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FEM: Revista de la Fundación Educación Médica

versión On-line ISSN 2014-9840versión impresa ISSN 2014-9832

FEM (Ed. impresa) vol.24 no.5 Barcelona oct. 2021  Epub 15-Nov-2021 


Seminario de reconstrucción sanitaria y profesional tras la pandemia en la Escuela de la Profesión Médica 2021: la reconstrucción requiere el rescate financiero del Sistema Nacional de Salud y la activación de las reformas postergadas

Seminar on healthcare and professional reconstruction after the pandemic at the Medical Profession School 2021: reconstruction requires a bailout for the National Health System and the activation of delayed reforms

Seminar on healthcare and professional reconstruction after the pandemic at the Medical Profession School 2021: reconstruction requires a bailout for the National Health System and the activation of delayed reforms

José R Repullo-Labrador1  2 

1Escuela Nacional de Sanidad. Madrid, España

2Comisión Asesora de la COVID-19 de la Organización Médica Colegial. Madrid, España

The use of the term ‘reconstruction’ to denote the necessary reversal of the deterioration of the Spanish National Health System that becomes apparent if we compare it before and after the pandemic is perhaps somewhat inappropriate, even though it has been widely adopted. It is a metaphor for recovery from a devastation that occurred in a particular moment and has been potentially extremely disruptive; yet, rather than destroying our public health system, the pandemic has actually exposed its weaknesses.

Indeed, COVID-19 is proving to be an enormous challenge, which has been met by an unsuspected capacity of the public health services to react and adapt (what we would call ‘resilience’) in order to defend the health of the population through voluntarism and professional commitment. This swift and generous response to the pandemic succeeded in temporarily offsetting the shortages of funding and resources that had plagued the Spanish National Health System since 2010, but the pandemic revealed the major dysfunctions that had been accumulating over the years. Among the many possible examples, two stand out above the rest: an anorexic public health service and rapidly deteriorating primary care.

After the first wave, and with all the horror and harm still present in the recent memory of Spanish society, the institutions felt challenged and the Congress of Deputies created a Commission for Social and Economic Reconstruction, whose opinion and conclusions were published in July 2020, with the remarkable support of the vast majority of the parliamentary groups [1].

But the summer of 2020 brought with it the second wave, then the third, the fourth and even the fifth, the last two with a diminished impact due to the high effectiveness of the vaccines. However, the health services could not relax and went from an acute state of being overwhelmed to a stress test that has been going on for more than a year and a half. And for this challenge there are no longer sufficient reservoirs of physical or human resources or of voluntarism and commitment. The so-called pandemic fatigue in society, together with a praxis marked by the lack of cohesion and a great deal of tension on the part of institutional and political decision-makers, has led to a feeling of abandonment and helplessness among many health professionals. The echoes of the applause that sounded in 2020 have been silenced by the din of parties and celebrations, as well as the noise of the harsh controversies that fill the public sphere.

In this context, the health professions have tried to build bridges and provide reformist responses to overcome the problems. The COVID-19 Advisory Commission of the Spanish General Medical Council has drawn up 12 reports on aspects that are largely related to the reforms needed to strengthen and revitalise our National Health System, given the limitations and dysfunctions that the pandemic has brought to light. Although many of them were already well diagnosed, they had been left lying half-forgotten in the drawers of various institutions [2].

The initiative to set up a Medical Profession School seemed a good framework to bring attention to the reflections and stances that the General Council of Medical Associations had been taking since March 2020. Hence, a series of relevant issues for healthcare and professional reconstruction after the pandemic were incorporated in a seminar. The sessions held on 23 and 24 September left a good number of ideas, clearly aimed at overcoming the crisis of implementation and the reformist lethargy.

The aim was to focus on the major issues that condition the solvency of our National Health System, that is, the political, economic and systemic components that will determine its chances of recovery and revitalisation. This framework is essential and unavoidable to situate all the issues of medical professionalism and to understand the environment in which the medical profession is going to develop in the coming years of what has been coined (perhaps prematurely) the post-pandemic period.

It is fair to recall that the attention paid by medical associations to the problems concerning the structure, organisation and functioning of the public health service has a long and committed history. More than 20 documents since 2002, with analyses, proposals and positions, testify to the concern and commitment of the Spanish Medical Association to improve healthcare.

The session on ‘healthcare and professional reconstruction after the pandemic’ reinforces the social and healthcare responsibility of medical associations and, in a way, gives continuity to the reflection that the conventions of the medical profession have been making on how to solve the problems and challenges of the health service deriving from the scientific-technological change, the malfunctioning of the National Health System, the austerity policies of the great recession, the weak recovery after the cuts and, now, the tremendous crisis caused by the pandemic.

The seminar consisted of two sessions, the first of which was focused on the institutional, economic and political framework:

  • - Tomás Cobo, president of the General Council of Official Medical Associations, offered an overview of the evaluation and prospects a year and a half into the pandemic.

  • - Francisco Sevilla, Spain’s permanent representative to the European Union, presented the vision, from the European institutions, of the main initiatives and instruments that have sought to provide a joint response to the tremendous health, social and economic upheaval caused by COVID-19.

  • - The economic dimension and the role of the European funds were discussed by the health economist, Beatriz González.

  • - The political and institutional dimension was addressed by José Manuel Freire and (in the closing session) Ana Pastor, both of whom had been active participants, representing the PSOE and the PP, in the aforementioned Parliamentary Commission for Social and Economic Reconstruction; they were also largely responsible for reaching a consensus on the conclusions and recommendations for the health sector.

  • - And of the many serious and urgent problems in the health dimension, particular attention was paid to the situation of primary care, where the alarm bells have been ringing for a long time. Salvador Tranche, president of the Spanish Society of Family and Community Medicine, addressed the problems and alternatives for a primary care service that is seriously at risk of collapsing.

  • The second part of the seminar dealt with a different but synergistic perspective: the material and moral reconstruction of the medical profession:

  • - The quality of medical employment, eroded by high numbers of temporary and precarious jobs, is unfair and creates disaffection and intra-professional conflicts. José Repullo explained how the public authorities must seek alternatives for stabilisation, as well as a reform of the selection system that prevents the periodic accumulation of cohorts of interim and temporary staff. These changes would be part of the compensation for the moral debt that the institutions have contracted with the world of professional healthcare.

  • - Manuel Martínez Sellés analysed the direct harm that COVID-19 has caused to doctors, and discussed the impact of the pandemic on the lives and health of professionals, especially due to the lack of protective measures they worked with in the first wave.

  • - The world of professional healthcare operates within the specialties and their scientific societies, in addition to the sphere of associations, which is why the vision of the Federation of Spanish Scientific Societies of Medical Specialities, presented by José Ángel Hernández Rivas, was important.

  • - Hospitals, health centres, emergency services and other healthcare services were surprisingly and commendably responsive in adapting their services to meet the overwhelming demand during the pandemic; they managed a crisis with exceptional speed and adaptability. For this reason, Rafael Tejido, manager of the University Hospital of Valdecilla, explained the keys to this response and to what extent experience can strengthen the role of professional teams in the management and governance of health centres and services.

  • - The health crisis altered everything, including regulatory frameworks and the processes of health management and the organisation and delivery of clinical care. We are thus talking about a wide range of new problems of civil and professional liability that Raquel Murillo incorporated into the analysis, from a legal perspective.

  • - And, finally, a very relevant aspect of these changes has been the emergence of non-face-to-face care through different instruments enabling the implementation of teleconsultation or telemedicine. Rosa Arroyo asked to what extent this technological change can affect the physician-patient relationship, whether it can be strengthened or weakened, and what can be done to ensure that greater accessibility does not lead to greater interpersonal distancing.

Healthcare reconstruction, understood as a bailout and the activation of delayed reforms, is the fundamental challenge that lies ahead of us. We must try to keep this debate alive, so that it becomes a stable element on both the public and the political agenda, as there is a risk of forgetfulness and solemn commitments can die out like the echo of the applause. It must also be kept in mind because the strangulation of public healthcare and the non-COVID care burden due to the saturation of public healthcare will deepen a dual model, where those who can afford to do so will look for alternatives to the waiting lists and insufficiencies. And this is serious, because a national health system for the poor will end up being a poor national health system, which not only goes against the interests of society but also against those of medicine and doctors.

Bibliografía / References

1. Comisión para la Reconstrucción Social y Económica. Conclusiones para la reconstrucción social y económica. Texto aprobado en el Congreso de los Diputados del dictamen de la Comisión para la Reconstrucción Social y Económica. Madrid, 29 de julio de 2020. Fecha de última consulta:12.10.2021. [ Links ]

2. Comisión Asesora de la COVID-19 de la Organización Médica Colegial. Informes. Fecha de última consulta:12.10.2021. [ Links ]

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