Manel del Castillo: "The new CAPs will have fewer regulations"

BarcelonaThere is only one month left until 27 Primary Care Centers (CAP) in the country become Comprehensive Reference Health Centers (CSIR) for a year. This isa pilot test that will begin on June 30 with the goal of transforming current centers, a long-standing demand of the healthcare sector that has so far never come to fruition.

There's been talk of transforming the system for years, but it hasn't been achieved so far. What makes you think you'll be successful?

— I understand people's skepticism because it has been attempted many times and it has always remained a document. Specifically, 51 reports have been produced in 30 years, but this time there will be no other document. We are action-oriented; we want things to happen, and that is the pact I made with the president when he appointed me: that there will be radical changes. The expected result of our work, therefore, will not be just another report that we will put on the table, but rather a series of pilot projects that we will support from conception to execution. And then we will have to evaluate them to see whether changes are necessary.

Has the reception been very good, have you been surprised?

— Yes, a movement of confidence and hope has been generated in the sector. When we announced the launch of the CSIR (Centers for Primary Education), we wanted 20 volunteer centers to carry out the pilot test, and 117 applied, almost six times more than we needed. We were surprised; that's almost half of all the CAPs in Catalonia. We believe this is good and positive because it shows that people are eager to do things and want to improve things in primary school.

There will be people who will tell you that so many schools have come forward because the situation in primary schools is dire and they want changes.

— They are eager to improve primary care because they see things aren't going well, yes. But I also sense enthusiasm among the participants, because our goal is to restore trust in the system's professionals. We will give them autonomy because they are the ones who know how to do things, and the centers will be organized as they see fit to achieve the best care outcomes. We believe this can improve access to care for people in a reasonable time and improve user satisfaction, among many other technical quality indicators.

What should citizens expect when their primary CAP becomes a CSIR starting June 30?

— They will continue to have the same doctor and nurse as their reference, but they will have fewer rules and less rigidity in their work. They will also have a healthcare administrator as their reference, who will assist the doctor with those bureaucratic tasks that currently take up consultation time and that another professional can easily handle. We plan to incorporate new technologies to facilitate the workers' work, such as a tool capable of recognizing voices that will transcribe the conversation between doctor and patient in a summary clinical note. This way, the doctor can look users in the eye instead of taking notes on their computer. There will be more professionals such as psychologists, physical therapists, and social workers.

Another relevant aspect is social and health integration.

— Yes, we want a more preventative model and more integrated care, especially for the elderly. This is very important because they often need healthcare and social care simultaneously, and we can't divide them; they must be integrated. We will have better relationships with social services and hospitals, as one of the major current problems is the fragmentation of services.

What will all these changes cost?

— We haven't finalized the investment yet, but it won't be a lot of money. In any case, there isn't a financing problem, there's a problem with the renovations. We've grown by 5 billion since the pandemic, more than any other sector, and we have more professionals. We've never had as many as we do now, but even so, we haven't improved the waiting lists. Sure, if we had more money we could do some things better, but we can already invest a billion more, and we won't solve the major challenges we face if we don't make renovations. For example, a car that doesn't work properly still needs gasoline, but if you don't fix the engine, it will continue to run poorly.

After this first phase, what will the transformation of hospitals look like?

— We haven't yet decided how we'll do this, but there will certainly be more structured measures and others that will be pilot projects. We hope to present them to you in October of this year, but the changes will focus on a new management model, the incorporation of technologies, greater innovation, professional competencies, team organization, and compensation recognition. We want a more preventative, more integrated, and results-oriented healthcare model.

What will happen if we don't transform the healthcare system?

— No human endeavor can survive 30 years without any reforms. So far, we've done nothing out of fear and resistance, but the welfare state is in danger if we don't adapt the healthcare system to the current reality. People still haven't lost confidence in the system because they know they should go when they're very sick, which is extremely important. They don't go to private healthcare to get better care, but because there are fewer queues. The problem is that we have a management tool that doesn't work well; we need it to be more agile and faster, and we must regain the legitimacy that's being lost. The moment people think the public healthcare system isn't worth it, if we lose legitimacy permanently, I think the welfare state will end.