The new head of the Conselleria de Salut, Manel Balcells (Ripoll, 1958), receives EL PERIÓDICO in the office that until two months ago occupied his predecessor, Josep Maria Argimon, the ‘conseller’ breve. The rupture of ERC and Junts per Catalunya made one go out and the other come in.
Balcells doesn’t have it easyThe doctors have called a strike for the 25th and 26th of January, which has been joined by other health collectives. He denies that the Catalan health situation is the same as that of Madrid, defends that the Govern bets for a “quality public health”. and announces a plan to support health centers, which are suffering from an overload of care.
What will Salut do in the face of the strike call? There are already two collective bargaining agreements in place, that of Siscat and that of the Institut Català de la Salut (ICS), and we believe that they should provide answers to many of your concerns. We are confident that the signing of the Siscat, which should be before the end of the year, will help the union to rethink whether to strike. In addition, last week we presented the emergency plan of Catalonia, which involves a reinforcement of 45 million, very substantial, of primary care emergencies. [recibirá 16 de estos 45 millones] and hospitals. And, on the other hand, we are preparing two plans: one to improve accessibility and the other to urgently address the lack of professionals, removing more bureaucratic burdens so that they have more time to work as doctors.
Where will these missing professionals come from? There are measures that must come in the medium and long term, such as the creation of new MIR places in medicine and nursing. All that takes time. Another measure is partial retirements.
The Ministry of Health has proposed to primary care physicians to delay their retirement: working part-time, they will keep 75% of their pension. Yes. We see it positively, it can help us. We know that there are professionals who, at retirement age, would like to continue working part-time. And, with these conditions that are put in place, we see it as a good thing. But it is not the only measure that would help.
When you were ‘conseller’ of Universitats, in 2006, there was a big doctors’ strike. They complained about the overload of care and poor salary conditions. How did we get to this point where 16 years later the demands are the same? There are several reasons. One is that there has been a pandemic that has put a lot of stress on society as a whole, but also on the healthcare system and professionals. There is still a great emotional overload and a feeling of fatigue. Another reason is that the salary increase that there has been does not meet expectations compared to the rest of Europe. Since 2006 until now, the chronic underfunding suffered by Catalan healthcare has not been solved. The financing system of Catalonia has not changed, we do not have fiscal sufficiency: that is to say, we do not have the resources that would be needed.
The professionals are tired and there have been no salary improvements because there has not been adequate funding
So it is not the responsibility of the management that Catalonia has done? I think there is never a single responsibility, isn’t there? You ask me about the causes. The professionals are tired and there have not been salary improvements because there has not been adequate funding. Probably there has not been a forecast of lack of professionals either. [en Catalunya se jubilarán 9.000 médicos en los próximos 10 años]. Therefore, it is a set of causes that causes tension in health systems in general, because here there is an announced strike, but in other parts of the State there are active strikes. The situation is general, also in France and other countries. The pandemic is clearly taking its toll on us.
You announced a couple of weeks ago billion more for Salut. Is that closed? The budgets are not closed. We are waiting for them to be closed and, with them closed, we will have a billion more for sure.
Will Junts and PSC support them? That would be nice, wouldn’t it? [Risas] I think it would be a very responsible action on their part, because the population needs it, the proposals we have on the table are of great consensus and I think they could perfectly support them both. But, apart from these billion from the ordinary budget of Salut, primary care, in addition to the 16 million it will receive from the emergency plan already announced, will receive 62 million more in 2023 from the European React-EU funds. Of these 62 million, 30 million will go to structural actions and 31.4 million to investment in technology.
Can you elaborate further? They will include 20 projects in CAP and CUAP, as well as a set of technological innovation and model transformation plans that are defined and that we will present in due course. We will present them one by one. We believe that technology can help: it is not just about putting more money into the system, but about changing the model to make this money more efficient. And when we talk about technology, we are talking about digitalization, telecontrol, intelligent switchboards in all the CAPs and also wifi in all the health centers.
In two or three years, primary care will receive 25% of the Salut budget.
And with these 62 million more, will we already have 25% of the Salut budget allocated to primary care? Not yet. But, if we make an important effort, I think that in two or three years we will have that 25% for primary care, which is the commitment we have made. To do it in one year is complicated, to do it in two or three years I think it is possible. In the 2023 budgets, once they are approved, we will see that there will be a significant increase.
In some CAPs in Barcelona you have to wait up to a month to be visited by the primary care physician. What will Salut do to improve accessibility? In the coming weeks we will present an urgent accessibility plan to improve these issues, both primary and specialties. It is true that it happens in some CAPs, but not in others. We have identified what the bottlenecks are and why that happens, and we are beginning to see that there are solutions. We can improve the situation of some CAPs, which I already said in an appearance in the Parliament that I found intolerable. Therefore, we are putting the focus and identifying what needs to be done. I sincerely believe that we can improve this accessibility in a short period of time.
And what would be a possible solution? It is not just one, but many. And that is why we say that there is a plan and we will explain it in detail when we present it, soon.
I am concerned that people are not happy with their health center and are going to private mutuals
Is the Catalan healthcare situation the same as in Madrid? Not at all, no; not at all, no. Basically because, when the State withdrew covid funds from the autonomous regions, the Generalitat supplemented them with its own funds. Thus, we maintain the hiring of personnel and the commitment to care. And, therefore, the situation is fortunately not that of Madrid, neither in this sense nor in the privatization that Madrid promoted and Catalonia did not. Catalonia is consolidating a quality public health system and this is our commitment.
However, the number of Catalans with private mutual health care is increasing. In Barcelona they are already 40%, an all-time high. This is a lower rate than in Madrid. [De todos modos] This is something that worries me, that people are not satisfied with primary care. Therefore, we have to reverse this because our will is that this does not happen, that people are sufficiently satisfied so that they do not need to go to a private mutual.