The medical strike and the reform of the Framework Statute They have opened a crack that can no longer be explained only with articles and epigraphs. It is a question of confidence and political direction. In the midst of a struggle between the Ministry of Health, the autonomies and the entire medical profession, the debate has jumped from the hospitals to the streets and to the patients, with the feeling that much is decided without listening to those who support the system every night on duty. In this interview, Rafael Matesanzone of the voices that best knows health management from within – he founded and directed the National Transplant Organization (ONT) for more than a decade, the crown jewel of Spanish healthcare – analyzes the error of origin that, in his opinion, has brought the conflict to the boiling point. And he does it his way, without mincing words.
The medical strike against the Framework Statute continues to unwind. What would you say is the Ministry’s original error in addressing such a sensitive labor reform for doctors?
Fundamentally, the lack of knowledge of the terrain they were treading on and their lack of connection with the health reality. They thought that, as happens with other areas of the Government, the agreement of the so-called “class unions” that is taken for granted was enough for everything to go smoothly… and they came face to face with reality.
Is it a problem of “content” (guards, shift, professional classification) or “method” (interlocution, legitimacy of the table)?
It is a problem of generalized satiety. Today’s doctors have, fortunately, little to do with those of 40 years ago. They rightly demand a quality of life in accordance with their training, work and responsibility and instead they find salaries that are not comparable with those of Western Europe, on-call hours and hours that are increasingly unbearable, higher than those of any other profession and, in short, a progressive deterioration of the system that falls largely on them in the eyes of the population. Faced with this situation, something that is seen as a possible lifesaver, such as the Framework Statute, is not even allowed to be negotiated by its representatives, but is proposed diluted among the rest of the health workers, obviously much more numerous and among those who have everything to lose.
He has assured that, if a specific negotiation is not achieved, it could take decades to be considered again. Do you think that Health is closing that door for ideological reasons rather than management?
It is evident that this is so. I am not saying that the issue is easy to manage vis-à-vis other ministries and communities, but that is precisely what the Ministry of Health should serve to do, to mediate with all the entities involved and not to act as a brake. Faced with this, we find ourselves with the most ideologized and sectarian ministerial team in all of democracy that is not willing to lift a finger for something that can specifically benefit doctors and that is going to do everything possible for a checkmate that closes any door to professionals in decades.
What cost does it have for the system to “win the story” in the short term if the medical labor conflict becomes chronic?
Falsely closing this conflict by manipulating public opinion through an agreement with related unions, as the Government has already attempted, would be a true disaster for the system because it would lead doctors to the conviction that there is nothing more to negotiate and it is not worth lifting a finger for things to change through rational means. A latent conflict would entrench itself from which nothing good could be expected.
“The guards are not sustainable with their current organization, but the Administration is not willing to assume what it means to change them”
What clinical and organizational risks do you see if a system that structurally depends on long shifts and overtime is maintained?
The guards at the time were more or less bearable while the doctors were younger and the pressure on care was less. All that has changed for the worse and now they are not sustainable with their current organization. The adoption of shifts and a reasonable schedule for continuous care implies an increase in staff and remuneration that the administration does not seem prepared or willing to assume but that is absolutely necessary on pain of a bankruptcy of the system which, if things continue the same, will occur sooner or later.
Which scenario do you fear more: a Statute that goes ahead without doctors or a strike that becomes normal one week a month?
Without a doubt a Framework Statute without doctors, from what we said before falsely closing the strike. I don’t know if this would mean a weekly strike every month, but in any case, the consequences would be a disaster.
Is opening the LOPS being used as a wild card, as a way to “gain time” in the face of strikes, or is it essential to fix the underlying problem?
I honestly don’t see that this is the way. It seems like another distraction maneuver to me.
The majority of regional councilors describe the conflict as “a chaos that the minister must resolve” and ask for an exclusive framework and finalist financing. What assessment do you make of Mónica García’s role in this crisis?
It has been and is being a perfect disaster. He raised an issue like the Framework Statute without evaluating the ground he was treading or having any idea of what he intended or how to move it forward, he managed to confront doctors, communities, public opinion and patients and shows no sign of being able to resolve it. Quite a record.
Changing the third. The CNIO has experienced very serious complaints: alleged million-dollar corruption, management crisis and internal problems. What damage does this do to citizen trust in the State’s health and scientific institutions?
I have been witnessing the successive crises of the CNIO with true astonishment and I imagine how they are seen by the citizen who, these days, has to file his income tax return for, among other laudable purposes, the fight against cancer and other diseases. I believe that the main risk factor of these institutions is their political use by the different governments and yet their lack of control by the corresponding administrations through totally ineffective boards of trustees. It is evident that the people chosen for the different management positions have not been the most appropriate nor have they had sufficient controls and from there, anything is possible.
“Only a massive replacement of the ministerial team could improve the situation”
What urgent measures would you take to protect strategic public centers?
Trust is something that takes a lot of time and effort to achieve, and is very easy to lose. Continuous accountability in any of these bodies is essential. What is our money spent on and what is the return obtained from it. Finding the right people to lead them, who know how to deal with a reputational crisis, is not easy, but the success or failure of these institutions will largely depend on it. To refer to the recent case of the CNIO, what is missing is a detailed explanation of what happened (which from the outside seems like a fight between egos and powers) by the new management and an exposition of the measures adopted and what the future will be like. None of this has occurred from anyone and that does not help clarify the picture.
You have led an organization, the ONT, based on trust, traceability and clear rules. What is missing from the Ministry today to recover that management logic?
Obviously a new ministerial team. The ONT fortunately maintains this line of seriousness and effectiveness and certainly not by chance, but for the ministry as a whole, only a massive replacement could improve the situation. With the current team, little or nothing can be done.
The surgical waiting list closed 2025 with 853,509 patients and 121 days of average delay What reading do you make of these figures?
When Pedro Sánchez became head of the Executive, in 2018, in Spain there were 584,018 patients on the waiting list for an operation. Today there are almost 300,000 more. I think that says it all.