This afternoon, in the Central Hall of the Rovira i Virgili University in Tarragona, the Minister of Health and Social Security, Marina Geli, explained the public health aims of the Ministry and of the Government of the Generalitat regarding the Camp de Tarragona regions to university members, managers and other representatives from the health field. Marina Geli announced the completion of the Llevant Primary Health Care Centre and the expansion of those at Sant Pere i Sant  Pau, Cambrils, Calafell and Cornudella .

Regarding the specialized hospitable network, she promised that, within a period of 8 years, mental health care will be balanced across Catalonia and that health and social resources will be increased to attend to those with mental illnesses. Furthermore, the Minister spoke about the joint planning between the Joan XXIII hospital in Tarragona and the Sant Joan hospital in Reus .

Summary of the Speech.

Camp de Tarragona

"With regard to health care:

• We will improve Primary Health Care Centres (CAPs), which will become the centre of the health system. We will increase their capacity to resolve health problems, their autonomy, and the time spent with doctors on a visit (a minimum of 10 minutes).
• We will complete the construction of the Llevant Primary Health Care Centre and we will further build on those of Sant Pere i Sant Pau , Cambrils , Calafell and Cornudella . 
• We will objectively assess the quality and efficiency of different management models.
• We will improve  the specialized hospitable network to achieve a health care continuum between primary health care and hospital care.
• The Joan XXIII hospital in Tarragona and the Sant Joan hospital in Reus  will be planned together in order to complement one another.
• The needs of Reus hospital will be attended to in the period 2004 to 2008.
• We will offer a new universal-access and public-responsibility model for mental health care, which treats the illness from biological, psicological and social points of view.
• We guarantee that, within a period of eight years, mental health care will be fairly distributed across the territory for everybody.
• We will increase health and social resources for caring for people with mental illnesses (for example, at Joan XXIII ).

• We will offer more comfortable healthcare facilities, improving accessibility, infrastructures and comfort in primary health care centres, emergency services and hospitals.
• We will Implement a single, comprehensive model of response to health emergencies in Catalonia, coordinating with other emergency services (police, health workers, firefighters and civil protection).   this means a decentralised, comprehensive Accident and Emergency Coordination Centre (112)
• We will change the management of waiting lists, making them more transparent through centralised records. We will e stablish maximum waiting periods of less tham 6 months for operations for non-severe illnesses (cataracts, knee and hip prostheses, hernias, varicose veins, etc).
• Regional management of waiting lists will be introduced, for complementary diagnostic tests, for specialist visits and for operations, with semi-annual evaluation and publication of results.

General framework

"From the new Government and the Ministry of Health we propose to constitute a new health model (a Health System of Catalonia) which integrates and prioritises public health (including in the workplace and environmental health), health care and social services for attention to dependence. This model will introduce  policies into the public health agenda to fight against inequalities in health related to regional differences, social class, gender, or immigration.

We therefore propose a new model, adapted to the needs of everybody: citizens, health professionals, the pharmaceutical industry, management, politicians, everybody.

The implementation of this new health model is the principal health commitment of the nationalist and left-wing Catalan Government to its citizens.

The new government will revise and update the health system, preserving the valid elements that are useful and effective and generating new ideas, projects and hopes which will permit solutions to current shortcomings. For example, we believe that the ICS (the Institut Català de la Salut, Catalonia 's principal provider of public health services) must be modernized. The new ICS will enjoy true autonomy of management, and operational decision making will be decentralised to the health centres or to networks integrated into the territory.

In short, it is necessary to reform the Catalan health administration, guaranteeing its economic feasibility, and to carry out a special investment plan to improve services. Public management of a health system can be, and must be, high quality and efficient.

The new health system (comprehensive, sustainable and adaptable) will take into account external factors (demographic and cultural changes in the population, sociological and epidemiological changes, scientific and technological advances, economic sustainability, etc) which condition the system and which, far from being considered a threat, must be seen as opportunities to introduce all the changes that we consider necessary.

With regard to the Camp de Tarragona area, it is especially  necessary to take into account its specific  geographical characteristics, particualrly that of population, since it shows considerable diversification: the central area, densely populated, with significant industrial development alongside a coastal zone more dependent on tourism (seasonal variations) and on real-estate development, and an inland area where the difficulties in advancing at the same rhythm as the rest of the region are well enough known by all those present."

Priorities of the system

"The priority of this new system that we want for Catalonia , will be the health of people and the health of the community. In this sense, citizens play a leading role in this system. We want to strengthen the perception of the citizen as an owner of the Health System as well as a consumer and user. We will therefore determine rights and obligations so that citizens share responsibility for making good use of the system and for using services and medicines in a rational way. Furthermore, we will make knowledge and the necessary instruments available to promote good health and prevent illness.

Another important element of the health system is the professionals who work in it (both the public and the private sector). We want to work together and avoid a divorce between management and clinical practice. We believe that the professionals have to be involved at an early stage in the decision making, above all in relation to clinical management and fixing clinical objectives.

The government will also revise training models and specialities to adapt them to the health needs of the Catalan population. We will make research and teaching an important asset of health professionals. Thus, we want to unify in a single circuit, and within the working day, the different tasks that professionals carry out (care, training, teaching and research), but distinguishing between the times devoted to each of these tasks.

Finally, Local Administration will also have a key role to play, since it is the closest part of the public administration to citizens and to professionals. Moreover, this administration already has responsibility for public health and basic social services and, in Catalonia , it manages or participates in many health centres and hospitals. The Generalitat will work together with the municipal authorities to plan and evaluate a health system for the Camp de Tarragona region."

Aims and measures

"Now that the philosophy of the new Catalan Health System has been explained, we must detail some of the main actions which we want to undertake at the Department of Health and Social Security. I will therefore repeat what I said at the beginning of this intervention about the three priority axes of this system: They are public health, health care and social services to attend to dependence.

Firstly, in relation to public health, we propose, amongst other measures:

• To create a Public Health Agency for Catalonia, with decentralization to establish an infrastructure of public health (epidemiology, scientific research, laboratories) based on scientific rigor and the necessary resources and  programs.
• To foster the promotion of good health with strategies related to physical exercise, a balanced diet, safe sex, the prevention of unwanted pregnancies and education for good health throughout life, with special attention to health at school and that of the most vulnerable collectives .
• To develop a comprehensive plan to reduce accident rates, mortality and morbidity in traffic accidents by 50% over the next 10 years.
• To promote and evaluate detoxification, rehabilitation and reinsertion programs for people with addictions.
• To regulate natural medicines as a part of  the resources for health, complementary to current conventional medicine, in order to guarantee quality and good practice.
• To give legal and scientific support and coverage to the therapeutic use of cannabis .
• To carry out constant, generic informacion, education and prevention campaigns about HIV virus infection as well as promoting respect and solidarity with AIDS sufferers and with the social services that work in this sector.

And, in relation to social services attending to dependencies:

We will create a Socio-Medical Agency for Dependencies. This will guarantee access, geographical equality and the quality of health and social care for all those with dependency problems. We will also offer a comprehensive health and social service at home, with a combined effort of all professionals involved ."

Funding

"Although health is a priority subject for this government, we are aware that we will not be able to suitably implement all of the measures which I have just detailed, unless we can improve the current system of funding, which is completely inadequate. It is for this reason that the new Government wants to improve funding of the health service: We will renegotiate funding of the autonomous regions with the Spanish State while, at the same time, in the Inter-territorial Council we will look for all possible alliances with other autonomic regions in order to achieve a pact which will improve this funding. Our goal is to obtain a comparable percentage of funding for health with respect to national product to that of other regions or countries with a per-capita income and other characteristics which are similar to ours.

However, as well as asking the Spanish State for an improvement in funding, we are also aware that the Department which I have the honour of presiding over must also make efforts to rationalize expenses (by developing a plan). Of course, this rationalization must maintain the quality and efficiency of the system. One of the most significant contributions to reducing expenses is, precisely, the rational use of medicines, since this would allow us to reduce our currently gigantic pharmaceutical expenses. Specifically, the first measure that we will apply from the Ministry of Health, and that I recently announced, concerning the reduction of pressure on health centres, operates, to some extent, in this sense: by contributing to reducing the excessive “medicalisation” of the system."