after discharge from the maternity hospital to the new mothers. 

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In connection with the consideration of a broader issue, the Ombudsman asked all maternity hospitals for an explanation of how they notify the health care service after the discharge of a new mother from the maternity hospital, whether there are any differences regarding the notification of the health care service depending on the municipality where the new mother resides and how long after the woman leaves the hospital the maternity ward informs the patronage service about this. The Ombudsman also asked for information on whether notification is made in writing, by phone or by e-mail. In the request, the Ombudsman also asked the maternity hospital to state the reasons for any potential deviations.

After reviewing the answers received from 12 out of all 14 maternity hospitals, with the Ombudsman not receiving a response from Murska Sobota General Hospital and the Dr. Jožeta Potrča Hospital in Ptuj (even being sent marked urgent), the Ombudsman found that the practice of notifying community services after the discharge of new mothers from maternity wards is quite different. In most cases (seven maternity hospitals), the method of notifying the home care service depends on the place of residence of the woman giving birth, namely, maternity hospitals only inform local health centres, and then the home care service contacts the new mother and arranges a home visit, while new mothers who do not live in in the area where the maternity ward is located, contact the attendance service themselves and arrange a home visit. At the same time, the Ombudsman also asked whether the provisions of the Rules for the Implementation of Preventive Health Care at the Primary Level (Rules) [3], which as a work standard require the capture of the newborn within 24 hours after discharge from the maternity ward, can be strictly observed in these cases. At the same time, the Ombudsman questions whether it is possible to expect new mothers to contact the health care service as soon as they arrive home, when their attention is fully focused on the newborn, and whether it would not be more appropriate that this responsibility rest with the competent institutions, which would through mutual cooperation be able to improve the method of mutual information and thereby ensure uniform treatment of all new mothers, regardless of their area of ​​residence

Furthermore, the Ombudsman found that three maternity hospitals inform the health centre in the area where the new mother resides, regardless of which area she comes from (that is, regardless of whether the new mother comes from the area of ​​the maternity hospital or from any other part of Slovenia). The Ombudsman assessed this type of maternity hospital practice as an example of good practice, as it ensures the same treatment of new mothers regardless of their place of residence. Such examples of good practices can also be found in SB Brežice, SB Novo mesto, and SB Jesenice.

From the responses received from two maternity hospitals, the Ombudsman concluded that new mothers must make arrangements to visit the outpatient service themselves, regardless of which area they come from. At the same time, the Ombudsman also detected different practices of maternity hospitals in relation to when and in what way the notification takes place – some maternity hospitals inform the attendance service on the day of delivery or the next day, while others issue the notification on the day of discharge from the maternity hospital or the day after, namely via internal mail, personal collection community services or via regular mail (in this part too, the Ombudsman found different practices of individual maternity hospitals).

The Ombudsman also asked the Ministry of Health for an opinion, which explained that the unification of the method of notification and digitisation of the transfer of sensitive personal data from the maternity ward to community services is being addressed and regulated together with the National Institute of Public Health, and according to the current timeline, all activities will be fully completed by the middle of 2025 at the latest, which should support all phases of the process of informing the patronage service.

The Ombudsman assesses that in view of the findings on the non-uniform notification of the health care service about discharge from the maternity hospital, the principle of equal protection of rights is violated in accordance with Article 22 of the Constitution of the Republic of Slovenia. In accordance with the Rules, the outpatient care of insured persons is provided at their home or in the local community by an outpatient nurse, which means that they actively take care of the health status of insured persons in a certain health area and develop health promotion programmes, thus encouraging insured persons to take as much responsibility as possible for their health and well-being of their own families, and priority groups of the population, including pregnant women and babies, require especially in-depth individual and family treatment.

The Ombudsman welcomes the fact that the Ministry of Health has recognised the need for a uniform way of notifying health care services after the discharge of women from maternity wards, and that certain activities related to the regulation of this area are underway, but he is concerned that the changes are taking place too slowly. It is an extremely important issue of the protection of human rights and fundamental freedoms, since the consequences of the organisational disorder of the system usually affect already vulnerable groups of the population, so he will monitor the activities of the Ministry of Health in relation to the issue in the future and demand urgent changes for the better. 9.4-48/2023

[1] Human Rights Ombudsman Act (Official Gazette of the RS, no. 69/17 – official consolidated text)

[2] Constitution of the Republic of Slovenia (Official Gazette of the RS, no. 33/91-I, 42/97 – UZS68, 66/00 – UZ80, 24/03 – UZ3a, 47, 68, 69/04 – UZ14, 69/04 – UZ43, 69/04 – UZ50, 68/06 – UZ121,140,143, 47/13 – UZ148, 47/13 – UZ90,97,99, 75/16 – UZ70a in 92/21 – UZ62a)

[3] Rules for the Implementation of Preventive Health Care at the Primary Level (Official Gazette of the RS, no. 19/98, 47/98, 26/00, 67/01, 33/02, 37/03, 117/04, 31/05, 83/07, 22/09, 17/15, 47/18, 57/18, 57/18, 57/21, 162/21, 39/23, 93/23 in 125/23)