Medical professionals from Hospital de La Paz, Madrid during COVID-19. Photo by Kiko Huesca (EFE), featured in Cadena Ser

Spain’s world-class healthcare: wrestling the shackles of the past and the failings of the present.

Despite being lauded in recent years for its high-quality and inclusive healthcare system, Spain’s current healthcare professionals have been ill-equipped to tackle COVID-19, the biggest humanitarian crisis facing the country since the 1936 Civil War.

Unfamiliar with the ins and outs of the Spanish healthcare system as I tongue-tied my way through daily interactions in broken Spanish back in 2016, I nodded and smiled, presuming that the receptionist in the medical centre in Alcalá de Henares was telling me that my bill would arrive shortly in the post: it never did.

Quality care for all

Living in a society where health care is free and accessible represents quite a change for us northern Europeans accustomed to paying anywhere up to €50 for a routine check-up at our local GP. Prescriptions are also subsidized by the state in Spain, and people are able to buy their medication very often for less than €2.

In the most recent Global Competitiveness Report by the World Economic Forum, it ranked right at the very top alongside Hong Kong, Japan and Singapore. Moreover, the country’s improving life expectancy cannot be put down to sunshine, citrus fruits and oily fish alone. In short, Spain has got healthcare right.

The aftermath of this pandemic will leave many questions to be answered and Spain’s first ever coalition government will be faced with the unenviable challenge of navigating a tremendous economic crisis while providing businesses of all sizes with vital oxygen. They will also have to tackle the glaring deficiencies of a healthcare system that has been pushed to breaking point in recent months.

The stories of hospital staff becoming infected and a horrifying lack of protective materials — which saw many resorting to refuse sacks — has shown to the world the devastating effects that years of austerity has had on Spain. “We have a shortage of materials, and that’s the most worrying thing,” says Silvia Sánchez, a nurse interviewed in El País Semanal magazine. “Every time we get kitted out, we expose ourselves to infection.”

The mental impact of COVID-19

Despite the overwhelming public display of support for Spain’s healthcare professionals on a nightly basis, lockdown-induced paranoia has seen a fear of contagion spread among those sharing residence with medical professionals.

A doctor in Barcelona found that two of her tires had been slashed and “Contagious rat” sprayed onto the side of her car. Other medical staff have been greeted with signs on their door from other neighbours in the apartment block advising that it would be in everyone’s best interests if they found alternative accommodation.

The psychological impact alone on the doctors and nurses who have watched patients die because of a lack of ventilators, many having to prioritise patients with a greater life expectancy over others in the care who were less likely to survive. Porfirio Córdoba, a nurse at Hospital Puerta de Hierro, Madrid described to Diario Enfermero how he would “return home crying in the car because of everything we went through during the shift.”

These are decisions no person should have to make but are the result of austerity and the actions of previous governments, as well as the lackadaisical approach by the current administration which reacted too slowly to how the virus situation was developing across the Mediterranean Sea.

Where has it started to go wrong?

It would be foolhardy to attribute the high COVID-19 mortality rate, the need for some retired doctors under the age of 70 to return to work, and the conversion of IFEMA, an events and exhibition centre in the Spanish Capital, into a 5,000 bed makeshift hospital entirely to aftermath of the 2008 recession.

Nonetheless, it has had integral role in Spain’s standing in this regard on the European stage. El País report that Spain’s investment in healthcare is 8.9% of GDP, below the EU average of 9.8%; its investment per person in healthcare totals €2,371, below the EU average of €2,884; and it has 3.9 doctors per 1,000 inhabitants, below Greece (6.3), Portugal (4.4), and Germany (4.2). They also report that the average salary for a doctor in Spain is approximately half that of their UK and French counterparts, a disparity not reflected in the respective cost of living differences.

In Madrid, the population grew by almost half a million people between 2010 and 2018 while the number of healthcare professionals fell by 3,300 in the same period. La Vanguardia report claims from the association for the defence of Madrid’s public health service (ADSPM) that the region closed 1,950 hospital beds between 2010 and 2018. Contrast this to the oversupply of beds in Germany along with their efficient testing system and the reason for the significant difference in mortality rates quickly becomes apparent.

Verónica Casado, previously named the best family doctor in the world by the World Organization of Family Doctors (WONCA), said: “since the crisis hit, primary care has been the most undermined (segment of healthcare).” She hoped that more funding would come.

What lies ahead

In a recent piece for El País, Eduardo Madina wrote: “When this is all over, hopefully the political forces will have learned how to translate all that they hear at 8pm every night (the public show of support for the healthcare professionals). Spanish society, which is losing so many lives, deserves it. And our national healthcare system, which is saving so many lives, deserves it.”

Across the pond we have seen the devastating effects that an employer-based, private health insurance system can have on society and it’s clear that Spain has created something quite unique.

However, just like the patients it is meant to serve, the system itself now badly needs care and attention. With an estimated €92.5 billion to be wiped from the Spanish economy from tourism alone in 2020, tough times are coming, but Spain can’t afford its national symbol of equality to fall into disrepair.

In an article published by the Guardian and nine newspapers across the continent, Spanish Prime Minister Pedro Sánchez called for solidarity across the European Union and a bolder approach in the face of mounting debt levels instead of resorting to the conservative austerity route.

As we edge towards a “new normal”, he now has the opportunity to practice what he preaches.

A pay rise for the front-line healthcare workers would not be a bad way to start.

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