2023-10-27 04:00:00
A banner at the doors of the Arganda del Rey Health Center in 2022.
“For me, working here has been extremely stressful, not only because we lost two doctors and because four nurses were displaced, but because every day there was uncertainty about whether we would have the complete team,” says Mar, a physician in an out-of-hospital emergency in Buitrago, a people of Madrid, who have decided to resign from the position. “This labor abuse and this change in my working conditions, being permanent, forced to apply in December 2022, has led me to make the decision to opt for internal mobility and leave the out-of-hospital emergency service,” she explains to Infobae España. Its precariousness has been the trigger for the decision, made after the reform initiated by the Government of Isabel Díaz Ayuso: “Patients do not deserve such a precarious emergency service and to live with the uncertainty of whether there will be medical care the day they have a urgency”, ditch.
After many delays, criticisms and unknowns, a year ago the Community of Madrid launched the new operating system for out-of-hospital emergencies, the night guard posts that replace health centers during those hours and serve for citizens to go for ailments. minors so as not to stress and saturate hospital emergencies.
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The configuration and inauguration was complex: the SUAPS (centers in the city of Madrid) and the SARs (centers in the towns and cities of the Community) were renamed Continuing Care Points (PAC), a total of 78 spaces that are distributed throughout the region. From the beginning of the project there was criticism for the lack of toilets. The SUAPS, closed for two years by decision of the Community of Madrid, reopened as PAC in 2022 and instead of hiring personnel, those who already worked in the SAR were distributed. Double the number of centers for the same number of workers, a decision that caused overloads of work in the region’s healthcare facilities and a degradation of the service provided in these rural centers.
The lack of hiring of health workers, the new formula for these centers, where about twenty operate without doctors and only have nursing staff and guards and many others only have one doctor, complaints for not covering sick leave, doctors transferred at the last minute before to enter their day to go to another center… During the year, countless criticisms and situations have arisen that, in the eyes of unions and health workers, have not been resolved.
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The idea of these centers is to serve as a firewall and prevent hospital saturation. If the ailment is mild or minor, these Continuing Care Points should be used for these ailments: “The objective is to avoid arriving at the hospital emergency room, but since we are overwhelmed because there is no staff, people do not want to wait and go to hospitals,” they explain from the SAR platform, which includes the healthcare workers affected by this reform and carries out exhaustive surveillance of these centers and the presence of doctors.
Archive image of a doctors’ strike in Madrid (EFE)
Ángela Hernández, general secretary of the AMYTS doctors’ union, assures that it has “worsened” compared to the previous formula, when the SUAPS and the SAR had their own staff and a more independent system. In fact, this union participated in a strike that lasted months to denounce the state of public health in the Community of Madrid. “The strike achieved important things such as 14 closed centers opening, but we did not achieve others and the administration imposed open centers without a doctor. This has not been solved and the population has not been well informed, we have gotten worse and there is still a lot of chaos,” the health company denounces.
Despite reports of chaos and disorganization, Almudena Quintena, general care director of the Ministry of Health, assures Infobae Spain that the influx to the centers by patients has been high: “Since they launched, they have attended almost 700,000 patients, 56% from nursing, which supports the strategy,” he points out, with “788 professionals distributed in 53 PACs with a doctor, the rest with nursing staff.” “I believe that the model is working and the result has been satisfactory,” assures the Ayuso Government. According to data from 2019, almost a million people went to these centers. The loss of confidence of almost 300,000 patients is, according to the opposition, the result of poor management and a loss of confidence.
Given this panorama, the SAR Platform also calls Ayuso’s reorganization deficient: “It is disastrous, there are fewer and fewer doctors, which is what was needed. “80 positions cannot be covered with a staff of 40. Every time there is a doctor’s absence or sick leave, they are replaced by nurses,” denounces the organization, which has called this Friday for a protest against the reform.
Javier Padilla, a deputy for Más Madrid and also a doctor, strongly criticizes Isabel Díaz Ayuso’s reform: “It seems that improvisation has been systematized. Nobody is clear in a year how these centers will be. Improvisation has become public policy. The department has assumed that these centers are no longer part of their emergency services, but rather care for minor things. “It is a decrease in services for the population,” says the politician.
This summer, the PACs were once again in the spotlight due to the continued absence of toilets. During the month of August, the centers were without a doctor up to 70% of the total days and in July more than 30% of the centers did not have doctors, even though they were assigned the presence of one. During that month, the emergencies in the south of Madrid functioned correctly for only one day. “In summer it has been dramatic because it has been bailing out water with a thimble,” Padilla says about these months.
The health workers themselves recognize that many have already abandoned this system and have chosen to move to Primary Care and even to other communities. “There are colleagues who leave because they can’t stand this pressure. There are colleagues who are alone in their PAC and have had to serve about a hundred people on a Saturday,” denounces Isabel, from the PAC in Navas del Rey.
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