We have all heard of Agatha Christie (1890–1976). This British writer, specialist in detective novels, achieved major international success and even set a Guinness World Record as the best-selling novelist of all time. A pioneer in the detective genre, she has been copied and plagiarised: yes, it happened to her work, too, though no copy has ever achieved the success of the original.
Her prolific literary career gave us titles such as The Mousetrap, Murder on the Orient Express, Death on the Nile, Philomel Cottage, The Witness for the Prosecution, Endless Night, The Mirror Crack’d from Side to Side and Appointment with Death, many of which have been adapted for theatre, cinema and television.
My favourite is And Then There Were None, which I will write about in this article. First, a quick reminder of the plot, a translation of the outline available in Spanish on the Casa del Libro website: “Ten entirely unrelated people are invited to a mysterious islet off the English coast by a U.N. Owen, owner of an impeccable, luxury mansion, and a stranger to all his guests. After the first dinner, and still without having met their host, the ten diners hear a recording accusing them of having committed a crime at some point in the past. Next, one by one, they are all murdered, without any explanation or apparent motive. Only an old children’s song seems to hold the key to the mystery of this growing nightmare.” In sum, a perverse person takes advantage of his power over others to achieve his own ends.
Today, attempts are being made to impose this plot on Spanish society. In Spain, we also endure figures who abuse their power to embed change in society, without caring whether or not this change damages society in the medium and long term. Some of these figures, both men and women, have now left the national political scene, because one or other of their numerous covert scandals, concealed behind friendly, populist masks, has come to light.
But many of these men and women are still here, determined to generate conflict and question the fundamental components of a democratic society, like free choice, free enterprise and freedom of opinion. And, worse still, they are appropriating the claim that they are “pro defence of public systems” and making it seem as though they are the only ones offering this defence. I believe they support public systems, but they do it in theory and not in practice. Practice shows that public-private collaboration is the best option to secure the long-term sustainability of the public system.
That is the conclusion of the latest EASP (Andalusian School of Public Health) study produced with the Universities of Granada and Jaén and ibs.GRANADA (Granada Biohealth Research Institute). The study is called “Análisis Multinivel de la Eficiencia Técnica de los Hospitales del SNS Español por Tipo de Propiedad y Gestión” (“Multi-level Analysis of the Technical Efficiency of Hospitals in the Spanish National Health System Based on Property Type and Management”) and it analyses more than 230 hospitals from 17 autonomous communities in Spain. The conclusion is that hospitals managed under the Alzira Model are more efficient than public hospitals managed by the public health services of the autonomous communities. A similar conclusion is drawn by the Informe de la Sindicatura de Cuentas de la Generalitat Valenciana (“Report of the Accounting Watchdog of the Regional Government of Valencia”). Commissioned by the current Regional Government of Valencia, the report concludes that the Alzira Model saves the public authorities some 25%, while offering better quality for citizens, with fewer waiting lists, higher healthcare-infrastructure investment per inhabitant, and greater patient satisfaction.
This is why I am disappointed and concerned by recent spin related to the Spanish general budget, which includes populist and demagogic statements pertaining to the critical topic of public-private collaboration in healthcare.
Given that we already have a report (the Informe Abril [“April Report”], commissioned in the 90s by the Socialist Party when it was in government) and a law (Spanish Law 15/1997, which the Socialist Party supported and applied in the autonomous communities where it was governing), it is surprising, sad and worrying, to say the least, that we are having to listen to this type of spin now, in 2018.
Moreover, the proposed line of action goes against the current trend in the majority of the most-advanced democratic countries on the planet. Remember that one of the sustainable development objectives set by the UN for 2030 is partnership between the public and private sectors, to progress towards a sustainable economic model.
We must have a care. It starts with a hamlet, then a village and then a town, but the goal is mass implementation of social experiments. What I mean is that the starting point is attacking public-private collaboration in healthcare, but the attack will move on to education, social services, internships at public centres for students from private universities, research agreements with the pharmaceutical industry, water management, pharmaceutical-distribution agreements, and other areas. And, of course, freedom of choice in MUFACE will come under attack because each year, 80% of civil servants choose private healthcare, which, as we all know, is a replacement model for public healthcare. If these statements are anything more than spin then this must be where they are launching the assault, since I see no other interpretation.
Many will remain silent while the first diners from our novel are attacked because they think their turn will be a long time coming, and something will surely change. But unless the sector coordinates itself and takes action, rather than contemplating its naval and its own interests, in no time at all, there will be no guests left at the table.
As José María Guelbenzu writes in the prologue to the novel: “And Then There Were None reflects a desire to give a coup de grâce to the world of detective novels, to show it who is boss, who is number one, the only one still able to take it to the next level.”
That is what I mean.