Ten years of debilitation and the lunge of a pandemic: how the Catalan healthcare system survives

Santa Coloma de GramenetThe Catalan health system was already in dire straits before the pandemic broke out, but covid has highlighted the shortcomings that for a decade its professionals have tried to compensate with sacrifices and, at the same time, visibilize with protests at the gates of the Department of Health. The system continues to be weakened by the cuts that began in the time of Minister Boi Ruiz, in the midst of the economic crisis.

Experts say that the annual budget that would have to be devoted to health would have to be increased by more than 5,000 million euros over five years, since the chronic underfinancing focuses on precarious conditions and low wages, lack of investment in equipment and more waiting lists. And now the virus has also highlighted that there was a lack of foresight in essential areas such as public health or the protection of socio-health environments and nursing homes, the spaces most affected and punished due to the fragility of the people who use them.

The health system is worn out and it burst at the seams in March and April with the first wave, an unprecedented emergency in the world. According to the latest data on the execution of the public sector budget, until November 30, Health spending grew by 16% compared to the same period of 2019, about 1,519 million euros more devoted entirely to covid.

Hospitals had to expand facilities to pavilions and sports halls, and local clinics and outpatient clinics were closed to respond in large primary healthcare centers that, between the endemic lack of staff and the increase in pneumonias, could hardly cope. At the height of the crisis, providers ran out of protective materials such as masks, respirators and diagnostic tests.

Professionals were exposed to the virus and many fell ill or were isolated after being in contact with positive colleagues. The labor pool is scarce and for years there has been no long-term vision in the training of new professionals. Last year, the integrated health system of public use of Catalonia (Siscat) made 10% more hires - without taking into account the staff in training -, and most (66%) joined the hospitals. A 30% did so in primary healthcare centres.

Change acceleration

Until well into the summer it was impossible to get a diagnosis before ten days and unthinkable to track positives and contacts. The Public Health Agency of Catalonia was a body in the process of development for its short history. It was created in 2009 and dissolved four years later "in the name of simplification and rationalization of the public sector", and until July 2019 the Government did not recover it.

Thus, last March the entity managing the epidemiological alerts was not prepared to take on the avalanche of the coronavirus and ended up collapsing. It was not until June that the service was strengthened with the controversial contract with Ferrovial, the creation of the figure of the covid manager, and the deployment of new technological tools.

Despite the difficulties, professionals have emerged as the most important actors in the response to the pandemic and proof of this is the continued assumption of new responsibilities to each onslaught. Not only do they diagnose and cure, but they also monitor and maintain the agendas of other pathologies as best they can.

The virus has also accelerated changes that have been pending for years, such as the great bureaucracy in consultations, which are increasingly telematic, or the elimination of unnecessary tests and visits. However, if on the one hand the citizen has become more responsible with the use of health services, there is also more fear to use them.

Healthcare professionals have faced major challenges, such as sectorising and establishing differentiated care circuits, longer working hours, or taking over the management of nursing homes. This change has made it necessary to make work in the primary healthcare centres compatible with care in these spaces and has reopened the debate on the future model of geriatric care homes; for example, whether to medicalise the centres or whether it would be better to create a social and health agency between Health and Social Affairs. In Catalonia, 19,885 people have died from covid, 43% of whom were nursing home users.

Vaccinating the elderly (75% of centres are already immunised) is key to stopping deaths from covid at their root, but despite the advance of the last few months, the vaccination campaign runs up against a new obstacle on an almost weekly basis.

The Catalan government cannot decide who it prioritises and allocates vaccines to - it depends on what is decided in the inter-territorial councils with the other autonomous communities - and due to the cuts in the supply of doses, they have barely finished vaccinating homes and health workers.

While the desired herd immunity is not achieved, then, health authorities continue to deploy restrictions on social interaction and mobility to control the epidemic.