Else Beekman
Five years after the outbreak of the coronavirus pandemic, Spanish healthcare workers still feel undervalued and abandoned. At the time, numerous promises were made that the crisis would mark a turning point for the healthcare system. However, criticism remains strong: improvements have failed to materialise, promises have been broken, and problems continue to mount.
When the first COVID-19 patients overwhelmed Spanish hospitals in 2020, there was widespread public support for healthcare professionals. Governments promised better working conditions, increased funding, and structural reforms. However, according to trade unions and professional associations such as SATSE and the Consejo General de Enfermería (CGE), these promises were never fulfilled.
Funding as the biggest issue
One of the most significant issues is funding. In 2020, public healthcare spending was increased to 7.5% of GDP, with a commitment to maintain it at least at the EU average of 7.7%. The reality is different: by 2022, this had already dropped back to 6.8%. “The government has completely ignored the urgency of structural investment,” says SATSE. The Ministry of Health, however, claims that total healthcare spending stands at 10% of GDP, but unions argue that these figures are misleading.
The crisis in primary care
Funding for primary care is particularly insufficient. Five years ago, there was a broad consensus that GP practices and health centres needed to be strengthened, yet the situation has only worsened since then. “Our centres are completely gutted,” complains CGE president Florentino Pérez Raya. The World Health Organisation (WHO) recommends that at least 25% of the healthcare budget be allocated to primary care, but no region in Spain reaches this percentage. Madrid ranks the lowest in healthcare investment per capita.
Severe staff shortages
The shortage of healthcare professionals is also alarming. According to the Ministry of Health, there is a lack of doctors, particularly in paediatrics and general practice, especially in rural areas and on islands. This shortage has direct consequences for healthcare quality: long waiting times, overworked doctors, and patients increasingly turning to emergency services.
Long COVID patients
Meanwhile, another issue remains unresolved: the lack of recognition for long COVID patients among healthcare staff. CSIF, one of the largest trade unions, points out that Spain still refuses to recognise long COVID symptoms as an occupational disease, despite estimates suggesting it affects around two million people. Although a healthcare worker in Castilla-La Mancha won a legal case in 2021 acknowledging their condition, little progress has been made since then.
Shortage of nurses
Spain also continues to struggle with a severe shortage of nurses. With 6.3 nurses per 1,000 inhabitants, the country lags far behind the European average of 8.8. According to SATSE, many Spanish nurses are moving abroad due to poor working conditions. This shortage not only increases workload but also directly impacts patient care.
Political deadlock and frustration
A bill is under discussion to establish a minimum number of nurses per patient. However, the political decision-making process remains frustratingly slow. “It is disgraceful that five years after the pandemic, we are still fighting for the most basic improvements,” says Pérez Raya.
Many healthcare workers who received applause daily five years ago now feel forgotten. They hope the government will finally take action.