These are the reasons for the crisis that is putting the health systems of the United Kingdom and Spain in check

• Health Health spending, doctors per inhabitant, consultations... This is the health system, with a primary school in constant crisis

If ordinary mortals were asked what they think is the best health system in the world, it is almost certain that they would cite one of these two or even both:

Both, with a similar structure, organization and financing, usually receive this recognition, and both are mentioned on countless occasions as one of the country's jewels by its citizens.

But now

sar a crisis that affects user assistance

, with infinite waiting lists, but

, who experience an overwhelming pressure for assistance and permanent dissatisfaction due to the lack of recognition at all levels, including work and salary.

All this combination is causing, in addition to strikes and protests, that many of them prefer or are considering going to work in other countries and that others think about early retirement.

What is failing in what are described as two of the best health systems in the world?

What differentiates them from the models followed by other countries?

Is its structure and organization still valid?

Why are the protests carried out by professionals from both systems?

Why do many of your toilets consider fleeing to other countries to work?

Is the United Kingdom still one of the favorite destinations for Spanish doctors?

.

Both the SNS and the NHS belong to the

-emerged after the Second World War- and which is based on financing through taxes and on the universality of care.

Other countries, such as Germany or France, continue

, focused on social security and with mandatory fees paid by employers and workers.

a complex design

Julio Mayol, Professor of Surgery at the Complutense University of Madrid and familiar with both, points out that

, "and in a particular way those of the United Kingdom and Spain. The Beveridge model is particularly complex due to its own design. To this we must add, in addition, that while in the United Kingdom there have been endless reforms (close to 19 ), in Spain nothing has been modified since 1986 with the General Health Law and this together with the process of transfers to the autonomous communities".

for mayol

.

It was working relatively well, with a lot of room for improvement, right after World War II, "but today, in his opinion, it has big problems." The first is the enormous variability in quality and results.

which are obtained.

That is the great transformation."

But the list of pending subjects does not stop there.

According to her, there are still six other issues to solve: "The second is that

and we are not good at avoiding adverse effects". Thirdly, Mayol points out "the

.

Are used

, but since what is financed is the activity, we are all encouraged to do more, not to do better.

That belongs to a model from the days of industrial society where doing more was the same as doing better, but in 21st century society it doesn't work that way anymore."

The

It is for Mayol, also head of the Surgery Section at the San Carlos Clinical Hospital in Madrid, the fourth problem: "

and we underuse them for those who would benefit the most". In addition, he points out that in the SNS little is dedicated to

: "And it is that

not to prevent health".

Lastly, he quotes

that the system itself generates -"supposes the

and this also has an impact on patients"- and adds depersonalization: "By industrializing the production of health services we have impacted not only on the people who need assistance but also on the professionals and this leads us to the current situation of unhingedness of these professionals ".

As in Spain, the NHS is structured into a first care level -our primary care- and a hospital level, in addition to emergencies.

To access the hospital it is necessary to register beforehand with a

, which will be in charge of referring to this assistance, except in the case of emergencies and emergencies that can be attended in urgent situations and that, as here, are saturated at many times.

A primary care that does not give more of itself and saturated emergency services that accentuate the collapse of the system.

Very similar to the Spanish situation.

For Rafael Bengoa, co-director of the Si-Health strategic support consultancy in the health sector and former Minister of Health of the Basque Country, not only are systems like ours or the English going through this care crisis, "the decline is also evident in the systems Bismarck type.

(cancer, cardiovascular, mental health...) to be able to care for Covid patients".

To all this delay, Bengoa also adds the epidemic presence of the three respiratory viruses of this time of year: flu, Covid and syncytial virus.

"When the winter pressure of these three viruses subsides, the pressure will not drop much because the recovery from the non-Covid delays will require many years of work."

In any case, he believes that

overflowed waits

In Spain, according to the latest data from the Ministry of Health for the month of June, there were close to

with an average waiting time of

(17.6% more than six months).

Regarding the first consultations, the same report indicates that the average time was 79 days and in the case of some specialties such as Neurology, the wait lasted up to three months.

In the case of

to receive treatment.

Regarding emergency care, according to the analysis of the

Royal College of Emergency Medicine

, last November 45% of the people who were waiting to receive care in these services had to wait

, reaching historical highs.

A situation that, according to the same organism, is generating

.

National Health Service workers protest outside University College Hospital in London.

NEIL HALL/

EFE

Sara Calderón is a family doctor and works two days a week in a health center in London.

This activity is combined with teaching and research in the Department of Primary Care at Queen Mary University.

She finished the MIR in 2017 in the center of Cartuja (Granada) and before the

.

From his experience, he acknowledges that "in the United Kingdom the situation is increasingly critical and affects the entire health system. In primary care, where I work," he says, "one of the main problems is

Care pressure increases (partly due to growing social inequalities and increased life expectancy) without being accompanied by a corresponding greater investment.

She herself mentions recent information published in

british medical journal

where it is stated that the United Kingdom should have

.

"This lack of funding leads to worse working conditions, consequent difficulties in attracting and retaining health professionals and poorer quality of care," says Calderón.

In 2021, and with 67 million inhabitants, the United Kingdom allocated 266,794 million euros to this expense (3,961 euros per inhabitant).

In the case of Spain, with approximately 20 million fewer citizens, this expense amounted to 90.3 billion euros, allocating 1,907 euros to each patient, according to figures from the Ministry of Health.

Protests 'in crescendo'

The protests and strikes carried out in Spain by primary care doctors also have their replica in the United Kingdom.

There, in addition to the nursing community, young physicians are already mobilizing and

.

These professionals who

and they have only been offered an increase of 2%, well below the inflation that the country is going through and which exceeds 10%.

That is why a large part considers leaving the islands and working in another country.

This is reflected in a recent survey of the

British Medical Association (BMA)

, where

and 62% of them would choose to go to Australia or New Zealand.

However the

.

This is demonstrated by the data from the OECD, as Sara recalls, who also advances some data from the analysis that she has carried out together with the

Collegiate Medical Organization

: "Most of the professionals surveyed,

".

She herself explains that

". Among them stands out "the higher salary, the lower care burden, job stability and greater flexibility to adapt the contracts to the preferences and circumstances of each professional, including the reconciliation of care with other professional ambitions such as research" One of the differences that this family doctor points out between the Anglo-Saxon country and Spain is that "

where medical students are researched and taught transversally and in collaboration with hospital specialists".

For Julio Mayol

"For a while you see it as a big win,

". He also adds that "young people don't just want money, they don't fix everything.

They want more time;

the greatest value of the 21st century".

In the opinion of Sara Calderón, possibly

". He points out, citing some studies, that this level of care is strong when "it is accessible to the entire population;

offers continuity of care by reference professionals;

is well coordinated with the rest of the specialists;

and is capable of solving the main health problems of its population".

For it to be given, "

.

I have the feeling -he says- that in both countries both the four dimensions indicated and their determining factors have been weakened in the last decade".

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