The expressions “disappointment” and “they haven’t heard A THING” summarise the response of the more than twenty social, health and trade union organisations promoting the Más Sanidad (More Healthcare) alliance following the final decision on public health and health care by the plenary session of the Congress of Deputies, which puts an end to almost three months of work by the Commission for Social and Economic Reconstruction. These organisations believe that the Commission’s commitments are patently insufficient and fail to respond to several structural issues in Spanish health care which have been underscored by the COVID-19 pandemic, such as the lack of funding, a medicines policy that puts the public interest before that of major pharmaceutical companies, and protection from privatisation.
After more than two months of work, with dozens of expert briefings and multiple reports from civil society, the political parties “haven’t heard a thing”, the organisations say. “It’s striking that, given the scale of the crisis we’ve experienced, the decision on Health and Public Health and Health Care—unlike the Commission’s other conclusions—lacks an initial diagnosis on which to base the proposed measures. It’s impossible to find the solution to a problem without knowing its causes”, they add.
The Commission, they point out, “has failed to evaluate health policies over the last decade, which have been shaped by austerity and the promotion of privatisation”. As a result, the final decision that will guide the necessary reforms of the Spanish National Healthcare System in the coming months is marked by ambiguity and a lack of explicit commitments in key areas aimed at ensuring quality public and universal health care, the organisations say.
Months remain to adopt the strengthening measures needed to restore our healthcare system to its rightful place as a cornerstone of the welfare state, but for this to happen, we need a bolder approach and commitment from our policies and politicians.
No clear commitments on funding
No strengthening of health care is viable without the corresponding financial support. However, the section on the funding of the Spanish National Healthcare System (NHS) is notable for its lack of specific commitments. In this regard, the organisations note that:
- It is a mistake to link the increase in the healthcare budget to GDP. The signatory organisations believe that this approach is ill-suited, as it is liable to result in a significant decrease in budget allocations in times of recession. On the contrary, they support a standard based on euros per person per year, setting as an objective reaching the EU average by the end of the legislative term. In absolute numbers, this increase translates into 1,000 euros more per person/year than current spending.
- A percentage of the healthcare budget should be allocated to under-resourced areas. Specifically, 25% of the public budget should be allocated to primary care, 2.5% to public health and 2% to health research, three areas that have proved critical in the current pandemic.
- The reconstruction fund should prioritise the contracting of primary care staff and increase the creation of beds for medium- and long-term care in publicly managed centres.
Ensuring the full universality of health care is urgent, particularly during a pandemic
The Commission aims to strengthen and consolidate the universality of health care as an objective, but its findings suffer from two major omissions:
- The urgent nature of the measure: making this measure subject to a future bill means jeopardising the health of many people who are still excluded from health care.
- To respond to the special vulnerability of reunified families. That is, to include older people who come to Spain through the process of family reunification, people who, due to their advanced age, are in an at-risk group in this pandemic and who currently lack any right to health care.
The importance of prevention in public health
The current crisis created by COVID-19 has made clear that when it comes to public health, action must also be taken to tackle those social and material conditions that are determinants of health. In this sense, the organisations consider it essential:
- To promote the coordination of public health services with social services.
- To create, strengthen and develop an Observatory of the Spanish National Health System with a special focus on the analysis of inequalities and the study of social determinants.
- To boost research in Public Health.
- To strengthen the Health Information System by incorporating health outcome indicators.
- To promote the patient safety strategy, the “Do Not Do” recommendations and clinical excellence.
Measures on pharmaceutical policy, public production and intellectual property in health R&D are lacking
This applies both to pharmaceutical policy and intellectual property in the research and development of medicines. The Commission for Reconstruction has missed the opportunity to further explore many changes that are urgently needed if access to and affordability of medicines and health technologies are to be ensured. Missing are:
- The commitment to implement the much-needed reform of medicine pricing processes, particularly for the newer and more expensive medicines.
- Measures to rein in the increase in pharmaceutical spending, specifically in the hospital sector.
- Specific proposals to boost public production of medicines and health technologies beyond advanced therapies.
- Open science and innovation through open, non-exclusive licences and data sharing. This is the only way to make medicines or vaccines that have been developed with public investment accessible to everyone who needs them, free of the current intellectual property barrier.
No provisions to protect the Spanish National Health System from privatisation
The pandemic has exposed the need to increase the resources of publicly managed health centres, as the clinical management of the pandemic has hinged on these points of care. According to the signatory organisations, “this decapitalisation of the public sector is not only a consequence of the budget cuts of the last decade, but also of the commitment to privatisation models that divert a significant proportion of scarce resources to the private sector. These models have not only proved to be more inefficient than direct public management, but also aggravate inequity, weakening everyone’s right to health protection”.
In light of this situation, these organisations request:
- The guaranteed end of the privatisation of health centres and services, and that systems be established to ensure the evaluation of the privatisation processes.
- Strict control of compliance with contracts and licences.
- Legislation that favours the recuperation of whatever has been privatised and a timeframe for its completion.
Médicos del Mundo, semFYC, Salud por Derecho y la Federación de Asociaciones para la Defensa de la Sanidad Pública -FADSP-, UGT, CCOO, Yo Sí Sanidad Universal, Asociación de Enfermería Comunitaria, Federación de Asociaciones de Enfermería comunitaria y Atención Primaria -FAECAP, FACUA, Consejo General del Trabajo Social y la Confederación Estatal de Asociaciones de Vecinos -CEAV.