KINGDOM OF SPAIN: Cruel austerity measures leave patients suffering

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9 May 2018
[International Secretariat]

Harsh austerity measures implemented by the Spanish government have had a devastating impact on some of the most economically vulnerable and marginalized people in society, resulting in unbearably long waiting lists and forcing patients to ration their medication to save costs, Amnesty International said today.

The Spanish government began to cut spending on healthcare in 2009 in the wake of the global financial crisis. Austerity measures- notably through the Royal Decree Law 16/2012 (RDL 16/2012) - included shifting the costs of certain products onto individuals, limiting the healthcare available to irregular migrants, and cutting spending on health workers, equipment and infrastructure.

Amnesty International spoke to 243 people in Andalucía and Galicia, including users of the Spanish National Health System (SNS),health workers, and public health experts.

Increased financial burdens

Amnesty International’s research shows that since austerity measures were introduced, many people with chronic health conditions have struggled to pay for medicines that were previously free. Although the sums involved may not seem high, for people with low incomes they can be devastating.

Amnesty International spoke to more than 100 users of the SNS and their families and carers. People described how they now relied on relatives to pay for their healthcare, and others said they had been forced to make choices about which medicine they needed most.

Health workers stretched

Spending on health workers has decreased since the start of the financial crisis, resulting in lower salaries, poor working conditions and insecure contracts. This has contributed to fewer staff being employed by the health service – according to official data, the number of workers in the SNS decreased by 28,500 between 2012 and 2014.

One nurse told Amnesty International: “We know of many cases where nurses have quit their jobs because of the stress. Many nurses attend to 33 complex cases a day”.

Several health workers also said that they were under increasing pressure to comply with economic incentives that limit, for example, the amount they should spend on each patient.

Exhaustion, economic incentives and an unsustainable workload are all hampering health workers’ ability to provide the best possible care. They feel powerless, exploited and disillusioned with the system.

Waiting lists

The increase in the length of waiting lists to access health care emerged as a key issue in all interviews including with experts, health workers and people using the health system. In 2010, the average waiting time for elective surgery was 65 days; in 2016 this had almost doubled to 115 days.

Mental health services have also been hit hard by austerity, at a time when unemployment and evictions, associated with a risk to mental health, have risen sharply.

Deteriorating quality of health care

Several health workers and health system users also complained that the quality of medical equipment had deteriorated since the crisis. For example, nurses said that lower quality needles for diabetes tests was making testing more painful for patients. Amnesty International also interviewed wheelchair users and health workers who said that the quality of wheelchairs had got worse after the crisis.

Almost all the health workers who Amnesty International spoke to confirmed that the consultation time they spent with each patient had decreased.

Given the human rights risks associated with austerity, international human rights bodies have developed guidelines to ensure that austerity measures are consistent with states’ human rights obligations.

Amnesty International found that the Spanish government has failed to comply with these international guidelines for a number of reasons, including:

  • No human rights impact assessments were conducted before the austerity measures were implemented, and the levels of participation and consultation in how they were developed and implemented were inadequate.
  • Austerity measures are having a disproportionate effect on marginalized groups
  • All alternatives were not exhausted
  • Many of the changes introduced to the health system, notably RDL 16/2012, remain in force years later, despite guidelines stating that austerity measures should be temporary

Amnesty International is calling on the Spanish government to take immediate steps to reform the RDL 16/2012 and ensure that good quality healthcare is accessible for everybody. This should include putting in place safeguards to ensure that vulnerable groups are not disadvantaged, and improving working conditions for health workers.

“The government should also urgently conduct a comprehensive human rights impact assessment to assess how austerity measures have impacted the right to health. A recession does not justify trampling on people’s rights.”

24 April 2018

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