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The example of Farnós

7 junio, 2021 • By

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.


English

Citizens lead the way

4 mayo, 2021 • By

The number of people taking out health insurance has steadily increased over the last decade. Almost thirteen million citizens in Spain (12,802,665 to be exact) currently have it in our country, according to ICEA, the Spanish Insurance Sector’s Studies Service, responsible for carrying out research and publishing all of the statistics. The number of health insurance policies has grown by 3.34% just in the last year and the average annual growth since 2015 has been 3.51%. And it is this data that has led me to share some of my thoughts in this new blog entry.

First and foremost, the private insurance sector isn’t experiencing the ups and downs of the crisis caused by this pandemic. And I’m referring to the figures. Rather, Covid has upheld a trend that already surprised many in the crisis of 2008 and that has now been affirmed: participating in and taking decisions about health management is a priority. Health insurance is not only thought of as a privilege or a luxury, but rather as a necessity. Regardless of their level of income, citizens value it as something that is becoming increasingly necessary.

Those who criticize private healthcare and try to put it opposite public healthcare show a complete lack of knowledge about the current society once again. They are still thinking about the same statist terms of their grandparents, and they use fixed expressions and the same old clichés, instead of realising that we live in an age in which the citizens have different criteria, priorities and wishes. I’m sure that the 12.802.665 people who have decided to take out health insurance hold public healthcare in very high regard. We are incredibly fortunate to live in a country with strong values, one in which no one is left behind when it comes to receiving any type of treatment in the public healthcare system. However, I also think that, despite that high regard that we all hold, especially in terms of the social nature of the system and the main public health centers of reference, all of these citizens  are willing to make a co-payment for peace of mind that, whatever happens, they’re going to be treated. And, what is more, quickly, and with quality care.

And why does this happen?

Firstly, because over the last few decades, health insurance companies have expanded the type of service they offer and have improved their own management and the services and assistance they offer to citizens. In addition, compared to our neighbouring countries, Spain provides quality health insurance which is accessible for broad sections of society. And the data that I gave at the start of my reflections confirms this. Together with accessibility and the high quality of healthcare provided, this has made health insurance a service that citizens want. This is because they also know that it is compatible with the treatment that they receive from public healthcare. It is complementary.

Secondly, I think that citizens are becoming more and more appreciative of having a private alternative, alongside the public system, because they realize that it suffers from organizational, bureaucratic and management problems from its own administration, since there are problems with accessibility, very long waiting lists, a lack of motivation from its professionals and obsolescence regarding the technological equipment in many of its healthcare centers. And, without a doubt, Covid has worsened those problems and will continue to do so in the short and medium term.

I can give you an example with which I am familiar. After Hospital de la Ribera moved to direct public administration, the number of health insurance policies in this area of the Valencian Community increased exponentially. When citizens have experienced a real loss in the quality of the service that they receive, with regard to before the reversion, they look for an alternative in the private sector, in order to guarantee themselves fast, quality and safe care.

However, I also firmly believe that health insurance is important as an accompaniment or an aid to maintain the public system, whilst guaranteeing access to certain services that our system is unable to offer. Private healthcare and health insurance play a key role, one that is good for the system, because it acts as a free co-payment that I think should be encouraged by the Government itself, with some type of tax credit. 

I’m a firm defender of freedom of choice both with healthcare and education. As citizens we want to participate and decide how to manage our health or our children’s education. It has been shown that it is much better for everyone to incentivize these freedoms rather than restrict them. Even the current Government has committed to this by bringing incentives to the table regarding a delay in retirement age. Why not do this in healthcare? These are effective measures to encourage a good use of public resources. 

I want to finish by pointing out that freedom of choice has also been a reality for many years in the civil service. At Muface, the officials can choose whether they want to be treated in public or private centers (the majority choose private, incidentally). The future is about placing people in the driving seat when it comes to decision making regarding their health.

P.S.Last week, parliament passed a non-legal proposal (NLP) for which the Government was requested to extend direct management to the whole public system, without looking into other ways. This NLP was approved by just one vote. There are people who have asked for my opinion and I don’t want to create a lot of controversy because the subject is clear. Years ago the Constitutional Count left it very clear that the Constitution protects both private or indirect management and direct management. Therefore nobody, not even through an NLP, can limit the current management models, because it’s the same as attacking the Constititution, even though we’re experiencing a time during which some endeavor to attack this text, in order to change the Spanish legal framework. Therefore, as the Constitution says, all management models are valid and these polemics are short-lived. I’m with the 1978 Constitution that has given us the longest period of prosperity and harmony in our history. And you?


English

Three challenges for the health system

17 marzo, 2021 • By

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 21st 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.


English

Overlooking healthcare is a mistake

5 febrero, 2021 • By

This is my first blog entry of 2021 and although the majority of us were hoping that the year would have started better, the truth is that this pandemic is making life difficult for us. As the president of Valencia’s College of Physicians quite rightly described, this is not a wave, this is a vertical wall.

And I’d like to add: it is impossible to face a challenge like that of this pandemic without order or planning or correct management from our authorities which, in addition, still do not count on physicians to make decisions. It seems that some public debates carry more weight than the deaths of hundreds of people every day, a terrible statistic that we have experienced for the last few weeks.

Almost a year since the start of this unprescedented health, social and economic crisis, our leaders still do not believe in the importance of uniting and combining forces and strengthening the coordination between public and private resources. Once again, it seems that they prefer to put beds in hospital halls, chapels or the corridors in the Emergency department rather than sitting down with all the healthcare workers and jointly planning the best way of treating Covid patients, as well as non-Covid patients that cannot or should not wait any longer. It is important to remember that, after a year of the pandemic, the waiting lists are unbearable in many hospitals. We are talking about people’s health.

I sometimes have the feeling that putting a patient in a private hospital bed is valued less than putting them in the cafeteria of a public hospital. And I find it outrageous that someone may even question what is better for that patient.

These types of situations are those that, in my opinion, we have to reflect on in terms of what we’re not doing well, both within the sector and in society in general, especially if we allow these things that shouldn’t happen to indeed happen. They shouldn’t even occur. You can’t close your eyes when faced with situations that have no justification. Not to mention the hospital tents that have been set up in the Valencian Community and I’m not going to go into the criticisms. All you need to do is hear what the poor patients who were admitted there have said. But the bottom line is that, unfortunately, our leaders have spent the last year making bad decisions and making them too late, investing in botched jobs that don’t improve the healthcare of the citizens or the work of the professionals and wasting and disregarding resources that the private sector has made available to them since the beginning.

And that bias regarding private healthcare and its professionals brings me to another disdainful gesture shown to this group, a group as professional and vocational as that of the public centres. I’m referring to the vaccination process. You don’t need to be an expert in the subject  or manage a health group to realise that neither the organisation nor the logistics of the vaccination process have been good on the part of the relevant authorities. And a lot of things surprise me: from the lack of foresight to the disastrous planning and distribution of the vaccine, in some locations a dose wasted due to a lack of adequate needles and countless other things. But it surprises me again that private healthcare professionals are marginalised when it comes to the vaccination process, as if they don’t treat Covid patients (and non-Covid, who could catch  it when they come to a consultation without knowing it). At least, there have been medical associations that have gone to the courts to demand the vaccination of these professionals and, after having it granted, the governments have taken it as an obligation…but putting them almost at the bottom of the list. It’s outrageous. All health professionals, regardless of where they carry out their work, are equally valuable. Today and always. But especially in the context of this virus. Marginalisation in healthcare during a pandemic is a very serious mistake.  

And I want to stress a fundamental idea. We have to focus all of our efforts on two objectives: to guarantee appropriate healthcare for all Covid and non-Covid patients; and to give a definitive boost to vaccinating. There are success stories and examples of unified efforts, resources, staff and infrastructures that have resulted in a very high percentage of vaccinations among the public, for example, Israel.

We have time to re-direct 2021 and turn some predictions around that, at present, are not optimistic. But I want to say loudly…together, we will achieve it!


English

Open letter to Torrevieja Health Department employees

21 octubre, 2020 • By

Dear colleagues,

As you all know, yesterday the Health councillor, Ana Barceló, unfortunately confirmed the Generalitat Valenciana’s unilateral decision to not extend Torrevieja Health Department’s contract with Ribera Salud.

I firmly believe this is the wrong decision for the professionals and citizens in this area, and worst of all is that I am certain that there are voices within the Government that believe so too, as well as within civil society.

Also, the Valencian Government has the data corresponding to the previous reversion to direct public administration of the Health Department of La Ribera, whose waiting list has grown threefold in two years, whose professionals are up in arms and which costs the Valencian people upward of 80 million euros a year. Furthermore, in the case of Torrevieja, this decision is even more serious and incomprehensible because of the terrible social and healthcare crisis and financial recession that we are living through. We are in the middle of a global pandemic and our leaders are going to allow their political needs to take time away from what is really important: ensuring citizens have access to the best healthcare.

The councillor’s unimaginable announcement yesterday cannot be justified in terms of quality or efficiency, even less so in terms of health results. Because this department is the best in the Valencian Community thanks to the excellent work, commitment and efforts of all the people that make its day-to-day operation possible. And we are not the ones saying it. The official reports and audits of the Generalitat Valenciana itself say so: patient satisfaction is higher, waiting times are shorter and the best healthcare is provided, thanks to the proven real commitment to healthcare plans, investments, technology and human and material resources. And this has been ratified by independent organisms that certify the quality of the healthcare provided to citizens in the Torrevieja area, such as The Joint Commission International.

But I am not writing to you to butter you up, because no one knows better than you the magnificent work you have done and continue to do during these 14 years in such a special region, with a multinational population for whom, in many cases, without a doubt, the quality of healthcare received is a reason for their residence here. And there is no question that what the Valencian Government want to do to this department will reach Europe and the authorities of the 138 nationalities that live here, with facts and figures.

Our intention, as you know, was and is to extend this commitment with the region for five more years. This is why we presented an investment plan with clear, real proposals agreed upon with the local councils, valued at 40 million euros. For this reason, we also recently signed a new collective bargaining agreement, with conditions regarding reconciliation, equality, training, professional career and internal promotion that no other public hospital in the Valencian Community has.

If your attitude and commitment in the last 14 years has been outstanding, your response during the hardest months of this pandemic that you continue to deliver today confirms that you are Ribera Salud’s main asset. And I take this opportunity to reaffirm my gratitude and admiration. Despite what some try to extend, this crisis has proven that public-private collaboration is essential, and that the only way we will get through this complex situation is together.

I will not deceive you. After yesterday’s announcement, this is the beginning of a period of uncertainty where we all have many questions and the Health Council has very few answers. This is the truth.

But in this letter, I want to convey trust, hope and perseverance. We will continue to prove that we are a great team and that we will not give up looking after the health of our citizens with the best professionals, the latest technology and the highest safety guarantees for you while you do your job.

Remember that the future is not set in stone. Who would have thought that 8 months ago we would be living in lockdown for months because of a virus and that still today we would be living a global pandemic. No one knows where or how we will be in a year.

I am committed to continue working with a positive attitude, seeking joint forces and resources, public and private, to ensure that citizens have the Healthcare they deserve and that you as professionals continue to do your job with all the necessary means, the highest guarantees and the certainty that, as we have seen in Alzira, others cannot give you. I refuse to believe that the message of unity and call to public-private collaboration by the president of the Generalitat Valenciana, Ximo Puig, last October 9, are hollow just five days later.

We all hoped this day would never come, but it has. I ask for your patience and trust and encourage you to continue to highlight the importance of the work, commitment, and vocation of the public service that Ribera Salud has always displayed.

We are all in this together.

Dear colleagues,

As you all know, yesterday the Health councillor, Ana Barceló, unfortunately confirmed the Generalitat Valenciana’s unilateral decision to not extend Torrevieja Health Department’s contract with Ribera Salud.

I firmly believe this is the wrong decision for the professionals and citizens in this area, and worst of all is that I am certain that there are voices within the Government that believe so too, as well as within civil society.

Also, the Valencian Government has the data corresponding to the previous reversion to direct public administration of the Health Department of La Ribera, whose waiting list has grown threefold in two years, whose professionals are up in arms and which costs the Valencian people upward of 80 million euros a year. Furthermore, in the case of Torrevieja, this decision is even more serious and incomprehensible because of the terrible social and healthcare crisis and financial recession that we are living through. We are in the middle of a global pandemic and our leaders are going to allow their political needs to take time away from what is really important: ensuring citizens have access to the best healthcare.

The councillor’s unimaginable announcement yesterday cannot be justified in terms of quality or efficiency, even less so in terms of health results. Because this department is the best in the Valencian Community thanks to the excellent work, commitment and efforts of all the people that make its day-to-day operation possible. And we are not the ones saying it. The official reports and audits of the Generalitat Valenciana itself say so: patient satisfaction is higher, waiting times are shorter and the best healthcare is provided, thanks to the proven real commitment to healthcare plans, investments, technology and human and material resources. And this has been ratified by independent organisms that certify the quality of the healthcare provided to citizens in the Torrevieja area, such as The Joint Commission International.

But I am not writing to you to butter you up, because no one knows better than you the magnificent work you have done and continue to do during these 14 years in such a special region, with a multinational population for whom, in many cases, without a doubt, the quality of healthcare received is a reason for their residence here. And there is no question that what the Valencian Government want to do to this department will reach Europe and the authorities of the 138 nationalities that live here, with facts and figures.

Our intention, as you know, was and is to extend this commitment with the region for five more years. This is why we presented an investment plan with clear, real proposals agreed upon with the local councils, valued at 40 million euros. For this reason, we also recently signed a new collective bargaining agreement, with conditions regarding reconciliation, equality, training, professional career and internal promotion that no other public hospital in the Valencian Community has.

If your attitude and commitment in the last 14 years has been outstanding, your response during the hardest months of this pandemic that you continue to deliver today confirms that you are Ribera Salud’s main asset. And I take this opportunity to reaffirm my gratitude and admiration. Despite what some try to extend, this crisis has proven that public-private collaboration is essential, and that the only way we will get through this complex situation is together.

I will not deceive you. After yesterday’s announcement, this is the beginning of a period of uncertainty where we all have many questions and the Health Council has very few answers. This is the truth.

But in this letter, I want to convey trust, hope and perseverance. We will continue to prove that we are a great team and that we will not give up looking after the health of our citizens with the best professionals, the latest technology and the highest safety guarantees for you while you do your job.

Remember that the future is not set in stone. Who would have thought that 8 months ago we would be living in lockdown for months because of a virus and that still today we would be living a global pandemic. No one knows where or how we will be in a year.

I am committed to continue working with a positive attitude, seeking joint forces and resources, public and private, to ensure that citizens have the Healthcare they deserve and that you as professionals continue to do your job with all the necessary means, the highest guarantees and the certainty that, as we have seen in Alzira, others cannot give you. I refuse to believe that the message of unity and call to public-private collaboration by the president of the Generalitat Valenciana, Ximo Puig, last October 9, are hollow just five days later.

We all hoped this day would never come, but it has. I ask for your patience and trust and encourage you to continue to highlight the importance of the work, commitment, and vocation of the public service that Ribera Salud has always displayed.

We are all in this together.

All the best,