Elizalde retired three years ago, but remains active in defending public health. His trajectory has been a good watchword for the public system. He was Technical Advisor of the Primary Care Directorate, Head of AIDS Prevention and for 20 years of Health Promotion. In the last legislature he worked in a public health service.

There are many problems in the health system, one of the most important is primary health care. Why is it so bad and what needs to be done to improve?

During the pandemic the citizen has moved a little away from the health system and people have been excluded. In addition, within the health system, professionals have had an enormous workload. The high temporality in health, 60% in different areas, means that on many occasions, citizens do not have a reference with the nurse, physician or administrative staff. This is a loss of quality.

In addition, before, care was an attractive place for professionals, but now not. It has become a field with many problems. In short, on the one hand there is the small staff and on the other there is a lack of budget. The World Health Organization (WHO) says that the budget for first care must be at least 25% of the health budget, and in Navarre it does not reach 15%, that is, we say that we are lacking in the budget to reach the WHO council of EUR 100 million.

Apart from this general view, there are other problems in the villages, it is said that many doctors do not want to go to the villages.

That too. In the 2007-2008 crisis, the Government of Spain decided that only 10 per cent of retired doctors would be covered on a stable basis; the rest would be temporary contracts, which makes the first care very weak and the lack of doctors enormous.

Three years ago, however, on the one hand, this restrictive measure was suspended and, on the other, the European Union urged the states to reduce their rate of temporality to 8%, so here too a few steps have been taken. However, the measures taken will not achieve compliance with the European order and the timing rate will not be reduced by 30 per cent.

Consequently, as a result of these cuts, the number of professionals in format was significantly reduced. Many doctors are now retiring, but the wages to replace them are mediocre and they also have to serve many people. Consequently, it is more attractive for many new professionals to go to other countries, such as the UK or Germany. In the medium term, good planning is needed to balance it, but now these are the main problems.

The Navarro Medical Union calls for a strike on 1 February. To what extent do your claims respond to the requests of doctors?

I would differentiate two things. They base their claims on two reasons: one, the poor situation of professionals and two, that the payment system is obsolete. This old system of remuneration does not currently recognise the work that doctors can do in areas such as the work of remote doctors, more complex work, teaching or research work or, among others, improvement groups.

All this is true, therefore, the remuneration system must be renewed, but not as the Medical Union says. Only in their demands do they call for an improvement in wages for a collective and not for everyone. A new approach would be needed.

They also call for the elimination of [Health Only] exclusivity. What do you think?

This acts directly against the public system. A company must retain its professionals and make them satisfied. This allows doctors to compete in the public space from the private sphere. They can manage waiting lists in favor of the private, bring resources to the private system, or the private system leverages the higher education doctors receive in the public. If anyone wants to make use of the private, let them do so, it is their right, but public health must guarantee the basic needs of citizens, and that does not depend on the money the citizen has, but on the need for health. This is not done by the private system.

What have we seen in the pandemic? That the public system has maintained this serious situation and that the private system has hardly contributed. This shows that we need to strengthen the public system, not the opposite, as the Medical Union requests.

They say money is being transferred from public health to private health. What can you see?

Some diagnostic tests and private interventions. In the area of mental health, more than 80% of the beds are in the private area, and the public system, instead of generating its beds, hires them to the private. In this year’s budget forecast, 9% of the public budget will be allocated to the private sector. Three years ago, however, it was 6%, where the evolution is taking place.

The residential private sector of the elderly has just made a five-day strike to improve their conditions. It is one of your concerns and investment funds are increasingly investing in this area.

The situation of people and professionals in residences is getting worse and worse, and that has been very clear in the pandemic, which died without caring for people. Here, fortunately, the health system intervened and went to the residences to inspect the sanitary conditions of the residents, which made the situation not so serious.

The increasing incorporation of these monetary funds makes the conditions worse in residences. In addition, along with the services that are contracted, health services are also contracted, and we believe that residents have rights to the rest of the citizenship and that they have to be treated in the public system.

They also say on the platform that we live in a society that consumes more and more drugs.

Yes, and especially in mental health, but not just there. Severe mental health is only addressed in the public system, but if you have anxiety or insomnia you do not have the possibility to be treated. So how is this problem addressed? Medication administration. At one time, public health served everyone, and we claimed that we had to return to that situation, and that this area should be strengthened economically.

In addition, 22% of what is currently spent in hospitals is on medicines, and that is too much. The training of professionals is in the hands of laboratories, because what the public offers is insufficient. We believe that some medicines are very expensive and of little value, for example in the area of cancer. Some of them are used to extend life for a few days, perhaps a week, and are expensive. It is not worth prolonging a life of poor quality. We must learn that life is limited and that we must die with quality. These amounts can be allocated to places where there is greater need.