Once the agreements of Catalan health professionals have been signed, the Minister of Health, Manel Balcells (Ripoll, 1958) promotes a transformation of the system supported, among other pillars, by an improvement in the connection between outpatient clinics and hospitals.
What does the signing of the ICS and Siscat agreements represent?
It is transcendent for the system. One of our priorities was to bring professionals to the level and stabilize the situation, both in terms of fatigue, burnout and cuts. Before being able to address any transformation, it was essential that professionals felt and were recognized not only from a salary point of view, but also with their professional levels. We are at a competitive level with the entire State and at the level of neighboring countries. Salary and labor issues are not a reason to have to leave.
But wear and tear creeps in
It will have to be fixed progressively. This emotional wear and tear of years does not disappear overnight. But a collective project is being generated that excites professionals. The objective is to improve equity and quality of care throughout the territory.
How will you do it?
There must be a set of transformations. For example, in residences from now on health care will be provided from primary school. This should substantially improve the quality of care for users. Or the primary school accessibility plan, with more management autonomy and decision-making capacity of the teams.
We have also approved at an informative level what will be the future decree that authorizes administrative staff to carry out more tasks to reduce the bureaucratic burden on health workers. This is an improvement in the quality of work.
Less burden on primary care doctors
Reducing the bureaucratic burden on doctors and nurses so that they can dedicate more time to care activities is a priority. We also promote better articulation between the primary school and the referral hospital. This will be the big change that we will notice in 2024: a better relationship between primary care specialists and those in hospital care, which was and is very much room for improvement.
It is not uncommon for hospitals to reject tests requested by outpatient clinics.
This is not tolerable. The structural changes so that the flow of patients between the primary and hospital networks is much more fluid should allow us to greatly improve the waiting lists for complementary tests and other specialists.
Why so much inequality in care appointments depending on the territory?
It is not normal. The other day we presented the Results Center and we can see, on a map, that some complementary tests or some waiting lists for specialties in one region are very high and in the region or side they are not. Sometimes it is due to a resource issue that must be compensated, or that there is no communication between the primary school and that specific hospital, or sometimes the problem even has names and surnames because it is a personal issue.
He guaranteed us in March that there would be a maximum of 5 days of waiting in the outpatient clinics
We are not going to reach that objective on time, which was ambitious, but has improved substantially. We are moving forward, because accessibility was very difficult. For example, telephone accessibility was something quite incomprehensible. This has absolutely improved. And in-person has improved a lot.
How do you deal with the lack of doctors, especially family doctors?
It is a set of measures. One is that family doctors and pediatrics voluntarily delay their retirement for a year or two. Then, the possibility of voluntary surpluses [overtime]. Then, improvements in working conditions mean that doctors who finish residency stay.
As for other specialties, this new health map that we are drawing allows professionals from one center to provide coverage to a smaller center. For example, at the Campdevànol hospital, the operating team is Vic's, who travels one day a week.
Would you be in favor of changing the system of access to Medicine?
We would be in favor of there not being a single district in the State and that we could decide it in Catalonia. We would put a test of attitude towards Medicine, what in other times would be the determination of the vocation. We would also very much like to manage the MIR places. We have asked for it repeatedly because with the single district, the resident who comes from other territories leaves when it ends.
As a doctor, the new minister may understand this
I have spoken with her [Mónica García]. We have a meeting pending and if she understands it it will be great. We opted for a bilateral relationship with the Ministry because our circumstances are quite different.
We lack instruments to manage our needs well. We are the benchmarks in the State for major pathologies and we want to continue to be so. But we would like to have the necessary management instruments to be competitive.
Are you going to dedicate 25% of the next budget to the primary?
It depends on how we tell it, today we are above it. We must provide the primary school, not only with resources, but with resolution capacity. And this means that CUAPs must work, they must be able to stop hospital emergencies. Primary care professionals should do more ultrasounds, infiltrations or chirotherapy, and have access to other specialists systematically. The model we are thinking about, especially in home care, is that the professional goes, sees the patient, maybe does a portable ultrasound, which he can interpret himself or send it to the hospital online.
Is the idea of banning smoking on terraces on hold?
No, we are talking with the City Council, with the Department of Business and Labor, with the Restaurateurs' Guild, with Public Health. And we are moving forward in what should be a specific modification of the current law that should allow regulating the use of tobacco on terraces and also inside vehicles, as occurs in other spaces. I don't rule it out. Terraces are a space in which we do not sufficiently protect passive smokers. I think we should do it, I would have liked it to have been in 2023, but we cannot cover everything.
Is the addiction law also advancing?
We are carrying out prior consultations with professionals. It is a law that also generates some discussion due to aspects such as the regulation of screen use, the use of cell phones in schools, children's access to porn or behavioral addictions such as online gaming...
We are very concerned about the effect of networks on behavioral disorders in adolescents. We have been putting more resources into mental health for children and young people, but they are never enough. We increase action in schools and institutes so that there is greater capacity to detect eating disorders.
This year flu and covid vaccination has decreased
There is a level of vaccination lower than desirable. We insist actively and passively but I have the impression that the population has relaxed a little. What is working is the issue of immunizing babies against bronchiolitis. Last year at this time we were very overwhelmed and we had the ICUs full, now we are very happy with the result of this vaccine.
