Spanish A&E care is on the verge of collapse

by Lorraine Williamson


MADRID – There is chaos in the A&E departments of Spanish hospitals during the summer. writes that the Infanta Sofía hospital in Madrid’s San Sebastián de Los Reyes has become the most visible example of this chaos. 

Primary care shutdowns and healthcare staff vacations have created a cocktail of circumstances, resulting in long hours of patient waiting and completely overwhelmed healthcare staff unable to properly treat all patients. 

“Extreme lack of medical staff” 

The doctors’ union Amyts has denounced in a public letter that the situation at the Infanta Sofía hospital is “devastating” because of the “extreme lack of medical staff”. In July, between two and five affiliated doctors took charge of a service. This would require at least nine doctors to cover the minimum. Furthermore, the situation is expected to repeat itself in August. 

Zero cost policy 

The professionals who sign the letter assure that they are “physically or mentally unable to cope”. They also defend that “being poorly organised” is by no means the reason for this situation. Rather, it is about the “zero cost” policy that has been implemented that has “gradually sank” the A&E. 

The doctors regret the closure of emergency services centres in the Madrid region over the past year. This forced many patients to go straight to the hospital’s emergency room, which was already saturated. 

“The situation is not new. With more and more people to serve and the fact that the number of healthcare professionals and beds has not increased proportionally, we are heading straight for collapse”. A collapse of professionals, with sick leave due to stress, sick leave due to fear, centre changes and even people quitting their jobs at the hospital to go on welfare,” said Elena Cabrerizo, a nurse at Infanta Sofia hospital and union representative CCOO. 

Triage Process 

When they arrive at the emergency room, patients usually undergo a triage process, where their clinical risk is assessed. Patients of greater urgency are seen immediately, but those of moderate urgency begin to pile up. Less urgent patients can wait hours, if not days, to be seen. The result: overcrowded waiting rooms, increasingly nervous patients and professionals forced to assist them in an endless race against time. 

One would expect that during the summer months the care burden of a hospital such as Infanta Sofía, located in a city in the centre of the country, could be partly alleviated by the population on holiday elsewhere. However, nothing could be further from the truth. 

ASSSA - health insurance in Spain

“Now, in the summer, the situation worsens. All hospitals close floors and beds because their staff goes on vacation. In addition, many hospitals need maintenance. Work often takes place in the summer because there is supposedly less demand for care. 

According to Cabrerizo, patients and professionals are then moved to other parts of the hospital. But they are also saturated so that at a certain point there is no longer any possibility to move patients in a humane way to reduce the pressure on the urgency. There are simply no more beds. 

The “desperate” situation 

Tomás Toranzo, president of the state confederation of medical unions, admits to that the Infanta Sofía hospital in Madrid is in a “totally desperate” situation. Although he believes that the hospital is not isolated in this and it is a widespread problem throughout Spain. One that has especially worsened in recent months. “All emergency services are overloaded in the summer, but this year it is more evident due to the staff shortage. Until now there was always a replacement, but there is no longer one. Many services have become completely overloaded. 

Emergency care from hospitals is “generally scarce”. Many professionals have retired, and there are a lot of outages due to the pandemic, which has already overloaded the system, according to Toranzo. This decline makes it very difficult to find professionals, so “the solution is very complex”. 

Professionals have left Spain 

The president of the state confederation of medical unions, Tomás Toranzo, believes that many professionals have left Spain in search of better conditions. He also emphasises that “there has been very poor planning in recent years”. He gives as an example that there are not only doctors from outside the EU but within Spain, who have a medical degree but who have no access to specialised training (MIR) because there were not enough state vacancies. Without the speciality, you cannot work in Spain or Europe in the public health system. 

There has also been criticism that many more people have retired without a plan to replace them. This problem will only get worse in the coming years. Between now and 2027, many doctors will retire, especially in primary care. 

Fewer beds 

In addition to the staff shortage, part of the saturation can also be explained by the fact that there are fewer hospital beds. Patients requiring a bed have to spend longer in the emergency room while waiting for a bed. 

Time bomb 

Moreover, the health situation of the past few months has not exactly helped with a snowball effect as a result. “In the primary, emergency and hospital care, dealing with the waiting list from the period of the pandemic will become problematic. If people have to wait too long, they still go to the emergency room which will become more and more overloaded. We are dealing with a time bomb that must be deactivated before it explodes,” Toranzo warns. 

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