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Healthcare professionals have been putting their own health at serious risk for the past three months. That much is clear to a large part of Catalan society, especially now that the Covid-19 crisis has shown the limits of a health system conceived in the 1980s with a social demography very different from today. Now, health leaders are demanding resources to empower professionals and strengthen the scope of primary care. They warn that the sector is physically and emotionally worn out and today have delivered an ultimatum: their poor working conditions can no longer be perpetuated and improvements are needed in the short term. They don’t want more “pats on the back”, but rather, commitments to real transformation.

This Thursday, major professional bodies representing Catalan doctors, nurses and health management personnel presented a decalogue of proposals to reform the health system of Catalonia, incorporating lessons learned from the pandemic. The proposals cover action on three specific axes: an increase in economic resources, the incentivization of the empowerment of professionals and a change in organization models at territorial and organic levels.

Covid-19 has shown that the well-meaning discourse asserting that the current health system is optimal "cannot be continued for another minute", and on the contrary, "it must be accepted that at this time, it is fragile," said Jaume Padrós, president of the Barcelona Medical Association. "Although the Catalan health system is cutting edge in the world," continued the doctor, "this crisis has highlighted the shortcomings of a system that has been losing funding over the last ten years without that being compensated for at all".

Padrós allowed himself some space for self-criticism, but asserted that the system has to be made capable of ensuring the essential elements of health protection. "In front of us, we have an opportunity for change, there is a consensus among the health world and the public, and governments must become committed to health."

Political pact on health

The professionals consider that the Catalan healthcare system suffers from chronic underfunding. This causes a brain drain and prevents it from being comparable to countries of reference in Europe and the world in this field. For this reason, health professionals demand a political pact in both Catalonia and the Spanish state on health, which would establish and identify the necessary resources for the sector regardless of the colours of the government. "An injection of 5 billion euros is needed," said Dr Padrós. A sum that the Catalan government is unlikely to be able to guarantee.

"Health should not be a political football," said Pere Vallribera, president of the Catalan Health Management Society.

Reinforce CAP centres

Strengthening care in the primary-level CAP centres, building a powerful public health agency and increasing coordination between different health levels are key aspects to the change in health model that is called for. The list of proposals includes measures in response to the structural inadequacies which the coronavirus crisis has highlighted. For example, the idea of "putting people at the centre of our actions" implies that the system of senior citizens' residences should be run by the Catalan health department, incorporating the design of a new model of support for the elderly.

Empower the professionals

"Communication between specialties needs to be improved," insisted Paola Galbany, president of the Official College of Nurses of Barcelona. Although the sector was very grateful for the daily applause they received from the public on their balconies, Galbany pointed out that "the best recognition we can give to health professionals is to give them decent conditions." "Nurses help people to be as self-sufficient as possible," she added, stressing the importance of making all health professions visible" and to "include nurses in decision-making."

The three organizing groups were to meet with the Catalan health minister, Alba Vergés, and the president, Quim Torra, to present this decalogue later on Thursday.

The decalogue

There were ten points in the proposals which the health sector professionals presented today:

  1. A new pact for health, among political forces at both Spanish and Catalan levels.
  2. More economic resources: an estimated 5 billion euros of additional funding for health in Catalonia
  3. Better conditions and resources for health professionals, allocating 60% of the additional funding. Emphasis on increased salaries for junior staff and those in training.
  4. More facilities and infrastructures: 40% of the additional funding to improve resources which are in many cases obsolete.
  5. Professionalism: the values, knowledge and professional opinions of healthcare personnel must be the basis of the reform.
  6. Health organisation: participative definition of healthcare goals and challenges within the Catalonia Health Plan. Results-based; autonomy in management; flexibility in labour models.
  7. Coordination across different healthcare fields, with the patient at the centre.
  8. Greater social accent. Linking social and health services, with a new model of support for the elderly.
  9. A solid public health service for new challenges. Protection, prevention, participation. International coordination.
  10. The experience of Covid-19, an opportunity to learn from failings and reinforce strengths. "Without health, there’s no future".