Transforming healthcare: integration with social services

The law establishing the Integrated Social and Health Care Agency is expected to be approved this fall. If it is passed, it will be a momentous milestone—without exaggeration—in the way we understand the coverage of citizens' material and health needs in this country, with broad consensus on their interrelationship.

It's a milestone because, on the one hand, it culminates years of preparation—between the previous and current legislatures—to outline, define, and place the issue on the public agenda and address it at the institutional level. On the other hand, it marks the starting gun for what should be—along with the development of the new health, social-health, and public health map (the sector's main planning tool)—a profound transformation of both the health care and social services systems, a transformation that is not only operational but conceptual: it involves moving from managing systems to coordinating ecosystems and truly putting them at the center.

The Catalan healthcare system is one of the best in Spain and the world. But for years, the sector and public administration experts have been warning of its exhaustion and limitations. The current healthcare landscape dates back to 2008, and the reality of the sector and its environment has changed radically. In addition to the demographic challenge—aging, low birth rates, and immigration, with all that this entails—are the challenges facing mental health and neurodegenerative diseases, in the scientific and technical field (robotics, connected devices, AI, gene therapies), and in the socioeconomic aspect of healthcare. Most of these issues are still often on the periphery of the system in terms of strategy, while they are at the heart of the daily work of healthcare professionals and technicians.

However, the field of social services has not yet fully articulated as a system, although this has been a long-standing demand in both the administration and the third sector. Despite the lack of coordination, citizen demand is growing in scope and complexity. Successive waves of migration overlap with turbulences such as the COVID-19 pandemic, the social ladder and socioeconomic development that have stagnated, and rising inequality. All of this has had cross-cutting impacts on the health sector, both in terms of care and clinical care, as well as prevention, accentuated by economic crises and the weakening of the welfare state..

Let's give two examples of this interrelationship between health and well-being and why it requires a comprehensive approach.

A 16-year-old girl from a low-income family lives in precarious housing and suffers from energy poverty. This environment hinders her academic performance and self-esteem, to the point that she begins to have suicidal thoughts. The social situation triggers mental health problems that require medical intervention and psychosocial support: at home, at school, and at health centers.

A middle-aged man with diabetes and cardiovascular problems receives ongoing medical treatment. However, his health forces him to reduce his work hours and he ends up losing his job, which exacerbates his economic and social difficulties. The starting point is healthcare, but the intervention also has multiple fronts: health centers, work, and home.

In both cases, the problems are intertwined—health, learning, professional, social—but the response, right now, can only be partial, limited to each area of expertise. We know, however, that integrated care is both much more effective in terms of results and efficient in terms of resources invested. This is the challenge before us, and it is being addressed honestly and decisively.

The definition of the to do It's well underway. As a result of the collaborative work of industry professionals and administration experts, with parties that have listened extensively and well, we now have excellent conceptualization documents, stakeholder mapping, and information systems, among others. And we have a collaborative design underway for the new map of the Catalan health system, in addition to the promise of a new agency. How to do it is the next challenge and, in all cases, the key word is governanceAnd the Agency must be its driving force.

The Agency is strictly necessary because it is called upon to perform a new and essential function, which is neither to decide nor to replace in any way the multiple actors involved in social and health care. In fact, perhapsIt shouldn't lead or coordinate, nor should it know much about health or social services. The bill describes it perfectly: "Ensure maximum coordination and collaboration." That is, it should provide the tools (methodologies, instruments) and resources (people, knowledge, environments) so that actors can be autonomous while aligning with common national objectives.

It should not be a command or oversight tool: it should perform a fundamental function often overlooked in administration: supporting frontline actors in the same way as a finance, procurement and billing, infrastructure, or people department, but here by providing vision, analysis, mediation, strategic and operational support, and evaluation. In other words, enabling incentives to align to achieve greater effectiveness and efficiency, but above all, impact and legitimacy.

The Generalitat itself has success stories to draw inspiration from, such as the fisheries co-management tables or the RIS3CAT 2030 strategy, but in integrated social and healthcare, the leap is both quantitative and qualitative. And also conceptual: it can and must become a profound institutional transformation. Unlike a closed, vertical government, the key to a new robust public governance is to direct decision-making towards the public. back: Prioritize consensus on diagnosis and values over what decision is made and who makes it. It's not about imposing a narrative, but rather establishing a shared grammar and spelling so that everyone can express themselves with complete autonomy and at the right time, ensuring that we all ultimately understand each other. In other words, putting ourselves at the service of the shared mission of the entire ecosystem.