• A Health in crisis (IV) José Polo: "It is key that in the faculties of Medicine an area of knowledge of primary care is generated"
  • A Health in crisis (III) Juan Torres: "We are facing the worst health crisis that the system has experienced in 40 years"
  • A Health in crisis (II) Gabriel del Pozo: "The Ministry of Health must also assume its responsibility for not having done the duties of planning professionals"
  • A Health in Crisis (I) Carlos Rus: "Health in Spain is a social achievement and private a choice of the health model, both at the level of management and users"

Specialist in Internal Medicine with more than 40 years of experience, Javier García Alegría chairs since December 2022 the Federation of Spanish Medical Scientific Associations (FACME), an organization that includes 46 entities and represents more than 120,000 medical specialists.

How do you see the National Health System right now? If the National Health System were a patient, it would certainly be showing worrying symptoms and signs. Before the pandemic, there was already data that showed us that there were issues to rectify and the pandemic has just revealed those shortcomings and structural problems that need to be addressed. The system was overwhelmed and the consequences of that were not only immediate, but we continued to drag them. What issues need to be addressed most urgently? We have made a document for the reconstruction and transformation of the health system that has four fundamental aspects. First, recovery for delayed patients is critical. It is also key to establish better management and follow-up for chronic patients; greater proactivity and identification of risk factors and improvement of diagnostic processes; and a reorganization of the allocation of health resources. We have public funding that is 25% lower than in other countries of the European Union. But not only is more funding needed, but we must reorganize the health system that is built on the basis of urgent pathology care, when the reality is that today there is a higher prevalence of chronic patients. The health system is not adapted to these requirements. We would have to reorganize health care because it is also very rigid and there are many aspects that can be improved. Is the system at risk? I hope that is not the case. The National Health System has been a real source of pride for our country, an example for many nations and a balancer of rights. We have built a great system and now the challenge is how to adapt it and how to face the challenges of the coming years. I am not so negative in this regard. I believe that the necessary changes will be introduced to solve the problems we have today. You recently lamented in a speech that health is not on the political agenda. I believe that citizens and professionals have to make health is on the different political agendas as a priority. I think we would need a national agreement, a national pact for health to define how health is going to be between now and the next 10 years. There are many issues to be addressed, in addition to those mentioned, also important aspects related to technological innovation, the application of information systems, artificial intelligence, also mental health care structures ... We must reach a minimum agreement to define what health system we want for Spaniards during the next 10 or 20 years. I believe that we all want to ensure that there is a public system, because the weakness of public systems is encouraging more inequality. An agreement must be reached, I am sure that there are many more things that unite us than those that separate us. A few weeks ago, FACME called on the Ministry of Health, along with other medical organizations, to be more closely linked to its proposals. Are professionals not listened to enough from health management? Professionals should have more representation in health decision-making bodies. We have never had more participation of technicians, professionals, in the organizational decisions of the centers than in the pandemic. We are escI was daily when adapting the centers, in the prediction of the patients we were going to have, in the organization of the circuits, etc. But that ended when the worst of the pandemic happened. We should have a system with representation of experts in every field of knowledge at all levels. For example, in the procedure for the approval and financing of medicines and therapeutic novelties, which is delayed compared to other European countries. Right now the scientific criterion does not have the weight it should have in health management in general? It should have more. The specific knowledge of each specialty resides in the professionals and in the representative scientific societies. It would also help with other problems associated with the national health system, such as the excessive bureaucratization of management or the fact that management structures change every time a government changes. How do you see the situation of professionals? What has happened with human resources management, with contracts up to one day, in poor conditions, the overload of work has generated a lot of dissatisfaction in professionals, you just need to read the newspapers every day. You can't see 60 patients in one morning, that's impossible. And then there's a bureaucratic burden on medical activity that's filling medical time. There has been a lot of discussion about whether we need more doctors or not, but what we have to do is reflect on what the dedication of medical time is, what tasks it should be used for. Working conditions must be improved and other aspects of management must also be improved. Physicians have an unwavering commitment to their patients. They don't like to go on strike. Strikes only occur when there is an extreme situation of lack of dialogue. Our country has emerged from very difficult situations. We must take advantage now to reflect and reach a national agreement and plan health for the coming years. That pact is possible.

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