|Implemented in this survey?|
The decision adopted last April of integrating the Department of Social affairs within the Ministry of Health finished with the discussion about the future of a Ministry that lost its competencies in 2003 when the health affairs were fully decentralised to the autonomous regions. New Ministry of Health and Social Policy will face the implementation of the new dependency law in a country with regions fully autonomous in these matters and with disintegrated social and health services.
To produce integrated health and social policies in order to better meet the new population health needs: aging, chronic diseases, dependency and migration.
The main objective is to produce integrated health and social policies in order to better meet the new population health needs: aging, chronic diseases, dependency and migration.
The administrative structure for Social Affairs, formerly a secretary of state, not a ministry, used to be linked to the Ministry of Education and one year before had been linked to the Ministry of Work. Now it has been attached to the Ministry of Health. The Ministry of Health, which assumes also the functions and competences of the former secretary of state of social affairs, is renamed Ministry of Health and Social Policy. The former structure, competences and functions of the Ministry of Health hardly changed with the addition of the social affairs structure. Only the sub-secretary, the top-level general manager under the ministry, has been renamed as sub-secretary of health and social policy, in order to integrate the social and the health perspective in policy and managerial decisions. Under the sub-secretary of health and social policy there is a secretary of health and another of social affairs who are in charge of the former, unchanged structures of each topic: a large health area and a small social area.
The main incentive for the government is to offer an image of dynamism, modernity and higher orientation to the people's real needs and to push forward the unfinanced Dependency Law.
Civil servants, citizens, especially patients with chronic conditions, immigrants, dependent persons and the socially deprived population, regional aotonomous governments
|Medienpräsenz||sehr gering||sehr hoch|
The integration of the health and social affairs at the ministry level might be the first step for coordinating the provision of services. Further changes in the ministry structures in the autonomous regions and in the contracts of services with the providers are also needed if this ministerial change is to to improve care for the population.
The changes appeared in midterm as part of a political re-restructuring of the government, when the executive was facing critics from the political opposition, the press and citizens which where based in its inability of coping with the financial crisis. The Socialist Party, already in power in Spain, lost the government in the region of Galicia in favour of the conservative Popular Party and feared a defeat in the European elections. The Minister of Heath was replaced together with other ministers.
The opposition criticized the continuous changes in the structure of ministries, the lack of a clear continuity in economic policy and the absence of austerity because the total number of ministries was not reduced. Citizens also were very critical with the Spanish government because of its slowness in providing universal social care coverage to the dependent population under the new dependency law. This law, passed in 2006, proposed a progressive implementation between 2007 and 2015, beginning with people with higher degrees of dependence and increasing the range of coverage year by year until people with lower level of dependence would be covered as well (also see Gabriel Ferragut Ensenyat. "Long-term Care System Implementation in Spain". Health Policy Monitor, October 2007. www.hpm.org/survey/es/b10/3). Initially the process was a responsibility of the Ministry of Work, it moved to the Ministry of Education for the period of a year and now is a duty of the new Ministry of Health and Social Policy.
|Implemented in this survey?|
The integration of the Ministry of Health and the Ministry of Social Affairs exists in other countries such as The Netherlands and in autonomous regions like Northern Ireland. This reform of the ministry structure might favour the adoption of policies and reforms that promote the provision of integrated health and social services to the population.
However, a social debate of this reform has not happened in Spain. Even if integrated policies were designed by the new ministry, the implementation of such policies by providers would be complicated by the high level of decentralization in the area of health and social affairs. It therefore seems likely that the main goal was to find a new ministry to implement the difficult and underfinanced dependency law after the failure of the Ministry of Work and the Ministry of Education.
The approach of the idea is described as:
renewed: The change took place without a previous debate. The government copied similar initiatives of The Netherlands or Northern Ireland.
The health sector felt relieved with the decision. It closed a large debate about the need (or the absence of a need) of having a Ministry of Health in Spain. The reform might support the difficult implementation of the dependency law, and the regions were not forced to change their own structures and policies.
Nevertheless the health sector believed that an opportunity was missed for a more radical reform and a reduction of the ministry structure. Several regions wanted the Ministry of Health to disappear and to transfer all its competences and responsibilities to the Inter-territorial Commission were all the regional ministers of health are present and have voice and vote
|The government||sehr unterstützend||stark dagegen|
|Opposition||sehr unterstützend||stark dagegen|
|Health and social services providers||sehr unterstützend||stark dagegen|
|Dependent population||sehr unterstützend||stark dagegen|
|Political Parties||sehr unterstützend||stark dagegen|
The structural change of the Ministry of Health appears in a short law published on 7/4/9.
|The government||sehr groß||kein|
|Health and social services providers||sehr groß||kein|
|Dependent population||sehr groß||kein|
|Political Parties||sehr groß||kein|
The structural change was implemented.
Although specific evaluation of the measure has not been announced, more integrated social and health policies are expected, as well as a more effective implementation of the dependency law. Although the new ministry has been in charge for a semester, little improvement has been achieved in these fields. The Flu Pandemic has been the major concern of the new ministry.
No review mechanism has been anounced, but society will evaluate the impact of this structural change in policy and in social and health serivice provision.
Altough the reform can be understood as a strategy to integrate social and health policies in order to better meet new citizen needs, in my opinion it is only a reaction of the government to the criticism of parliament, the political opposition and society, as well as a new attempt of finding a ministry that will push forward the dependency law.
An integrated health and social policy would hardly be implemented because the regions have full autonomy in health and social affairs. In the regional governments, health and social ministries are still separated and municipalities manage most of the social services. In addition the difficulties in the implementation of the dependency law are due to its under-financing, ist funds come from the general budget. An increase in the budget for this programme is not likely to happen in a period of economic crisis.
The new ministry will face the same difficulties as its predecessors, although a bit of hope exists. Maybe the new ministry will be able to produce modern and more integrated social and health policies.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
If other changes are not produced, the impact will be very low. The first gain could be a better coordination between healthcare services and social services in the implementation of the dependency law, currently totally independent of the others.
Pradera J. La remodelación permanente. El Pais. 15/04/2009
El Pais.com. Angel Gabilondo, Trinidad Juménez Y González-Sinde, principales novedades del gobierno. http://www.elpais.com/buscar/creacion-del-ministerio-de-sanidad-y-politica-social/desde_01-01-2009/hasta_30-04-2009 (accessed 23/9/9)
El Pais.com. El congreso censura el cambio de rumbo de Zapatero. http://www.elpais.com/articulo/espana/Congreso/censura/cambio/rumbo/Zapatero/elpepuesp/20090422elpepunac_2/Tes (accessed 23/9/9)
Ley 39/2006, de 14 de diciembre, de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia. BOE núm. 299 de 15 de diciembre de 2006
Gené Badia J, Contel Segura JC, Hidalgo A, Borras A, Porta M, Oliver A, et al Aten Primaria. Los problemas de salud también explican el uso de servicios sociales en atención primaria. 2009 Feb;41(2):91-101
Joan Gené Badia