“Collapse” of Spanish primary healthcare and A&E imminent

by Lorraine Williamson
Spanish healthcare
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MADRID – CSIF, the Spanish sector association for healthcare, sounds the alarm. The organization speaks of a “serious national emergency” in the Spanish healthcare system. The biggest problems are in the emergency room and primary care. 

Fernando Hontangas, the chairman of CSIF, estimates the shortage of doctors in health centres and clinics at 29,500 professionals and 130,000 in case of nurses. That extra number is needed to reach the European average level. “We can’t go on like this,” the union representative said. He is urging the Ministry of Health to meet to develop a state-level plan to resolve the issues as soon as possible. 

Main problems national health care system in Spain 

The collapse of primary care, the saturation of the emergency room, the “disproportionate” increase in waiting lists and the general shortage of professionals, together with the lack of planning and replacements, are the main problems of the national health system in Spain for CSIF. These affect the entire territory. “This situation is an endemic disease that affects all Autonomous Communities,” said Hontangas. 

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According to the union, in regions such as Madrid and Catalonia, the waiting time for an initial consultation in primary care is up to fifteen days. A period described as something “outrageous” by Hontangas. The chairman stated that “this leads to a serious inaccessibility of the health system”. 

The saturation of primary care leads citizens to go directly to the A&E department in the hospital. According to the union representative, “complaints that are not urgent, but that must be done” are dealt with here, according to the union representative. He continues: “Citizens cannot spend fifteen days with knee pain, but they cannot spend even one hour with chest pain… Thus strokes, heart attack, really urgent pathologies can be missed,” he laments. 

More than 380,000 healthcare professionals short 

The waiting lists are proof of the lack of staff. Spain currently employs 165,000 doctors and 213,000 nurses, according to data from the Ministry of Health. Of these, 43,000 and 41,000 respectively work in primary care. 

To bring the national health system in line with the European average, CSIF estimates that 29,500 primary care physicians and 130,000 nurses are needed. As well as 1,250 midwives, 1,100 paediatricians, 44,000 nursing assistants and another 176,000 other professionals, including clinical psychologists, physiotherapists and social workers. This brings the total shortage to 381,800 healthcare professionals. 

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More than 50,000 jobs were cut in two months 

With this situation in mind, Hontangas has blamed the autonomous communities for cutting 51,327 jobs in the months of September and October. He bases this on data from social security. Moreover, that was in the middle of the flu vaccination campaign and before the arrival of bad weather. Something that is normally associated with an increase in respiratory pathologies and a consequent increase in the burden of care. 

“If they have fired 51,000 professionals, there will be people to hire again. It cannot be the case that healthcare professionals have been fired and there is unemployment at the same time,” said the union representative. He was responding to the argument put forward by some government officials in recent weeks. 

The union representative also points out that due to job insecurity and relatively low salaries, many healthcare professionals are seeking refuge in other countries in search of decent working conditions. 

More investment in primary care 

Spain invests €2,027 per person in healthcare, which is well below the European average of €2,746. In particular, Hontangas has called for more investment in primary care. The general budget for 2023 provides €176 million for the primary care action plan. This is far from the €4 billion that the sector believes are needed to correct the staff shortage and bring the human resources of all professional categories in line with the European Union average. 

No strike yet 

CSIF has drawn up an employment plan with 289,000 new jobs between 2023 and 2031. In addition, the association is calling for an “urgent” meeting with Health Minister Carolina Darias to ask her to promote a State Pact. “Depending on the outcome of that hypothetical meeting whatever they would give us, CSIF will consider a strike or other equally strong actions,” Hontangas assured. 

Nevertheless, the union does not consider a national strike in the care sector appropriate at the moment, although that option is not excluded. “We have considered a general strike across the national territory, but we are in a situation of vaccination campaign against covid-19 and flu and an increasing number of cases of illness and it is difficult to imagine a strike in the situation in which the citizens are in,” explained the president. 

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