Salud por Derecho, Médicos del Mundo, semFYC, 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 and the Confederación Estatal de Asociaciones de Vecinos (CEAV) have delivered a document with 12 economic and social recommendations to members of the Commission for Reconstruction to strengthen and protect public and universal health care.
The crisis unleashed by COVID-19 has exposed the weaknesses in our health system, which has been undermined by the policies of the last decade, marked by a steady decline in public funding for health care and the rise of privatisation. According to Eurostat data for 2018, Spain currently has one of the lowest health costs per inhabitant in the Eurozone, at 1,667 euros per person compared to the European Union average of 2,660 euros, which has resulted in a significant reduction in the public health network’s resources.
In light of this situation, expert organisations like semFYC, Médicos del Mundo, Salud por Derecho, and FADSP, as well as several other organisations and unions, some of which have also been invited to participate in Congress’s Commission for Reconstruction, have delivered 12 recommendations to the members of the Commission. The organisations stress that we are at a critical moment that urgently requires measures that strengthen the National Health System in anticipation of a possible resurgence, as well as possible future pandemics, or simply for routine doctor’s appointments.
One of the most glaring consequences of the cutback policy the administration has pursued in recent years, which has been exacerbated by the recent crisis, is the shortage of hospital beds, currently numbering between 50,000 and 70,000. Also of note is the job precariousness with which health professionals (in medicine, nursing, administration and social work), who have been reporting on their working conditions for years in vain and have made an unprecedented effort during the pandemic. This health crisis has also revealed major coordination issues between the different actors and areas of responsibility in healthcare management and between the health system and the social services system, which need to be corrected as soon as possible.
Prevention is built on a daily basis
Administrations are responsible for preventing potential collapses in the face of situations like the one we have experienced. But prevention is built on a daily basis by strengthening primary care, which is undervalued and under-resourced, as well as a social system that is supportive and inclusive. One of the lessons learned from this traumatic experience is that there is an inextricable link between individual and community health. Therefore, it is imperative that the protection system includes everybody who lives in the region, particularly the most vulnerable, without discrimination and leaving no one behind.
This requires a healthcare system with universal coverage and an extensive network of social services that have an impact on the social determinants of health (circumstances in which people are born, grow up, work, live and age), guaranteeing all people decent living conditions, the most effective form of prevention against illness. If there is one thing this crisis has made clear, it is our strength as a society that champions the Spanish National Health System as the protector of our health.
The signatory organisations’ recommendations
Given these shortcomings of the National Health System, we urge all political parties to rise to the challenge of this reconstruction process. To this end, we recommend:
- To increase and guarantee the public health budget per inhabitant per year, with an aim to reach the EU average of 2,660 euros at a minimum.
- To reinforce primary care as a cornerstone of our National Health System (NHS), the heart of a quality and accessible public health system, progressively increasing the budget allocated to primary care until it reaches 25% of public health expenditure within a maximum of 4 years.
- To increase hospital infrastructure, human resources and available beds (between 50,000 and 70,000 more beds are needed), with the aim of strengthening the public hospital network.
- To improve the capacity of healthcare response to future pandemics, but also to strengthen its preventive role from the perspective of social determinants of health. This would require increasing the public health budget to 2.5% of public health expenditure.
- To establish a strong and real partnership between health and social services.
- To ensure that everyone who is a permanent resident in Spain has universal access to all social and health resources and services, regardless of their legal status.
- To ensure the coordination, connection and cooperation of all staff and resources within and between the Autonomous Communities, working as a network and assigning tasks to different centres according to their capacity and accumulated experience.
- To strengthen independent public R&D in health, ensuring public interest and promoting a sustainable pharmaceutical policy to guarantee universal access to affordable, effective, safe and quality medicines and health technologies.
- To create a strategic reserve fund of healthcare supplies with production and distribution centres, as well as research into PPE.
- To implement employment measures that guarantee the adequate provision of well-trained staff so that they work under good conditions and receive continuous training. This measure should provide for the reversal of the 2010 wage cut (5% on average) and the loss of purchasing power, due to wage freezes, from that year.
- To adopt legislative measures to protect the NHS from privatisation. Recover the health system that was privatised in the past.
- To safeguard the universally and tax-financed NHS as a cornerstone of the welfare state by elevating the right to health protection to the status of a fundamental right.
Médicos del Mundo, semFYC, Salud por Derecho, 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 (este documento está abierto a la incorporación de nuevas organizaciones que deseen sumarse a la iniciativa).