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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,


English

The Challenge of digital transformation

22 septiembre, 2020 • By

Based on my intervention during the 1st Public Health Observatory Symposium, organised by the newspaper El Español on September 10, I would like to share some of the thoughts I was able to contribute to that interesting forum, specifically during the discussion panel dedicated to digital transformation.

When we talk about digital transformation, of the healthcare system and the challenges we face, we must make a diagnosis beyond this crisis that’s been triggered by COVID-19.

The macrotrends within the Health sector are there. We have an increasingly ageing society, and we speak about disease chronicity precisely as a result of this ageing population. There are also three other components or factors that we must know how to redirect or lead in the right direction, to ensure the sustainability and quality of our healthcare system. I’m referring to the introduction of new healthcare and information technologies, the shortage of healthcare professionals and the unsuitable training and experience of current healthcare professionals for the demands of today’s society.

Let’s start at the beginning, along the path that should guide the present and future of our Public Health. Digital transformation must become the system’s springboard.

Likewise, when we talk about our ageing population, we must tackle how we’re going to organise the social-healthcare space that has been (and still is) under so much stress during this pandemic. But we mustn’t resign ourselves to this. We must seek solutions.

Nursing homes must work more closely with the healthcare system, allowing professionals to follow up on residents, especially Primary Care professionals. There’s no need for nursing homes to turn into hospitals, but the Healthcare System must create mechanisms that will allow us to comprehensively follow up on the health of our elderly, the most fragile members of our society, and anticipate risks.

When approaching the chronicity of many diseases, largely due to this ageing population and also because of the advances in treatments, it’s essential to discuss including all the different healthcare levels: from primary care to hospital care, including social-healthcare and home care. As part of the system, we must all share a common vision and outline common strategies for action.

Because there’s no question that we’re heading towards a more predictive and preventive model. It’s important to be one step ahead of circumstances, to anticipate citizens’ health issues, to foresee the progression of their disease… In this sense, primary care must play a fundamental role within the system. Because we’re heading towards a system that, as well as healing, must also take care of and be by people’s side throughout all stages of life.

Which is the role of healthcare professionals within this new model? Through these digital transformation processes that all organisations within the sector are working on, we must disentangle the healthcare professional from more bureaucratic tasks and allow them to focus on what provides citizens with the most value, which is better care, which also entails greater satisfaction and recognition. Therefore, we must leave behind the traditional hospital concept to come home, working hand in hand with primary care, and thus see Public Health in a new light, with a more holistic approach.

To face these issues and enable new solutions, digital transformation is a fundamental platform and an ally to changing the health model, beyond COVID-19.

And these changes and the sector’s necessary evolution have a single objective: the citizens. Because people are going to play a leading role in this transformation. If someone had told us on March 1 that we’d be under lockdown, not just us but our businesses and the entire world, and that we’d be capable of adapting our organisations to working from home in less than 15 days, we wouldn’t have believed it. But we were able to do this and much more, both organisations and people. And this must give us hope, because citizens must take on the leading role in this transformation.

Some say that the population lacks digital culture… We may not know the inner workings of a mobile phone or computer, but we all know that if we want to reach a destination, know the weather forecast or stay in touch with our loved ones, our mobile phone, in short, technology, is indispensable. And that’s also digital culture. Without it, we wouldn’t have survived.

I also firmly believe that this digital transformation will empower citizens, giving them a larger role in managing their health, and making ours a more democratic, open and efficient system.

Technology also makes us more transparent, which involves trust. And digitalisation is key within the British concept of accountability, because transparency makes us more responsible.

In short, we must be capable of doing more and better things.

We can’t forget that digital transformation helps the Health system’s long-term strategies, as well as the 2030 Agenda and the Sustainable Development Goals, where goal 3 is good Health and Wellbeing. I believe that these are concepts that we, the agents that work within the system, must all strive for. In addition, goal 17 is partnerships between institutions. I’d add between public and private institutions. Because the goal is to end poverty and provide our citizens with wellbeing, and we shouldn’t place before these main goals nuances, political positions or personal whims that may become an obstacle to reaching these worldwide goals.

These days are highlighting that innovation is linked to public-private collaboration, where we find the pharmaceutical industry, big companies within the healthcare sector that participate in this symposium, and institutions. We all need to work towards common goals, discuss new relationship models between the payer, whether public (such as the State or the Autonomous Communities) or private (such as insurance companies), and suppliers of all kinds (industrial, pharmaceutical, hospital and professional) and, also, reconsider the funder’s relationship with citizens. A new relationship must arise. We must bring to the table the need to share strategies and plans, and change the relationship by moving towards shared risk models, so that we understand everyone’s mission.

Let me finish with some thoughts on this healthcare crisis brought on by COVID-19, which has already been with us for six months, and will most likely stay for some time. It has shown us that, when faced with such a crisis, we should have worked together even more, with a greater joint effort than up until now… I hope that we’ve learnt our lesson and that we’re all aware that, without bringing something to the table, without coming to an understanding, we’re going to struggle to overcome this situation, not only in the field of healthcare, but also in the social and business world. This is the greatest lesson the pandemic has taught us.


Alberto de Rosa, English

A new opportunity

1 julio, 2020 • By

We have been talking about this for many years. The post-COVID-19 reality means that it is now more necessary than ever to undergo reformations in the Health sector that will allow the system to be more flexible and provide it with the tools necessary to face health care crisis such as that we have just experienced. However, most researchers agree upon the fact that COVID-19 has been the first pandemic of the 21st century, but it will not be the last. First of all, we need to be prepared to coexist with this virus, at least until a vaccine is available on the market.

The great axes around which an urgent restructuring of the healthy system must pivot are, in my opinion: an increased Health budget, with total transparency; the introduction of reformations in the management of human resources and implementation of new organisational models, where digitalisation plays an essential role; the overcoming of barriers between levels of care, with greater integration in the social space; and the necessary involvement and collaboration of all resources in the system, both public and private.

Any type of reformation necessarily involves flexibilisation of the health system, the rigidity of which has been causing a lack of efficiency and loss of quality with regards to citizen care for decades. At a time when it is more important than ever to contribute, innovate and position ourselves one step ahead of any health care crisis that may threaten the population, the institutions must be brave and make effective decisions.

I have spoken about the necessary increase for the Health budget, of course, always from absolute transparency, prioritising resources and specifying items. But perhaps the most urgent challenge for a health system such as the Spanish one is the necessary reformation of the management of human resources, where, in my opinion, it would be advisable to redefine the legal framework in order to permit a more modern management of human resources and to introduce variable remuneration models and bonuses, in order to recognise the value provided by professionals at all times.

In the same way as the citizens have new needs with regards to the care for their well-being, I believe that it is essential to restructure the current medical specialties and to make decisions that permit an increase in the number of certain disciplines in order to adapt the offer to the demand for care. Spain is currently generating a large number of specialists that, as a consequence of the technological advances or the demographic profile of the citizens, are no longer necessary in these quantities. Even so, there is a lack of specialists in modalities where jobs for Resident Medical Interns (RMI) are not anticipated. This situation generates imbalances, rigidity in the system, low performance and, most importantly, a decrease in quality and care for citizens. Because if there is a lack of specialists, the waiting lists grow longer.

This COVID-19 crisis will imply an acceleration in the digital transformation process. It is fundamental to implement new organisational models to consolidate the general focus on digitalisation both for health care (with predictive models and online and offline care, useful healthcare websites, direct communication between the patient and their physician, promotion of home care and remote medicine, etc.) and for managing medicines (integrate complements for pharmacists in the care circuit, guarantee online prescriptions and a medicine cooperative, among others).

Another aspect to be learned from this health care crisis is that we must progress the citizen’s perspective as the protagonist of our system and overcome all barriers between the levels of care: primary care, hospital, nursing homes and specialised services. It is essential that we strengthen primary care, guarantee human resources and materials in order to offer personalised, approachable and quality care for our citizens.

It is urgent, after the devastating effect that COVID-19 has had on nursing homes, to reconsider the creation of a single socio-healthcare space in order to break the duality between Health and Social Well-being. Nursing homes must be added to the work areas that are currently integrated to the health departments.

Throughout this transformation, we must avail of all of the agents in the system, both public and private, because if there is something else that we’ve learned from this pandemic it’s that without working together and collaborating, it would have been much more difficult to provide an effective and quality response to our citizens.

I would like to dedicate this article to all of those who have lost their lives as a result of this pandemic.

(This article was published in New Medical Economics on 1sth July 2020)