Once the Catalan health professionals' agreements were signed, the Minister of Health, Manel Balcells (Ripoll, 1958), promoted a transformation of the system supported, among other pillars, by improving the connection between outpatient clinics and hospitals.
What does the signing of the ICS and Siscat agreements represent?
It is system-transcendent. One of our priorities was to level up the professionals and stabilize the situation, both in terms of fatigue and attrition and cuts. Before any transformation could be tackled, it was essential that professionals felt and were recognized not only from a salary point of view, but also from a professional level. We are at a competitive level with the State as a whole and with neighboring countries. Salary and labor issues are not a reason to leave.
But wear and tear creeps in.
It will have to be fixed gradually. This emotional wear and tear of years does not disappear overnight. But a collective project is being created that excites the professionals. The aim 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 for the teams. We have also approved in the information field what will be the future decree authorizing administrators to do more tasks to reduce the bureaucratic burden on health workers. This is an improvement in the quality of work.
Less burden for primary care doctors.
Reducing the bureaucratic burden on doctors and nurses so that they can devote more time to healthcare activity is a priority. We also promote a better articulation between the primary school and the reference 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 improveable.
It is not uncommon for hospitals to refuse tests requested by outpatients.
This is not tolerable. The structural changes to make the flow of patients between the primary and hospital networks much smoother should allow us to greatly improve the waiting lists for complementary tests and other specialists.
Expectations that are very unequal according to the territories.
It's not normal. The other day they presented the Central Results and we can see, on a map, that some complementary tests or some waiting lists for specialties in one county are very high and not in the county or next door. Sometimes it is due to an issue of resources that must be compensated, or that there is no communication between the primary school and the specific hospital, or sometimes even the problem has names and surnames because it is a personal matter.
He guaranteed us in March that there would be a five-day wait at the outpatient clinics.
We will not reach this goal in time, which was ambitious, but it has improved substantially. We are making progress, because accessibility was very difficult. For example, telephone accessibility was something quite incomprehensible. This has absolutely improved. And face-to-face 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, voluntarily, family doctors and paediatricians delay their retirement by a year or two. Then, the possibility of voluntary overtime [overtime]. Then, the improvements in working conditions mean that the doctors who finish their residency stay there. As for other specialties, this new health map that we are drawing allows professionals from one center to cover a smaller center. For example, at the hospital in Campdevànol, the team that operates is that of Vic, which travels there 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 an attitude test towards medicine, which in other times would be the determination of the vocation. We would also like to manage the MIR places. We have asked for this repeatedly because with the single district, the resident who comes from other territories leaves when it is over.
As a doctor, the new minister may understand.
I spoke with her [Mónica García]. We have a meeting coming up, and if you understand that, that will be awesome. We opt for a bilateral relationship with the ministry because our circumstances are quite different. We lack tools to manage our needs well. We are the reference in the State for major pathologies and we want to continue to be. But we would like to have the necessary management tools to be competitive.
Will you dedicate 25% of the next budget to primary school?
As we explained, today we are on top. We must provide the primary school not only with resources, but also with decision-making capacity. And this means that the CUAPs must work, they must be able to slow down hospital emergencies. Professionals in the primary must do more ultrasounds, infiltrations and chirotherapy, and have access to other specialists in a systematic way. The model we are thinking about, especially in terms of home care, is that the professional goes to the patient, looks at him, and maybe does a portable ultrasound, which he can interpret himself or send to the hospital on line.
Is the idea of banning smoking on terraces parked?
No, we are talking to the City Council, the Department of Business and Work, the Restaurateurs Guild and Public Health. And we are moving forward with what must be a specific modification of the current law that must allow the use of tobacco to be regulated on terraces and also inside vehicles, as is the case in other spaces. I don't rule it out. The terraces are a space where we do not sufficiently protect the passive smoker. I think it should be banned, I would have liked it to have been 2023, but we can't include everything.
Addiction law is also moving forward?
We are doing the preliminary consultations with the professionals. It is a law that also causes some discussion for aspects such as the regulation of the use of screens, the use of mobile 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 put more resources into mental health for children and young people, but it is never enough. We increased the action in schools and institutes so that there is more capacity to detect eating disorders.
Vaccination against flu and covid has dropped this year.
There is a lower level of vaccination than would be desired. We insist on it both actively and passively, but I get the feeling that the population has relaxed a little. What does work is the issue of immunizing children against bronchiolitis. Last year at this time we were very overwhelmed and had the maximum number of deaths, now we are very happy with the result of this vaccine.
