Browsing Tag

community of Valencia

Alberto de Rosa, English

Digitalisation and reindustrialisation, more lessons from this crisis

23 abril, 2020 • By

Last Friday I was interviewed on Cadena Ser by Amadeo Salvador and Arturo Blay, with whom I talked about the importance of global strategies when facing healthcare crises like COVID-19, how this worldwide emergency has proven that we need digital technology and the importance of undertaking an urgent reindustrialisation in Spain. As I have said in this interview and in similar statements that I made in the Levante-EMV newspaper and several blogposts, this worldwide pandemic has allowed us to prove that we can do many things very well without being physically present. Also, not having the resources to produce all the necessary supplies in Spain, at a time like this, has been detrimental. We should not leave two areas such as industrialisation and research completely in the hands of other countries, so that we can always have our own resources, when necessary.

– Journalist: What is the first thing that comes to mind when you realise that unfortunately in the Community of Valencia we have already had 1,000 deaths due to COVID-19?
We are facing the first pandemic of the 21st Century. And, unfortunately, I hope that we learn consequences from this new disease and the challenge we are facing for the future. But we are definitely living through a dramatic tragedy. 

– Does the fact that Germany invests three times more in healthcare than Spain have to do with their country being less affected than us?
Many conclusions must be drawn. First, it is affecting the northern hemisphere much more than the southern hemisphere. I am really worried about what is going to happen in less-developed countries when southern winter starts. This week, at Ribera Salud and in collaboration with the World Bank, we have had the opportunity to explain to 150 government, public and private institutions the experience we have had facing this situation. Because, from the point of view of solidarity and sharing knowledge, we realise that this is a global epidemic and we must respond globally and share experiences. Right now, Europe has become the epicentre of this pandemic. And, more or less, collective decisions have been made. Which I think is very important: creating this kind of collective strategies and organisations. 

Some countries have decided to perform massive testing from the beginning. Which means numbers do not add up, they have many cases but an exceptionally low mortality rate. In Spain, we may possibly have more cases than we officially recognise, precisely due to the lack of massive testing. Something that we are now trying to correct. 

– Have there been warnings in recent history? Where there precedents that could have made us suspect that this could happen?
There have been other cases of warnings by the World Health Organization with SARS, and other cases that were stopped. Because that virus did not have the same characteristics as this one. I would say that it is a virus that spreads easily. And that is something that was possibly unknown or could not have been foreseen at the beginning of the disease. Only China, the source of it, was able to contain it by isolating the entire region of Wuhan. 

But it has spread very quickly because it is easily transmitted. It also has a peculiar development, in that there are no standard parameters, or at least, to date, they are unknown. And it affects people who initially seem to have similar physical conditions very differently. Some are much more intensely affected than others. And we have cases of young people who are seriously compromised. And children are hardly affected. It has focused on adults. 

In our case, for example, we know that we are in four autonomous communities. We have seen the mortality rate of all the people that have died in our hospitals, 90% of them are over 70 years old. And, for example, 75% are men, which is also something that should be studied. 

“PUBLIC HEALTHCARE IS DEFENDED BY LISTENING TO TECHNICIANS AND EXPERTS. WITH FAST DECISIONS. NOT WITH POPULISM, SLOGANS OR IDIOMS” 

– Should national industry be strengthened so that we do not run out supplies?
In an article I wrote a few days ago, I was saying that one of the lessons we must learn from this situation is that we must strengthen global organisations. It is obvious that the virus does not distinguish between regions, borders or ideologies. If we want to provide an effective response, we must do so globally. And coordinating country strategies, especially among European countries, is essential. But we must also think about the future. For example, we must invest more in digital technology. Now we are trying out how organisations can be connected without being physically present. Investing in digital technology can be a good lesson. 

Regarding reindustrialisation, we have realised that not having solutions within the country, at a time like now, has left us at times defenceless to get essential supplies to ensure the safety of our professionals and citizens. Therefore, this service economy that we have developed has perhaps proven that, at this time, it should be reformulated in favour of reindustrialisation. 

And a third topic that I find really interesting: if we want to be a leading country, we must invest in research. And not depend on third parties, but have enough independence. These are the three lessons I think we should focus on moving forward. 

PUBLIC AND PRIVATE HEALTHCARE HAVE PROVEN THEY CAN WORK TOGETHER” 

– What do you think about the statements that have been made about public healthcare?
I feel like a manager of public healthcare and I think it must be taken seriously. I would like for the people who write headlines about public healthcare without really understanding how it works, to think more about experts and technicians for once. And less about slogans, populism, and idioms. We have a strong public healthcare in Spain because it has great professionals, who are the real heroes of this story. And within public healthcare, which we value so much now that we are in a crisis, what we can and must do is talk about how to make it more effective. I think we have proven that we must be very fast and search for very flexible formulas to be able to face a crisis. 

And if we want to be strong enough within the healthcare world to face these situations and the challenges of the 21st Century, we must not forget ageing or chronicity. And learn to combine forces… Combine the resources of the Administration, the State, the Government as well as private resources. And we must not be afraid of realising that right now we are all together. Public healthcare managed by the Government, by companies like ours and private healthcare, all working hand in hand. It is a good example for the future. The fact that we can work together towards a goal, which is to provide citizens a better service. 

– Do you think that we have taken advantage of all the elements that private healthcare can offer?

It depends on the situation. For example, in Madrid and Catalonia, where the crisis has been greater, there has been a single authority, called “Plan 102”, where public, private, and public-private resources, which is what we are, had exactly the same value. Because there was an urgent need to do so. In the Catalan system, where historically the public and state-subsidised sectors often work collectively, no issues have arisen, and they have worked well together. In the Community of Valencia, we considered the need to work together. But fortunately, the system has not become overrun as many managers feared. And the intense collaboration with the private sector that was expected has not been necessary. 

I think this is positive because it has not been necessary. But we appreciate and recognise that all the private clinics have been at the disposal of the Healthcare Department. 

MASSIVE TESTING IS ESSENTIAL. WHEN WE ARE SITTING NEXT TO EACH OTHER, WE MUST KNOW WHO HAS HAD THE DISEASE AND WHO HAS NOT TO LEAD A NORMAL LIFE” 

– What do you think about the fact that many people have stopped going to PHC clinics, or self-medicate, or A&E Departments are quite empty…?
At all our centres in the Community of Valencia we are doing many virtual consultations with other specialities. Many have preferred to stay home to follow the recommendations, because they do not want to risk becoming infected and have preferred to not come to hospital. But that does not mean that the tools are not in place. This is why I insist on investing in digital technology. We have a health portal called “Yo Salud” [My Health]. We are amazed by how its use has increased among citizens to stay in touch with hospital and PHC professionals, with a 900% increase this month. 

“OUR VIRTUAL PORTAL “YO SALUD” [MY HEALTH] HAS INCREASED ITS ACTIVITY BY 900% IN ONE MONTH” 

Before we had 100 consultations, now they have been multiplied by 9. Therefore, one lesson is that, obviously, there are serious diseases where you definitely have to go to the A&E department. But for communication about chronic diseases, going to the physician is not indispensable, although being in touch with them is. And we must promote formulas such as digitalisation. 

– Spain has a lot of fibre optics, but digitalisation is more than that, right?
These are discussions that come up in recent years. Seeing how we can improve citizen-patient communication, not only with physical visits, which are essential. But also, in cases like high blood pressure, being able to send your physician a message saying “Hey, I don’t feel well but I’ve taken my blood pressure, here are the results” and for your physician to reply… We must promote that closeness in communication and being more in contact. 

This is another challenge that the crisis is bringing to the table. And now, when they were announcing the data, I remembered something essential: the necessary relationship between the hospital and healthcare sector in general and the social sector. We have been talking about social-healthcare space for years. And perhaps this crisis has made us realise that we have focused all our attention on the healthcare sector, especially on how to strengthen hospitals to respond to this crisis. And care in nursing homes has been overlooked. Unfortunately, we are seeing tragic data. But now is the time to think about that idea of social-healthcare space. 

– Could the system collapse when this current crisis is over because of everything that is not being treated?
We are starting to look into how to set ourselves in motion again. Because we have already overcome this critical phase where it was difficult to foresee what would happen the following week, we had to be ready for the worse outcome and we have been focused on getting by day-to-day. 

Now that we are not absolutely obsessed by this, we must start thinking about what happens after the crisis. And we are working with a concept that is very important: working with the maximum safety for our professionals and our patients. Because we must move forward. And that is something that I am also insisting on many times: on doing massive testing. Because, when we are sitting next to each other, we need to know who is asymptomatic and who has had the disease to try to lead as normal a life as possible. That is why we must insist time and again on doing massive testing. 

This is the link to the full interview on Cadena Ser, in case you find it interesting: https://cadenaser.com/emisora/2020/04/17/radio_valencia/1587126029_909395.html


Alberto de Rosa, English

For a sincere collaboration

21 abril, 2020 • By

We have been under a state of alarm for over a month in response to the COVID-19 healthcare crisis, which has forced most of the population into lockdown and has ground practically the entire economy to a halt as a consequence. This decision, absolutely necessary to help curb this public health crisis, had to be taken very drastically, partly because it took so long to implement and partly because there was so much initial reluctance to the required social distancing, as I noted in my 11 March blog post. And the consequence is that this situation may now potentially go on for a long time, with the subsequent drastic impact on both the economy and society.

As I commented in last week’s post, now is the time to start looking to the future and prepare to face a new reality. How long it takes to get through this crisis is up to us and we have to put aside what separates us and focus on what unites us. Well. It seems that our leaders aren’t entirely sure about which path to follow, and even contradict each other in statements and actions, which slows down decision-making. However, I would like to positively underscore how Ximo Puig, President of the Community of Valencia, holds video conferences with business leaders and, in an “exercise in realism” about the COVID-19 crisis, publicly acknowledged that recovery is unfeasible without private initiative. Completely impossible. I’m delighted to hear it because, ever since i started posting on this blog, I have emphasised that ongoing public/private partnership is crucial, despite attacks from the usual populists.

But governments are now going to have to face a harsh reality: more than three million people affected by Temporary Redundancy Plans (ERTEs for their Spanish acronym) today, hundreds of thousands of small businesses on the brink of closing forever, tens of thousands of families who have seen their income disappear overnight, and public coffers which, already heavily indebted before the crisis, are now going to have to handle an unprecedented situation. “You have my full support (…) and within my power, we are going to support you in the projects in progress to overcome this situation”, Puig assured the entrepreneurs. It is a pleasure to hear these words from the President of the Valencian Government. As head of Ribera Salud, the company that has worked most closely with the administration, these statements give us a sense of support. 

Now it’s time to put words into action. Good intentions fall short in a national emergency like this. All of us, public institutions and private initiatives alike, must work together now more than ever before. In fact, this has always been Ribera Salud’s desire. It’s part of our DNA. This desire to serve our community, to put the public interest first and to guarantee the best health care, was the basis for the creation of Ribera Salud and the launch of Spain’s first hospital based on a unique model of public/private collaboration, the Hospital de La Ribera. 

Incidentally, two years after this collaboration ended, it has become clear that the reversal of the Hospital de Alzira has been a disaster. I’ll discuss it in depth in another post. But it’s clear: Every reality that is ignored seeks its revenge.

And returning to the public/private collaboration that President Puig noted: at Ribera Salud we have not only always defended this model but also the transparency and periodic evaluation of quality of care and healthcare outcomes. And coincidentally, the Audit Office of the Valencian Government has always valued the strength and advantages of this collaboration. The latest report on this subject has focused on the Hospital Universitario de Torrevieja, and its conclusions leave no room for doubt about its advantages. The surgical waiting list in Torrevieja is four times shorter than the average hospital in the Community of Valencia, its sound management translates into a savings of €45 million a year on public spending, 85% of its patients are very satisfied with the care they receive, and private initiative has invested €105 million in this health department to date.

Moreover, we now have to add that it is one of the hospitals that has emerged as a social leader in the fight against COVID-19 and has demonstrated the strength of the public system, contributing effectively to the recovery of many patients while providing for the safety of its professionals, and not surprisingly, it is one of the hospitals in Spain with the fewest cases of infected healthcare workers. So, yes. The Hospital de Torrevieja has also demonstrated the benefit that this public/private collaboration brings to society during a health emergency like the current one.

I’m confident that the President’s statements are more than just words and will be translated into concrete actions. And from this blog, I once again reach out to our leaders to continue working to build an excellent healthcare system in which the public system, including direct management and private collaboration, becomes increasingly stronger and seeks to join forces with others. From a place of commitment, responsibility, and serious decision-making, together we will be able to face the challenges of the 21st century and the tough times like the one we’re experiencing now.


English

Tripping twice (or a thousand times) on the same stone

26 febrero, 2020 • By

I have spoken several times on this blog about waiting lists, and this time I want to start with public recognition of the transparency exercise undertaken by the Generalitat. Even when the data isn’t good, there is no doubt that transparency is essential in a mature society that aspires to progress. Unlike many, I like to recognise and appreciate other people’s work when they do things right.

The publication of the waiting lists by department may have generated a certain level of controversy and debate, but these advances in transparency by the public institutions are fundamental in order to search for solutions to the problems: just like in Healthcare, when there is a clear diagnosis, the correct treatment can be applied. If you cheat at Solitaire, you’ll always be deceived.

The information made public by the Conselleria de Sanidad (Department of Health) has allowed us to learn that there are hospitals with an average waiting list of five months (154 and 140 days). And given that the average is almost half a year, that means that there are people who wait a year or more… something which is incomprehensible in the year 2020. The average waiting time in the Community of Valencia is 86 days, which is a slightly better figure in comparison to last year, which shows that, beyond the inefficient government policies, the professionals are always committed to offering good healthcare to the citizens. For them to have the necessary tools is another story. As the regional secretary stated at an appearance, “operations don’t take place in the offices, they take place in the operating theatres”. I couldn’t agree more.

However, beyond these general details, there are two points that I would like to highlight. The data provided by the Department of Health clearly reflects that the concession model significantly contributes towards the reduction of average waiting times, with tremendously favourable and positive data. I have read some comments that question these figures, coming from people that I have not seen in my day-to-day work in healthcare management during 30 years of experience in the sector, ladies and gentlemen that have never asked or learned about the reality of healthcare offered by the public-private collaboration model. In politics, as in almost all scopes of life, we must first learn the reality in order to later have a valid opinion and not just talk about what we’ve heard or follow scripts, which, by the way, are written by more people who have never seen the reality of what they are now discussing as though they are authorities on the subject.

These types of people are the ones who believe that the best way to hide the failure of their management is to question the success of others. Mediocracy is a way of life for some. What a shame.

Well, let me tell you that the Department of Health itself recognises, in this publication of waiting lists by health department, that the Ribera Salud hospitals are positioned among the top three in the Community of Valencia. That is to say, at our hospitals, citizens wait for half the amount of time than the average in hospitals in our region and up to four times less than the longest waiting lists. The numbers are stubborn.

There is another point of information that must be highlighted and that is interesting to analyse in this scope of Healthcare: the decreased quality of care at Hospital de la Ribera just 20 months after the Department of Health took over direct management. The waiting lists have moved from 57 to 78 days in less than two years, and those who wait for longer than 90 days have tripled in number, despite having hired almost 900 people. And this is only just getting started, despite the commendable work that I know the professionals at La Ribera are carrying out. The fact that something (or many things) are failing is evident.

I know that some people find it difficult to understand that it is important to have an open mind in order to seek new formulas that can help us, as a society, to improve the healthcare system and, above all, to make it sustainable over time. We must be flexible. And brave. To publish the waiting lists by department might be the first step, but bravery is necessary in order to make decisions.

If there are many indicators that clearly describe a situation, the problem is not the data but rather the underlying cause behind the data. I understand that I can get repetitive about these types of analyses, but it is necessary because sometimes we are forced to undertake positive pedagogy. When we talk about waiting lists, we’re not talking about numbers but about people.

This leads me to the appearance by the regional secretary of healthcare technology and efficiency, Concha Andrés, on February 10th, where the solution she suggested for current waiting lists was to send patients to hospitals with shorter waiting times. Given that she has not contacted either of the Ribera Salud hospitals, both positioned among the three hospitals with the shortest waiting times, I will take this opportunity to offer the healthcare clinics in our group to help them to improve the waiting times for patients in the Community of Valencia.

Cataracts, bunions, hernias and whatever is required in Traumatology, Ophthalmology, Otolaryngology or General Surgery. I’m sure that may of these ailments with the longest waiting lists are suffered by older patients, and we cannot allow political prejudice to have a negative impact on those who deserve our utmost respect for everything they have contributed, and continue to contribute, to our society.

For this reason and for the good of all of our citizens, I will never stop trying to be constructive and positive and trying to build bridges and collaborations with the public administration, always in favour of quality, efficient and sustainable healthcare.