The Department of Health is looking for formulas to redistribute health personnel in Catalonia without increasing spending. The department considers that the community does not guarantee territorial equity and that large urban hospitals have significantly more favorable ratios than intermediate or rural hospitals in certain services. Health aims to redistribute professionals from the main health centers (Vall d’Hebron, Clínic and Sant Pau, for example) to others to optimize resources and guarantee activity everywhere. “It is not just that there is a lack of professionals, but also that they must be distributed appropriately,” highlights a source from the ministry.
How can the lack of equity be reversed? Health defends that a part of the personnel incorporated during the pandemic in the core of the system must be distributed throughout the network. And that those professionals who currently have a temporary connection with the large hospitals in Barcelona will now have it in other hospitals that are more in need of hands. To do so, the ministry has asked hospital managers for “containment” to limit personnel spending that has been maintained in the last two years. “In 2021 and 2022 we made a significant hiring of personnel without raising the salary; and in 2023 we will increase the salary without adding more staff,” summarizes the same Health position. “Now we have to consolidate this global improvement by guaranteeing equity and rebalancing efforts.” Among the priorities of the counseling is also the “optimization” of resources so that the system is as “efficient” as possible in every sense. The ICS has gone from having 44,158 professionals in 2019 to around 52,521 in 2022, according to its activity report. In the system as a whole, the increase is close to 20,000 more employees.
It does not seem easy to find the perfect formula to harmonize the healthcare system. “The centrifugation of the workforce is possible with temporary or interim workers, but not with statutory personnel,” anticipates health economist Guillem López-Casasnovas, who is finalizing a study to quantify the millions necessary to balance the Catalan Health system and renew the figure of 5,000 million required years ago. The administration, explains López-Casasnovas, has two ways to increase productivity: “Either the workforce is increased and not the salaries; or you pay more for them to do more hours. And in this dilemma, hiring more staff always wins.” After the Third Agreement of the labor agreement of the Catalan Health Institute (ICS), which aims to guarantee breaks and reduce the workload of health workers, a productive contradiction is generated, the expert understands. “If you have a greater workload with a workforce with fewer hours; It implies that you will have to use part of the temporary workforce to cover the lower productivity of the statutory staff,” explains the expert.
And it is in this scenario of permanent care burden where the unions demand to protect resources: “Everything is a question of money. If there is no money, neither activity nor equity can be guaranteed,” laments Ignacio Montoya, regional secretary of the Satse nurses union. “Perhaps health should be prioritized more than other items.”
The CC OO union already denounced last week that Vall d’Hebron internally announced a reduction of 33 million in the center’s budget due to the increase in personnel costs derived from the increase in salaries of the Third Agreement of the Catalan Institute of Health (ICS). ), something that the institution denies: “There is no planned cut. What we are doing is a redistribution of the economic effort in the ICS that has nothing to do with the Third Agreement,” he stressed before knowing that there would be no budgets. Without new accounts, the situation seems more complicated.
The first movements in the sector worry the unions. “The chapter that assumes the most expense is personnel,” insists Montoya, regional secretary of the Satse nurses union. “And the easiest thing to take action is to reduce staff. We completely disagree. The pillars of healthcare are professionals, not machines,” he emphasizes. CC OO also expressed its rejection: “It is not acceptable for restrictions to be announced.”
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A year after the end of the pandemic, without the economic injections derived from covid, and without budgets, it seems that spending has been perfectly adjusted. The Minister of Health, Manel Balcells, already anticipated the new context in the Parliament’s last Health Commission: “In 2024 we will not take new actions. The money will be to consolidate the actions started in 2023, which are very important and transcendent.” The problem is that the planned money (3.6% more than in 2023, lower than the global 9.6%) will not arrive.