Alberto de Rosa

Joaquín Farnós, a person to whom the healthcare and politics of the Valencian Community and Spain owe a lot, has passed away. He was always a pioneer and, in my opinion, someone very ahead of his time. This is because he didn’t hesitate to defend projects, initiatives and management models in order to guarantee quality in public healthcare and the sustainability of the system with a long-term view.  Farnós represented a liberal, reformist and forward-thinking figure, who set a precedent and whose proposals have been inherited and kept by the parties that have had responsibilities within the Valencian Government since his time as Minister.

Farnós liked to innovate in the 70s, which were difficult years. He was a pioneer in the implementation of thermalism for rehabilitation and rheumatic diseases in the Valencian Community. And not only in a medical capacity but also on a political level. With a liberal, reformist and centrist spirit, as a peacekeeper and integrator, he contributed to the consolidation of democracy in Spain, from the foundation of the Union of the Democratic Center in Castellón to participating in the drafting of the Constitution in 1978.

Joaquín Farnós loved his home,  Castellón, but from there he was always committed to territorial balance. And during his time as the Valencian Government’s Health Minister he launched some incredibly pioneering initiatives. I would like to highlight three of them:

The first one is the emergency plan, which we now know as agreements to combat waiting lists. Although they already existed previously, with the Socialist party governments, the big achievement was to systematize them so that anyone on a waiting list for more than 90 days in the Valencian Community could choose between being operated on in their hospital or in a private clinic. This initiative was the first to break the dichotomy between public and private, with the health system as a whole serving the citizens. That measure, which at that time was highly criticized by those who like to repeat the “privatization of healthcare” mantra in almost any forum, was so successful that it has not only been maintained for 25 years, but has also spread to the rest of Spain and is implemented by governments regardless of the political party.

The second revolutionary initiative that  Joaquín Farnós launched was the creation of addendum C, which brought an end to the exclusivity of doctors in the public system. Before this addendum, doctors that earned their place in the public system could not work in the private sector.  Farnós, with his humanistic, open and inclusive vision, saw immediately that it was not necessary to impose how to work onto medical professionals, but rather that it was more appropriate to enable professionals and give them the freedom to choose whether they wanted to dedicate themselves exclusively to public healthcare or if they preferred to complement that with a period of time in private healthcare.

And last but not least, Doctor Farnós is and always will be the father of the well-known Alzira model, set in motion at Hospital de la Ribera. As a doctor and as a person who knew both the public and private system very well, he firmly believed that it was necessary to maintain values, quality and universality in the public system, but that it was also necessary to allow the private sector to take part in the management of those public resources, maintaining values but innovating prevention policies and providing flexibility in human resources or purchases, amongst other things. The important thing in the long term is to pool resources, opening and improving a system that is too bureaucratized and restricted. In order to achieve that, incorporating the private initiative, of civil society at the end of the day, is key.

Due to that Farnos was able to make the region’s dream a reality in just a year and a half and put an end to the promise that had been unfulfilled since 1982, after the extreme flooding in Tous, by constructing a hospital in Alzira to provide a service to the whole region of La Ribera. He will always be remembered for that.

I had the incredible fortune of knowing and working with Doctor Farnós for a while. One of the memories that I have clearly ingrained in my mind is that he was the first person that I heard say that he was the Minister of public and private. Joaquín Farnós always sought to unite, promote consensus, demonstrate the centrist and conciliatory spirit of the UCD and, with that, managed to unite right and left. He exuded the spirit of the April report, with a vision of the future of the public system above and beyond any ideology, because he was committed to the sustainability of the system, with his view always based on universality, excellence and innovation.

Doctor Farnós always clearly saw that there there are two types of people in life. There are those who propose, construct, create and work positively, always thinking about better services and a greater well-being for citizens; and those that live to destroy the present and even make an effort to change the narrative of the past, because, obviously, facts cannot be changed.

Today I want to advocate for the “ Farnós spirit” in this blog, to make him an example of an unbiased, modest and peacekeeping visionary. Thank you for everything, Joaquín.

I would like to take advantage of this blog to publically reflect on and provide my post-pandemic vision. You know, those of you who follow these blog entries, that I often like to reflect on and analyze the current situation, in order to try to stay ahead of the game and make the best decisions for my organization, for the great professionals that work within it and, above all, for the citizens and their healthcare. Therefore, based on my analysis of the current problems and challenges of the healthcare systems, I would like to explain why I think that we will be dealing with impact of Covid in the medium and long term.

I think that there are sectors such as tourism, hospitality and leisure that, although they have had a tough year, with closures and restricted opening times and capacity, will overcome the crisis quickly. If they have survived this year of the pandemic  without vaccines, although unfortunately many haven’t, it is highly probable that they will be able to regain their strength and value for the Spanish economy within a few months, once production and distribution of the Covid vaccines is normalized, the restrictions are relaxed or removed and citizens feel safer. In other sectors, such as that of the industrial, recovery may take longer, because consumption needs to be reactivated. But if our leaders take good advantage of the boost of European funds, we will be able to overcome the crisis and, even, allow a genuine industrial policy that strengthens industries that a year ago we didn’t believe to be as necessary.

But I have absolutely no doubt that this pandemic is going to have many repercutions on the healthcare systems all around the world, in the medium to long term. It has been shown that although Covid has limited the movement between countries, globalization is a reality and it will continue to be so after this healthcare crisis. And, therefore, the problems of many are and will become the problems of everyone, in spite of the shortsightedness of those who think Spain is the only reality that exists, ignoring the fact that we live in an open world.

And why am I saying that we are going to live with the consequences of this pandemic in the medium and long term? I’m going to explain in a very schematic way. There are three elements that are going to put pressure on the healthcare systems which will be unbearable, if we don’t remedy them.

1. The increase in costs. And I’m referring not only  to the short term, but the need to hire more staff in order to strengthen services, cover leave, buy vaccines, protective gear for professionals, Covid tests for patients, etc. Also for the repercutions of this illness itself that are not yet known. The healthcare professionals are warning, after one year, of neurological effects, not only psychological but also physical, that affect organs and systems such as the respiratory system, and that they will continue and put pressure on healthcare, lasting beyond the short term. In fact, I don’t believe we know all of the consequences of the virus and its impact on the physical and emotional health of the population yet.
2. The worsening of surgical waiting lists.  We are experiencing the worst waiting lists in public healthcare in not only Spain but also in other countries. All resources have been dedicated to the urgency of the pandemic and interventions have been postponed which has caused a delay, even greater than before, of waiting times for patients. That, in addition, is going to be difficult to recover from without collaboration from private healthcare. This is because I think we will keep experiencing “pandemic waves”, which won’t be of the same intensity as the current ones, but that at certain times of the year will place such pressure on healthcare that it will be necessary to temporarily delay interventions and consultations to attend to emergencies, as has happened on occasion until now with the flu. In this way, if the waiting lists were already a problem, now they will be even more so. Furthermore, we are now seeing that these waiting lists are causing more complex interventions, with a worse prognosis and a slower recovery time, with all of the impact being on wellbeing and the cost that it generates.
3. The delay in diagnoses and treatments. Our Head of Emergencies in Ribera Povisa Hospital, Ángel Martín Joven, outlined it very well a few days ago, in an interview in La Voz de Galicia: “There is a hidden pandemic, above all among the elderly, who don’t come to Emergencies through fear of coronavirus. They downplay chest pain, for example, that we later discover was a heart attack that we would have been able to treat if they had come to the hospital”. This is the other reality of the pandemic. We found, months ago, that many patients aren’t going to check-ups, health examinations, diagnostic tests and Emergencies through fear of contracting it. In addition, the delay in diagnostic tests and specialized treatments, such as scans, radiotherapy, etc. means, as we said in point 2, treating diseases such as cancer at a later stage, having a significant impact on the prognosis, complexity and recovery as we have already mentioned.

The combination of these three elements results in unsustainable pressure on the healthcare system in the medium term. And faced with this situation, if anyone thinks that the solution or political response, “the citizen rescue program”, is to nationalize the healthcare system, they live on another planet. Or perhaps even in another galaxy. Some people even talk about a public pharmaceutical industry and nationalizing pharmacies…I will never tire of repeating that what we need to do is combine resources and seek consensus and coordination between organizations and administrations, in order to give a solution to today’s problems, which are a real threat to the healthcare of tomorrow. And I’m referring to the literal “tomorrow”, because time is against us. I hope that policy makers and healthcare managers in Spain are aware of this reality, because the image that they transmit – which I’m not saying is true, but rather that which is reflected – is that of those who put seats first, fleeting leadership and power games before the health of the citizens.

It is sad that at this point in the 21^st century and after suffering with the pandemic, political leaders are not capable of speaking normally about collaboration with the private sector to face this tragedy. I can’t understand how with what we are experiencing there are those who think that, rather than publically acknowledging the work of all professionals, private healthcare is considered to be less than public, when vaccinating their professionals and acknowledging their work. A true public service is one that provides solutions to the real problems of the citizens, in order to improve their wellbeing and quality of life. Everything else is secondary. I would like to think that politicians, at least, have learned this during the tragedy that we are experiencing.