Policy responses for Spain - HSRM


Policy responses for Spain

2.2 Workforce

COVID-19 infection is deemed a work accident. Social Security will provide special benefits to those health and social care workers infected until one month after the end of the state of alarm. Likewise, the Social Security will consider COVID-19 as the death cause if the fatality occurs within the five years after the onset of the infection (Royal Decree 19/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-5315; https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4937).

After the state of alarm expires, regional health authorities have to guarantee sufficient health workers for the early detection, epidemiologic surveillance, infection control and patients’ care. For that purpose, the workforce could be reorganised according to specific needs (Royal Decree 21/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5895).

As of 30 September, and as an exceptional and temporary measure, if required, Autonomous Communities will be allowed to hire health professionals not certified according to the Spanish legislation; in particular, those graduate students who have passed the 2019/2020 exam for accessing specialised training still without a position within the Health System, and non-EU health workers with a specialization degree. The contracts could be extended up to 12 months.

In addition, in case of shortage of personnel due to COVID-19, regional authorities will be able to assign healthcare personnel (doctors and nurses) to specialty units different from theirs within the same hospital. Likewise, hospital personnel could be transferred to primary care centres and, vice versa, primary care personnel could be assigned to hospitals. Finally, this regulation provides that civil servants with a health degree, irrespective of his / her position, could be required to serve at any healthcare centre within their province (Royal Decree Law https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11415).

As of 4 February, COVID-19 has been given the consideration of occupational disease for healthcare workers and social care workers infected during their job duties. In this way, health and social care workers get covered for their whole life in case of any disease or eventuality stemmed from the COVID-19 infection, not only for five years as it had been previously issued by law when COVID-19 was considered as a work accident (Royal Decree 3/2021 https://boe.es/diario_boe/txt.php?id=BOE-A-2021-1529).

Since the declaration of the “state of alarm”, the Minister of Health is fully entitled to determine the best distribution of human resources, including those from military forces, work and accident mutualities and private healthcare centres or hospitals throughout Spain in accordance with the needs arising from the current public health crisis (Royal Decree 463/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692). The measures already taken (15 March Order SND/232/2020 https://www.boe.es/buscar/act.php?id=BOE-A-2020-3700; 27 March Order SND/299/2020 Order SND/299/2020; 1 April Order SND/319/2020 https://boe.es/buscar/doc.php?id=BOE-A-2020-4265) include:

● Authorization to hire GPs and specialists who have obtained their titles in a non-European Union state, even if they have not been accredited in Spain yet.
● Retired medical doctors and nurses (under 70 seventy years old) may be returned to active service by the regional competent authority. Whenever possible, these professionals will be directed to primary care centres, to perform triage and home care functions.
● Regional health authorities may temporarily suspend the exemptions after on-call activity (that is, exemptions after overnight service), as well as the compatibility authorizations for the exercise of other activities. Likewise, measures may be adopted regarding working hours and rests, permits, vacations and reductions in working hours.
● Extension of the hiring period for “resident doctors” in their last residency year (that is, doctors that have completed their 6th year of their medical studies and that are currently undertaking their 4th year of training to become specialists). The regional health authorities may determine that residents, who are not in their last year of training, can provide services in units with special needs. Residents' ongoing or scheduled external rotations are suspended, so that they can provide services in those units where a reinforcement of personnel is needed.
● Authorization to hire health professionals who passed the 2018 and 2019 exams to access specialized residency programs and did not obtain a place in the health system.
● Regional health authorities may issue fixed-term contracts to final-year medical, nursing or other health professions students. These personnel should provide support functions and work under the close supervision of a health professional.
● Regional health authorities may hire those students who have finished their nursing assistant vocational training, but have not got the official title yet.
● The Ministry of Health may ask regions to transfer resident doctors to another region with greater healthcare needs.
● Medical doctors from other specialties such as internal medicine, anaesthesiology, pneumology and geriatrics, as well as trained nurses have teamed up with intensive care specialists to increase care capacity for severe or critical COVID-19 symptoms.
● In turn, general practitioners (e.g. family doctors), primary care paediatricians and nurses have been reallocated, after minimum training on protective measures and patient management, to hospital emergency care wards or to COVID-19 telehealth units, where patients are screened, identified, followed-up and, if required, visited while they are quarantined at home.
● Other specialties such as microbiologists, radiologists and occupational medicine and public health specialists have been requested to expand their activity to tackle the increasing demand for diagnosis and surveillance.

By April 8, the Minister of Health announced a placebo clinical trial (named “EPICOS”), aimed at preventing COVID-19 infection in health professionals. EPICOS (Ensayo Clínico para la Prevención de la Infección por Coronavirus en Sanitarios) will test three preventive treatments in 62 hospitals from 13 regions involving 4,000 professionals (https://www.mscbs.gob.es/gabinete/notasPrensa.do?metodo=detalle&id=4853; https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/sanidad14/Paginas/2020/260820-ensayo.aspx).

On May 6, the Carlos III Health Institute (ISCIII), through the National Network of Epidemiological Surveillance (RENAVE), began the publication of epidemiological reports on the impact of COVID-19 in health workers in Spain. So far, 30,660 cases of COVID-19 have been reported among health professionals (https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Paginas/InformesCOVID-19.aspx).