In recent days the Osakidetza leadership has dismissed two senior officials of OSI Donostialdea, followed by two others who have resigned. In view of the "reckless" decisions of the Directorate and the silence of the Department of Health, 28 heads of service of the Donostia Hospital have signed a letter requesting the departure of the management team, among others. The Diario Vasco has received the following letter and the list of professionals who have signed it.

"The 28 professionals who have adhered to the manifesto, which are the heads of service and institutions of the OSI Donostialdea de Osakidetza, including the University Hospital Donostia and the primary care that serves a population close to 400,000 people, want to transmit to the citizens of Gipuzkoa and the Autonomous Community of the Basque Country, in general, their concern for the lack of vision. Moreover, the situation has worsened with the cesses of recent days, on the one hand with the expulsion of Itziar Pérez Irazusta, managing director and Idoia Gurrutxaga, and on the other with the resignation of the Deputy Directors of Medicine and Surgery: Adolfo Begiristain and Maite Martínez de Albeniz, respectively. Neither the Osakidetza Directorate nor the Health Advisor have given convincing reasons for their decisions.

These cesses, together with the previous and subsequent resignations of other members of the management team, show a serious management crisis as a result of the decisions taken by the Osakidetza Directorate at the University Hospital Donostia. In the face of criminal and absurd decisions, we cannot remain silent.

Outdated responses to current needs

With a ten-year vision of public service, we have never objectified that we do not listen to the professionals and managers of the hospital, a situation that prevents us from providing services effectively to citizens at a particularly critical time. In fact, the collapses produced by the epidemic in health care, the shortage of professionals, caused by the lack of resources for their retention and attraction, as well as the unstoppable growth in health care demand, have been combined with the failure to take the necessary measures. In order to make constructive criticism, we clearly and forcefully call on the leaders of Osakidetza and the Department to abandon suicide policy. In fact, impeachments are conduct repeated by the authorities for a long time, although all they have done is indicate the errors that need to be corrected, always from a position of loyalty and commitment to the organization.

It is an unwillingness to centrally manage a service organization that demands increasing technical capacity, without giving voice to institutions and managers, with criteria for selecting absolutely obsolete professionals, unless merit and knowledge appropriate to needs are prioritized. Thus, it is not understandable that in work relationships the determining merit is age or non-technical conditions, without valuing the technical competencies appropriate to the needs, without evaluating the consequences for the users. Despite the repeated promises of successive advisors, OPERs remain obsolete and inadequate in design that does not solve the problem. This situation means that most of our young professionals, who are in their most fruitful professional stage and in their most important educational level, are in intermediate positions, in some cases up to 20 years. It is certainly incomprehensible to us that the management of Osakidetza will not be able to undertake in the next 5 years the necessary reforms to face with guarantees the generational shift affecting 30% of the doctors of the HUD (establishment of places, Post-MIR plan, etc. ). ). It is not possible to make this fundamental change to maintain the standards of quality of care achieved, without allowing integrated organizations to more rationally manage their specific needs. If this requires legal reforms, do it in the same way as for other matters. It is not acceptable that a government with full parliamentary support to legislate should not be faced with an increasingly serious situation.

The inescapable consequence of this is that the stages of post-specialized training of young professional students of the MIR system cannot be channeled, guiding this process and adapting it to the needs and forecasts of the system, so that the renewal of the cadres is done rationally and not based on a permanent improvisation that is the current reality. The Spanish health system, and especially the Basque one, has stood out for the excellence of the medical training systems of MIR, PIR, PIR, PIR, Nursing, etc., but for many years it is clear that training does not end with this period and that the demand for continuous recalification is absolutely necessary. Job insecurity and lack of specialization among young people make it difficult to adapt the health system to the needs of the population. Post-specialization steps would strengthen, create and reform some care structures. Too many years ago some of us proposed to Osakidetza the establishment of a specifically Basque POST-MIR, in addition to retaining its own, external talent. This plan was and is economically viable, but the current leaders of Osakidetza have left it unjustifiably behind. The indifference and lack of understanding of what should be a modern and effective public health system drives these decisions, which puts us behind the rest of the Spanish health systems, which are being carried out in different ways. Reiterating the legal difficulties in implementing such systems of human resource provision is false because we have lived with stable governments and an absolute majority for decades.

Daily discomfort

Another unacceptable example is that the system is not able to manage contracts for professionals working simultaneously in research and direct care, nor to include doctors with a research profile through their own systems (Ikerbasque) or other systems (Rio-Hortega contracts or similar to the Ministry of Health). Research workers will also not be able to opt for a reduction in working time, as permitted in other jobs for maternity or care of the elderly. In addition, research work is undervalued both in the curricular and in the economic sphere. In this globalised world and with Spain’s presence in the European Union since 1986, it is regrettable that our health system values less training or work periods in the public health systems of another country in the European Union than those carried out here. This case shows that the organization lives anchored in a very diffuse and distant past. It is not acceptable for health professionals, doctors and nurses to have to fight before the courts to recognise their rights (in other areas of the administration the right to recognition of external working periods is recognised). These professionals go abroad in search of post-specialized training or better working conditions and are not allowed to return.

These days ' closures are a clear indicator of the vertical behavior of management and imply a progressive limitation of the management capacity of the managers of each integrated organization. In fact, once these organizations have been designated, their management capabilities are reduced to the benefit of a central organization increasingly remote from the reality and needs of the care units. Members of these units are appointed on the basis of political criteria rather than merit and capacity. We believe that Osakidetza has not listened to the professionals, nor the managers, who are warning of the lack of logic of certain decisions of the organization. Professionals dismissed in recent days lead a management team that has successfully faced a recent crisis, and many Hospital care parameters published last week value us as leaders of the health system. That is why, among other things, the decision to dismiss OSI workers is absurd, while showing sectarianism and lack of capacity, and demotivates the staff who have made every effort to maintain the system at a very delicate time.

In addition to these general and global problems, the Basque Health Service presents other problems due to the lack of understanding of the needs and capacities of the organization in Gipuzkoa, which harm both the population served and the adequate staffing of other territories. In particular, the Heads of Service of this OSI Donostialdea in which the University Hospital of Donostia is integrated, we wish to denounce that, in practically all the services we run, there is a downward difference in the number of human resources compared to the OSIs of other territories, according to population ratios. These differences may in some cases be close to 25% in medical specialists and somewhat less in nursing.

The lack of transparency in information by the Osakidetza Central Service Assistance Directorate prevents us from knowing whether there are even greater fluctuations in other aspects such as holiday coverage, casualties, etc. But taking into account the data we know, and depending on the reality we live each day, we suspect that in these areas too we have great differences, and hopefully parliamentary transparency is required in this respect. Theoretical or economic labour rights which overburden those who remain in such situations cannot be enjoyed. A dignified labour policy should correct not only pay but also the factors that cause everyday discomfort.

We know that many of these measures involve more investment, and that Osakidetza’s budgets, despite being the highest of all times, are partly financed by the issuance of an increasing debt, although the revenue has increased. But that money, the money that the citizens spend on budgets, must be spent on technical criteria and with territorial balance, on the basis of population and needs, and not on the basis of the most convenient, imaginary or worse budgets. In this regard, the situation in Tolosaldea, with a non-network main hospital and quite disconnected from the network, the dance of decisions on the Bidasoa Hospital or its future integration into the Onkologikoa network, or the inability to cover casualties are particularly serious, to name but a few examples. The latter is serious in the Home Hospitalization Service or in the Emergency Department, one of the most valued and needy by the population, where displacement, lack of decisions and lack of explanations have been constant in recent years.

In short, the imposing way in which the current Osakidetza DG operates already generated uncertainty and concern for erroneous decisions. However, after the last dismissals, the concern has been added to the anger: How will we explain to our colleagues, as heads of service, incomprehensible decisions? The professionals consider that their opinion is not heard in the management areas and consider the usual channels of communication with the organization exhausted, as they see that what they are trying to speak and resolve is dismissed.

That is why we urge the Health Advisor to immediately abolish the posts of the Osakidetza Directorate-General as directly responsible for these latest decisions, if it does not want to be complicit and co-responsible for this absurdity. In addition, we demand the immediate and complete translation of the OSI management team and that it initiate a process of dialogue, re-establishing the Optional Committees of the Hospital which once served to guide these issues. Meanwhile, we inform Gipuzkoan and Basque society in general that, as always, we will try to maintain the quality standards as far as possible, but we ask that, as a mature society, it be very attentive to the decisions taken by the Department of Health. In this way it will be possible for politicians to realise that they do not deceive the citizens and that they are asking for the same level of capacity and permanent commitment that is required of them in the election campaign. This is not a political struggle, it is a health management problem. We're not against any party."

Seconded professionals:

Aguillo, Arantza. Chief Emergency Service

Altuna, Xabier. Head of the Otolaryngology Service

Arrizabalaga, Julio. Former Scientific Director of the Biodonostia Institute

Azkarate, Begoña. Head of Teaching

Berezibar, cristina. Head of Palliative Care Unit

Calvo, cristina. Head of Paediatric Service

Carbajo, Iban. Head of Rehabilitation Service

Enriquez-Navascues, José María. Head of the General Surgery Service

Goikoetxea, Xabier. Head of Unit Clinical Management Chronic Patient and Convalescence

González-Jorrin, Nuria. Head of the Anesthesiology, Resuscitation and Pain Therapy Service

Iribarren, José Antonio. Head of Infectious Diseases Service

Izquierdo, José Miguel. Head of the Thoracic Surgery Service

Lertxundi, Ana. Head of the Traumatology and Orthopedics Service

López de Munain, Adolfo. Head of Neurology Service

Marquet, Loreto. Assistant Director of Nursing of Central Services and Human Resources

Mendikute, Javier. Head of Ophthalmology Service

Núñez, Antxo. Chief of Admission and Clinical Documentation Service

Oyarzabal, Igor. Head of Urology Service

Perez-Rico, Manuela. Head of Home Hospitalization Service

Piera, Pep. Head of Medical Oncology Service

Querejeta, Ramón. Head of the Cardiology Service

Rodrigo, Mariate. Head of Nephrology Service

Ruiz, Irune. Head of Pathological Anatomy Service

Salegi, Iñaki. Head of Pneumology Service

Sukia, Elena. Head of Service Quality

Telleria Arrieta, Look. CHIEF SECTION OF HEMODYNAMICS

Yoldi, Alfredo. Head of Endocrinology Service

The bridge, Félix. Head of Intensive Care Service