the health care and welfare in Spain they suffer one coordination deficit which has become apparent, above all, during the course of the Covid-19 pandemic. To this lack of coordination must be added the lack of resources suffered by the care system and the abandonment of care at the end of life, one of the biggest problems facing the elderly and a challenge that the cities of the future have to face. The result, as a whole, have been the most of 30,000 deaths have been recorded since the start of the geriatric center pandemic, According to data from IMSERSO. Fundació Víctor Grífols i Lucas and Fundació Mémora analyzed all these issues in the webinar “Attention to social and health needs, do we add or divide?”, Framed in the project Cities That Care.
“This crisis has shown that there is a division between health and social care. There is talk of humanizing medicine and bringing care to hospitals, but we have been able to see that there is an exclusion of health care in geriatric centers, ”he says Victoria Camps, President of the Grifols Foundation and patron of the Mémora Foundation. In this regard, the expert criticizes that the main problem of this situation is linked to the excessive technicalization. “There is a division of functions that has ended up neglecting the basic needs of people. This separation has not been correct. Both health and social care professionals have an obligation to care,” he explains.
Match it Rafael Bengoa, Co-Director of SiHealth and International Health Policy Advisor. “Many seniors have died from neglect and not from Covid. The pandemic has taken advantage of system vulnerabilities and found that the public sector needs to be reformed through innovation,” Bengoa points out.
Collaboration and connectivity agreements
For experts it is essential to strengthen a governance structure that facilitates the union between the health and the social. In this sense, Bengoa highlights the collaboration agreements between the two systems. “There is a need to put in place a governance structure that facilitates dialogue between stakeholders. If there are none, it is important to set up collaboration agreements to discuss how to build a shared vision and what decisions to make. this does not happen in Spain “, assures the expert.
One of the biggest criticisms that Bengoa makes is the non-existence of a digital connection that facilitates communication between the health system and care. “There is no reason why in recent months there has not been a quick connection between the residences and the primary care doctors. There is already talk of a third vaccine and there will be residences with outbreaks, which will take time to resolve. , because they are not connected to healthcare, ”the health expert argues.
For Bengoa it is essential that the social services have financial and structural support to achieve rapid and effective integration with healthcare. “Once this social system has matured, integration can be done. It cannot be done artificially until the social system has received support in human and technological resources,” the SiHealth co-director points out.
A local and local healthcare model
“We have to bet on the environments of proximity because it is where we feel that we care, it is where our dignity and the determination of our community are at stake,” he says. Ana Isabel Lima, Former Secretary of State for Social Services. This expert believes that there have been “advances” at the conceptualization level but no model has been defined to ensure coordination between health and social. In this sense, Lima is committed to review the geriatric model with the reactivation of the Dependency Act. “We need to move towards a city model where the people who live there contribute to the care of people, here lies the importance of the model of caring cities,” says the expert.
In this sense, Camps emphasizes that more resources need to be invested in Primary Care and highlights the figure of the doctor as the “best figure to synthesize the best of health care and care.” “The last stage of life is not only because of age, but also because of fragility and vulnerability. Medicine must not only cure and prolong life, it must also prevent disease, take care and help die,” he says. the president of the Víctor Grifols Foundation. For Camps it is necessary to rethink the model and not think so much about residences, but it is important to promote home care and models such as Assisted Living from other countries.
For its part, Bengoa is committed to breaking the current silos through a model of local governance. “The social and healthcare sector must converge into a single leadership figure that promotes dialogue between different professionals from different fields and thus improves patient care,” says the expert.
Deficit of economic resources
Transforming the healthcare model in Spain and improving coordination with healthcare is also important a matter of economic resources, Beyond raising ideas. “We know what to do and how to do it. There is enough experience and knowledge to start walking. But embarking on this path without resources is difficult. There is not a single euro, nor is it expected,” he says. Guillem López-Casanovas, Professor of Economics at Pompeu Fabra University.
Lima, meanwhile, also laments the resource deficit and the precariousness of the care sector. “We are talking about a person-centered model that is also more expensive. To be able to do this, we need to invest and we cannot have precarious workers. The world of care is very feminized, it is absolutely precarious. and it is an invisible job. We have to take this factor into account to dignify the sector, “explains the former Secretary of State for Social Services.
Cities that Care
Mémora Foundation has launched the “Cities that Care” Observatory, A space for collaboration and debate to combat unwanted loneliness. The aim is to bet on the collaboration with the city councils of Spain to work in plans based on shared experiences, with the participation of more than 100 experts from 22 different thematic areas.