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11 October 2004

From Spain, a not so healthy role model

Both Labour and the Tories hold up a foundation hospital near Madrid as the blueprint for Britain to

By Antonio Maqueda

On a visit to Spain to recruit nurses in 2001, the then health secretary, Alan Milburn, came across what struck him as a brilliant initiative – foundation hospitals. Introduced to Spain in 1997 by the Conservatives (against loud protests from Spain’s Socialist Party), the hospitals were publicly owned, privately managed, and under local control – with the mayor and other local functionaries on their boards. The new-breed hospitals could receive donations and raise funds independently. They could also sell parts of their assets.

Milburn visited the Fundacion Hospital Alcorcon, near Madrid, which opened in 1998. By 2001, this flagship health centre was, according to Nicolas Pombo, its first managing director, leading the way in implementing IT technologies. It invested heavily in cutting-edge computer equipment and software. It claimed to have cut average waiting times from the 67 days in conventional hospitals in 1999 to 54. The buildings and grounds were undeniably impressive – shiny, clean and scrupulously well kept, resembling more a four-star hotel than the run-of-the-mill hospitals to which most Spaniards are accustomed.

Milburn was enthusiastic. Back in London, he told the House of Commons that he had found the model for the foundation hospitals that the new Labour government was planning for Britain – and the model was Alcorcon. He praised the Spanish hospital’s greater autonomy and its excellent record of service improvement. Milburn even invited one of the Alcorcon managers to London in May 2002, so that he could explain to the British the revolutionary formula which had proved so successful.

New Labour was not alone in falling in love with these new-model hospitals. Britain’s Tories were believers, too. Liam Fox, Conservative shadow health secretary from 1999-2003, had visited the Fundacion Hospital Alcorcon a couple of months before Milburn. In 2002, he held up the autonomy that made foundation hospitals work in Spain, praising the Spanish prototype for its “freedom” from the stranglehold of centralised government. “The concept of foundation hospitals goes clearly in a direction with which a future Conservative government would be comfortable,” he told the 2002 Tory party conference. And indeed Michael Howard, the current Tory leader, in an interview last month with the New Statesman, reiterated his party’s faith in Spanish foundation hospitals.

By 2003, the two major parties were convinced that Britain had found the perfect solution to its healthcare problems. Unfortunately, the prototype they both praised was far from perfect.

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If Milburn and Fox had scratched the gleaming surface of the Spanish model, they would have discovered that in 2000 the hospital had recorded 13,069 complaints, the highest number in Spain. While the official figures for 2002 and 2003 – at 921 and 1,009, respectively – are much lower, local unions maintain that the records are being fudged and that complaints are still rife. Indeed, one local union leader, Ismael Sarrion, filed a complaint himself after discovering that “a GP had been practising for seven months as a bone specialist, without any of his patients realising that he was not an expert at all”. Jose Gomez-Borrego, the Socialist local councillor for health, said: “Some of my constituents were sent back home and ended up having to go to a different hospital. One was refused an ultrasound scan although she was later found to have kidney stones.”

This year, Rafael Simancas, the Socialist candidate to lead the Madrid regional government, pledged as part of his campaign manifesto to turn Alcorcon back into a public hospital.

Criticism continues to mount. A recent report by the Federation of Associations for the Defence of the Public Health Service showed that foundation hospitals sent the most costly and difficult patients to nearby institutions; they also offered fewer services and fewer beds. Even when Alcorcon was being ranked among Spain’s top 20 hospitals, local unions pointed out that patients with difficult conditions were being referred to the nearby, conventionally run hospitals of Mostoles and Doce de Octubre. They also complained that Alcorcon was short-staffed and that staff, some of them on casual contracts, were being forced to work long shifts. At the management level, too, Alcorcon has a rocky record, with an extraordinarily high turnover since it first opened its doors. Seven managers – four official and three interim – have succeeded one another over the past six years.

The Tribunal de Cuentas, the Spanish equivalent of the UK’s National Audit Office, has recently denounced the lack of transparency in the hospital’s accounts. To make matters still worse, Fundacion Hospital Alcorcon suffered an outbreak of hepatitis C last month. Seven people fell ill and one died. Local unions accused the hospital of using cheaper medical equipment. “At least in public hospitals we do not skimp on resources,” said a GP from Cadiz who asked to remain anonymous.

Spain’s Socialist Party has had enough. Lucas Fernandez, its spokesman on health for the Madrid region, is threatening to hold a press conference imminently at which he will reveal that, over the past six months, numbers of patients waiting for consultation or diagnosis at Alcorcon have leapt from roughly 10,000 to roughly 18,500. He wants to reveal, too, that 90 beds at the hospital are being kept closed – presumably, in order to spend no money on contracting more staff, while keeping up Alcorcon’s statistics per bed. “All this happens because there is no real control over the hospital,” Fernandez said. “It very much depends on whoever is in charge of the hospital.”

That might just give Milburn and Howard pause for thought.

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