Health workers protesting for a strengthened primary care in Madrid on November 13, 2022. Photo: Medicos y TS-Madrid
Family doctors and primary-level pediatricians in the region of Madrid are preparing to go on strike on Monday, 21 November. Health workers are fighting against problems that have long plagued primary care services, including workload.
“All the time we are being told that primary care is the bedrock of the health system. But the base is falling, and nobody seems to care”, says Elena Polentinos Castro, primary health care physician and member of the Society for Family and Community Medicine (SEMFYC).
The industrial action comes just a week after hundreds of people took to the streets of Madrid to demand a better health system. Earlier in October, more than 50 thousand had done this. Yet the regional government, headed by Isabel Diaz Ayuso from the right-wing People’s Party, has been denying that there is widespread public support for reforms that would make healthcare more accessible to all.
They have been proven wrong by a growing mass movement including platforms like María Blanca. For more than 10 years, these groups have been campaigning against budget cuts and the preference for the private sector in the private health system.
Richest region, smallest investment in health
The protest on 13 November was organized by a coalition of community groups, trade unions, civil society organizations and professional associations. As Pollentino points out, all of them have been battling a deteriorating health system for more than 20 years. After the COVID-19 pandemic aggravated many of the already existing problems, people decided to stand up for a truly universal public health system.
Health workers had long been warning about the dangers looming over the local health system, but it was the pandemic that drew more attention to the issue. Given how things have changed with the onset of the COVID-19 pandemic, more and more people are realizing that their right to health is at risk.
“One of the problems patients are facing right now in Madrid is long wait times, even in primary care, for the most basic procedures. Up to 50 patients in the case of doctors and up to 40 children in the case of paediatricians are forced to attend.
For many, the workload is proving unbearable, forcing practitioners to move to other regions of the country or to emigrate outside Spain. Adding to this is inadequate pay in primary care. The combination of the two factors means that the region of Madrid is not able to employ the number of physicians it needs, despite being one of the richest regions in Spain.
“If you look at per capita health expenditure, Madrid has one of the lowest in Spain. And from the small regional health budget, a negligible amount goes towards primary care, about 10%,” says Polentinos.
In some recent attempts to hire new doctors, the Madrid region was able to fill less than a third of the advertised vacancies. In June this year, the region put out a call for 197 practitioners and managed to sign up 59 of them. In May, it advertised 128 positions and only 21 joined.
“All the time, you can hear that there are no doctors, but that’s not entirely true. The working conditions are so bad that they go to other places,” says Polentino.
Zoom-Based Emergency Services
People are realizing they have less access to health care than ever before, and a new plan from Isabel Diaz Ayuso could make their situation even more vulnerable. The plan would reshape the system of emergency care outside hospitals, based partly on telemedicine.
In the earlier stages of the pandemic, staff from existing emergency posts were temporarily redeployed to other health centers to better accommodate the needs of COVID-19. This was done to take maximum advantage of the existing health workforce resources. But when it was time to return to normal, the regional administration announced that fewer checkpoints than before would continue to function. Instead, some of them will provide long distance medical advice.
Doctors and nurses are refusing to work in this way, fearing that it could harm patients.
“You can’t provide real emergency care via videoconferencing. You have to be with the patient to see them. And what if they live in a place where the first hospital is an hour away? What if you talk to them on Zoom? how can you make sure they’re taken care of until they get there?” asks Elena Polentinos Castro.
Prioritizing public health services as the crisis approaches
In other parts of the health system, for example hospitals, budgets are slightly larger, but they are grappling with the effects of privatisation. Many hospitals in Madrid are either private or public-private partnerships, making access difficult for those who cannot afford to pay for care.
At the same time, privatization has bled the public health system for millions of people. This again puts rural and poor communities at greater risk. “These are the communities that rely the most on public order. They cannot go to the private sector. What should they do if they get sick at a time when they are exposed to the effects of rising cost of living and food without investment in public health care? asks Polentinos.
The problems of the health system in Madrid cannot be solved overnight. “But we must talk about them, we must prepare for what lies ahead. This is the time everyone must stand together to demand universal health care and equity. Nothing else will do the trick,” Elena Polentinos Castro concluded.
People’s Health Dispatch is a fortnightly bulletin published by public health movement And People’s Dispatch, For more articles and to subscribe to People’s Health Dispatch, click Here.