Browsing Tag

pandemic

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)


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