In 2022, several of the largest municipalities in Navarra approved a motion in support of the public health system (SPS), demanding six points from the Government of Navarra. In this writing we assess the degree of compliance with the motion in the current draft Regional Health Law (LFS).
Point Six of the motion requested a new LFS.
By presenting the draft the Government meets this demand. However, the town councils requested to participate in its preparation and we do not know if they have been consulted to date. As guiding principles, the Project cites the need to provide quality services, consider the interaction between environmental, animal and human health (One Health approach), address the social conditions of health, assume the participation of system professionals , establish a health focus in all policies to be led by the Department of Health, etc. Regarding the universal right to care for residents in Navarra, it does not clearly resolve the right of all people.
We will review the rest of the points of the Motion and their embodiment in the LFS project.
First Point: Strengthening Primary Care and Public Health.
The explanatory memorandum of the bill correctly criticizes the current hospital-centric model. But it does not specify or define criteria to guarantee the necessary resources for primary care, beyond stating that they must be sufficient. Regarding guaranteeing presence in healthcare, the project relegates telemedicine to contexts of geographical difficulty and low added value care.
The relationship between Public Health and Primary and Community Care is not developed. Public health focuses on promoting healthy individual living habits (nutrition, physical activity, unhealthy consumption) but barely mentions creating healthy collective living and working environments (housing, transportation, access to healthy food, stable employment…). It poses few challenges in public health, except in occupational health, where the role of the Public Health Service is reinforced in caring for the health of the working population and controlling prevention services and business mutual insurance companies, a reinforcement provided for in the General Public Health Law. of the year 2011.
Second Point: No to the privatization of the Public Health System
The LFS Project not only does not limit, but rather expands the privatization formulas, citing the figure of private health centers with unique agreements with the SPS. It sets out in detail the payment modalities to agreed entities or activities. There is no requirement that offering public services always be the first alternative before their derivation.
It does not foresee incorporating new necessary benefits or reversing other privatized ones such as oral health, a large part of mental health, palliative care, provision of hearing aids and glasses to the most economically vulnerable groups, etc. nor does it resolve the irregular historical favoritism towards a private clinic in matters of hemodonation and transplants.
It does not guarantee priority to develop scientific research from the public system, a reality denounced by its professionals. In addition, it opens the possibility for them to participate in research projects of private entities.
It does not commit to shielding the SPS from the powerful strategies for its privatization promoted by the business community and Social Security through mutual companies or investment funds.
Third Point: Decent and stable work, reducing the eventuality of the SPS workforce.
The project separates the SPS from the rest of the Public Administration of Navarra, and transforms the SNS-O and ISPLN into public business entities of private management without raising its advantages and disadvantages. It is committed to the progressive disappearance of the civil servant character of the staff and establishes a single Area compared to the current three, enabling their mobility within it. All of this could deepen the precariousness of employment conditions and could lead to a scenario with less guarantees in access to public employment, without forgetting the increase in the probability of privatization of services.
Point Four: Progress towards a quality public health care model.
It proposes enabling a common social and health strategy of the Departments of Health and Social Rights. Extends the figure of private centers with a singular agreement to social and health centers. The approach to health and social health care is located in the new Districts, a grouping of several basic health areas. It does not propose promoting a public social and health care system.
Point Five: Public and sufficient mental health system
The project cites mental health care as an area to strengthen. It proposes a comprehensive approach, from promotion and care to recovery, avoiding stigma for affected people. It includes family and environment care for people with mental health problems. Mental health resources will focus on addressing the most serious cases (eating disorders, social and/or judicial problems, dual pathology, suicide risk…), and addictions from a community perspective. Cites community involvement in this area. It is not necessary that the system resources be public.
Assessment
It is positive that the mandate of the previous Parliament of Navarra and the municipal request are fulfilled, but it is a project that is not opposed, but rather consolidates and expands the avenues of privatization, authentic sinks of money from the public health system for the benefit of business private toilets. By converting the SNS-O and the ISPLN into privately managed public companies, a scenario of greater risk of precariousness of the workforce is outlined.
The most advanced aspects such as the One Health approach, addressing health inequalities or interdepartmental coordination mentioned are not specified in operational criteria. It does not address the necessary collaboration between public health and primary health care. Health promotion affects so-called lifestyle habits, but barely addresses the promotion of healthy living and working environments.
The project forgets to guarantee the linguistic rights of the Basque population in health care. Nor does it mention the challenge of resolving waiting lists or the high and growing pharmaceutical and technological expenditure to be rationalized.
Regarding the essential participation of citizens and professionals in the health system, the current failed model is maintained.
The project aims to respond in part to some of the past and present problems of the public health system, but not to the foreseeable problems that the current multifaceted crisis of the current socio-political system poses to the health of the population.
We therefore have a project that has a wide margin for improvement before becoming law. It is time for social entities and union organizations to make their critical contributions before November 30. However, without mobilization in defense of the public health system, the numerous current shortcomings will not be solved nor will the positive aspects presented by this LFS project be applied.
Iñaki Moreno – Sueskun, Lázaro Elizalde Soto, and Mari Sol Saiz-Aja
Navarra Health Platform / Nafarroako Osasun Platform