State of implementation

Patient Safety strategy:

Strategic Framework for Primary and Community Care

In the context of the Strategic Framework of Primary and Community Care on October 1, 2021, a joint declaration was signed by the Ministry of Health and the Autonomous Communities with the main objective of approving an Action Plan before the end of 2021. This plan should reflect the broad consensus and convergence of initiatives that had been launched by the Autonomous Communities as well as new ones that emerged in the process of elaboration. For the elaboration of the Action Plan, a Technical Committee was formed, consisting of the Scientific Societies involved in the matter as well as Societies and Associations of Patients and Users. In particular, the Federation of Associations for the Defense of Public Health, the Spanish Patients Forum, the Platform of Patient Organizations and the State Confederation of Neighborhood Associations have participated.

The forms of participation have consisted on the one hand in the collection of proposals for actions and prioritization of actions through a questionnaire sent on October 13, 2021.

The prioritization part of the actions contained two types of questions:

• Questions about the degree of agreement or disagreement with Likert scale with scores from 0 to 5 (being 0 totally in disagreement and 5 totally in agreement.
• Ask for a free text in which an alternative wording proposal is requested limited to a maximum of 40 words, in case it is strictly necessary. They have also participated in the meetings with the Technical Committee held until the fecha.La first meeting took place on 04/011/2021 where they worked on the proposal of the Action Plan and the responses to the questionnaire sent previamente.La second meeting took place on 07/03/2022. It included as an item on the agenda the invitation to participate in working groups necessary for the development of the Action Plan.

On the other hand, in the context of the project “Adaptation of Primary Care to the current needs of the Spanish population” there is also the participation of Patient Associations in the workshops. They also participate in the proposed recommendations in the project development process. The final project conference on 19 April was attended by the main patient associations involved in the project.

Finally, in the context of the elaboration of a Case Study on the situation of Spanish Primary Care developed by the European Center for Primary Care of the European region of the WHO in collaboration with the University of Amsterdam, the main patient associations participating in the Strategic Framework of Primary Care participated in a specific focus group on citizenship and patients.

On 22 October 2023, the European Centre for Primary Care of the WHO celebrated the International Conferencel 45th anniversary of the Declaration of Alma-Ata and 5th anniversary of the Declaration of Astana. This event was preceded by a series of online debates whose conclusions were presented at the conference. All of them were streamed and had the possibility to participate in live discussion forums. Dissemination was made among the main patient associations for their participation.

Primary and Community Care Plan

Mental Health Strategy

The Mental Health Strategy was approved by the Interterritorial Council of the National Health System on December 2, 2021. In this context, the collaboration of patient associations in its design has been counted on:

• Association “After Suicide – Survivors Association” (DSAS)
• Red AIPIS- FAeDS (Association of Research, Prevention and Intervention of Suicide and Relatives and Relatives in Grief by Suicide)
• Confederation of Mental Health Spain. He has been part of the Advisory Committee for the development of the Mental Health Strategy of the SNS 2022-2026 and the Mental Health Action Plan 22-24.

To operationalize this collaboration, they have been invited to join the Technical Committee. Once they are part of this committee, they participate in all the necessary actions for the development, implementation and subsequent evaluation of the strategy. Such participation includes attendance at meetings, filling out questionnaires, and any other activity that is organized during the strategy’s lifecycle.

Specifically, on November 4, 2021, the Technical Committee was convened at a meeting prior to the approval of the Strategy.

Sometimes, it is also possible to invite them to participate in another type of activity such as holding conferences or presenting events in a timely manner and according to the situation demands it.

On November 28, 2022, a meeting was held with the Bipolar World Foundation to discuss, together with a representative of the WHO, the international online training on human rights. We want to explore next steps to continue contributing to the dissemination of online training so in line with several of the main values of the strategy and aligned with many of the objectives included in it. On March 7, 2023, a second meeting was held with the same person representing the WHO on the online training of Quality Rigths and with the Institutional Committee of the mental health strategy to promote the implementation of this training in our country.

Mental Health Plan 2022-2024

• On June 30, 2023, the General Subdirectorate of Quality of Care carried out the report on the fulfillment of objectives,
• The distribution of credit to autonomous communities within the framework of the mental health action plan 2022-2024, for the financial year 2023

LINE 024

Since its inception in May 2022, this benefit is maintained for all citizens, and all relevant actions are carried out for it (Subrogation, Contract…). The number of dedicated professionals is increased.

CHILD AND ADOLESCENT MENTAL HEALTH GROUP

Meetings to continue working in subgroups and to reach consensus documents. Two subgroups were created, one for screening tools and the other for training.

Joint Actions (JOINT ACTIONS) co-financed between the European Commission and the Member States in the 4th EU Health Programme (EU4Health):

• Joint Action ImpleMENTAL.
• Healthier Together’ EU NCD initiative – Mental health

SPANISH PRESIDENCY OF THE COUNCIL OF THE EUROPEAN UNION

Collaboration with the REPER in the preparation of the different tasks necessary for the Spanish Presidency, where mental health is considered a priority:

• Preparation and discussion of the CoEU conclusions on mental health with meetings in Brussels with the Council's Public Health Working Group on 11 September, 13 October and 23 October. Silence procedure from November 7 to 8 without receiving comments. Approved in Coreper on November 17. Approval of the conclusions at the EPSCO Council on 30 November.
• Holding of the High-Level Meeting on Mental Health “Mental Health Conference” in Asturias on November 14

https://www.sanidad.gob.es/en/organizacion/sns/planCalidadSNS/docs/saludmental/PLAN_ACCION_SALUD_MENTAL_2022-2024.pdf

Strategy in Cardiovascular Health

Meetings have been held with the Scientific Coordinators of the Strategy on the following dates:

• June 3, 2023
• June 13, 2023
• December 4, 2023

As well as with the ESCAV Institutional Committee on the following dates:

• 23 June 2023
• 18 December 2023

Elaboration of a Questionnaire with the 16 priority indicators indicated in the ESCAV to be completed by the CC. AA., to analyze the state of the situation in them. The SGCA made an exploitation of these data and later presentation at the meeting on December 18, 2023.

The Ministry of Health together with the collaboration of the Spanish Society of Quality of Care (SECA) is working on a call for the collection of GOOD PRACTICES IN THE FRAMEWORK OF THE ESCAV, through the autonomous communities, covering the following topics: Health Promotion and Disease Prevention, Diagnosis, Treatment and Rehabilitation. Each of these 4 topics may be aimed at all or some of the pathologies included in the Strategy: ischemic heart disease, heart failure, heart valve diseases and arrhythmias.

Monitoring of Joint Action EU4H-2022-JA-03: Direct grants to Member States’ authorities: prevention of NCDs – cardiovascular diseases and diabetes (AWP Ref: DP-g-22- 06.03) Spain leads one of the work packages, and co-leads in two other work packages.

Diabetes Strategy:

• Diabetes Strategy: On 1 February 2021, a meeting was held with the Spanish Diabetes Federation (FEDE), the President, the 2nd Vice-President, the Secretary and the Manager of the Federation, with the General Director of Public Health, with the Deputy Assistant Director of PPC and with the Coordinator of the Strategy. Topics such as the introduction of people with diabetes in COVID19 vaccination groups, the application of FEDE to be part of the Patients and Users Committee and accreditation diplomas are addressed. FEDE requested information on the normative development of Specialized Health Training.
• Meeting with the Spanish Diabetes Federation (FEDE), on February 8, 2021, the president, the secretary, and the manager meet with the Deputy Deputy Director and the Technical Coordinator of the Strategy. It addresses the role of FEDE in the Strategy, the proposal of a specific committee for the evaluation of new health technologies, and the diabetological education initiative in coordination with the network of schools. As a result of this meeting, the first draft of the document is sent for evaluation and contributions. Diabetic Foot Boarding (not yet public).
• In the year 2022 the document “Perspective of the paceintes in the current approach of Diabets Mellitus”, made in collaboration with FEDE, is published
• Joint Action Monitoring (“CARE 4 DIABETES”)

Cancer Strategy:

• Technical Committee on Cancer Strategy of the SNS: The following patient associations are members of this committee: Spanish Association Against Cancer (AECC), the Spanish Federation of Parents with Children with Cancer, and the Spanish Group of Cancer Patients (GEPAC). The Technical Committee has been actively involved in the preparation of the latest update of the Cancer Strategy of the SNS recently approved by the CISNS on February 24, 2021.[FGR1]
• Right to oncological oblivion: Spain has legislated the right to oncological oblivion through Royal Decree-Law 5/2023 of 28 June (establishes the right to oncological oblivion in the contracting of insurance and banking products for patients with oncological pathologies after 5 years from the end of treatment without relapse), in compliance with the Resolution of the European Parliament and the commitment made with associations and groups in defense of the rights of people with cancer. After its publication, the former Minister of Health transferred to patient groups and insurance companies that would put at their disposal a communication channel to answer questions and resolve possible doubts when applying the new regulations.
• Cancer Psychological Care Working Group: Meeting on 20/07/2023. The Spanish Association Against Cancer (AECC), the Spanish Federation of Parents with Children with Cancer and the Spanish Federation of Breast Cancer (FECMA) participate in this group. Within the framework of this group, work is being done on a document of recommendations for improving psychological care for cancer patients in the SNS, both for adults and for children and young people.
• High-level meeting “Challenges in cancer care”: on the occasion of the Spanish Presidency of the Council of the EU, this RAN took place on August 31 in Barcelona. The objective was to reflect and discuss with national and international experts, on the current challenges and opportunities in cancer care at European level.During the Conference, the progress made in health policies for cancer control, both at the level of the European Commission and the SNS, was updated. And through the format of round tables, the different speakers addressed the current challenges in relation to the multidisciplinary and quality approach of cancer patients in comprehensive care centers, as well as the inequities and inequalities in cancer within the EU, followed by a space where the audience can interact with experts enriching the debate and discussion. The Spanish Association Against Cancer and the Spanish Federation of Parents of Children with Cancer participated as speakers.

Quality in nuclear safety:

In the processing of the project of Royal Decree establishing the criteria of quality in nuclear medicine, public information has been processed, informing by email to:

• Platform of Patient Organizations.
• Alliance of Patients.
• Spanish Patients Forum

Reproductive Health Strategy:

The Strategy Monitoring and Evaluation Committee (scientific and professional societies, associations of women users and representatives of CCAA) has renewed and brought together Working Group on Indicators of the Strategy, to work on the updated battery of indicators that will serve to monitor and evaluate the implementation of this Strategy within the framework of the Sexual and Reproductive Health Strategy of the SNS (2011) as development of the Organic Law 2/2010 on sexual and reproductive health and voluntary interruption of pregnancy (Chapter IV, article 11 and Chapter II articles 7 and 8). In the first quarter of 2021, this “Group of Indicators” met by videoconference on 4 occasions, to update the situation analysis after 10 years of approval of the Strategy, and having the background of the Group of Indicators of the Strategy of Attention to Normal Childbirth (2007).

Also within the Committees of the Strategy, an expert group was formed that worked during 2022 in the elaboration and subsequent presentation for approval by those Committees, of the Common National Health System Guide on Voluntary Termination of Pregnancy (EVI). Pharmacological Method (IVE). Pharmacological Method, accessible in the web of the Ministry of Health. This Guide was presented at the Technical Conference on Voluntary Interruption of Pregnancy in the SNS, on 27 September 2022.

Strategy health actions prevention and early detection of gender violence:

Within the framework of the Commission against Gender Violence of the Interterritorial Council of the National Health System, work is being carried out on the elaboration of the SNS Common Protocol for Health Action in Response to Sexual Violence. For this, the Group of Protocols and Guidelines for Health Action The Commission, made up of experts, representatives of CCAA and various ministries (Equality, Justice) as well as civil associations of women are working on the drafting of the Protocol. This Working Group in the first four months of the year has met by videoconference on 5 occasions to establish the conceptual and dynamic framework of work to be followed for the drafting of the contents of this Protocol, which has begun to be drafted in May.

During 2022 and until June 2023, work has continued on the elaboration of the SNS Common Protocol for Health Action in the Face of Sexual Violence (PCASVS), waiting for it to be approved at the next Interterritorial Council of the National Health System. CISNS (scheduled for June 2023). Once approved, it will be available on the website of the Ministry of Health, in the space of the corresponding page where all content production is located (common protocols, Annual Reports, common training criteria, good practices, etc.). de la Commission against Violence of the CISNS.

Likewise, the Annual Report on actions against the VG in the SNS. 2022, it is expected to be approved in that CISNS scheduled for June 2023, and will also be put on the web as soon as it is approved.

Currently, they are already in the web of the Ministry of Health – in the content production area of the Commission against the VG of the CISNS; having been approved in 2023:

• El SNS Common Protocol for Health Action on Sexual Violence (PCASVS)
• El Annual report VG 2022.

On the other hand, in November of 2023 the Journey Early detection and prevention of gender violence in the SNS: common instruments and BBPP.

This Day, is considered the act of closure of the Courses continuous training designed and coordinated by the OSM to improve the Early Detection of VG and aimed at professionals of the SNS teams (3 students per CA) from: Primary Care, Mental Health and Pregnancy, Childbirth and Puerperium Care Teams. This training responds to the implementation of the Measure 5 del Catalogue of Urgent Measures of the Plan for Improvement and Modernization against Gender Violence.

In the Journey, presentations were made openly (via streaming) on: mental health and GV; health of older women and GV; reproductive health and GV; and sexual violence.

All of them are available in the web of the OSM:

Also, during 2023 they have taken two Web Seminars Specific to this area of work:

• Sexual Violence: Sanitary and medico-forensic BBPP (30 March 2023)

https://www.observatoriosaludmujeres.es/violencia-sexual-bbpp-sanitarias-y-medico-forenses/

• Violence against women Prevention and detection from health services (30 November 2023

https://www.observatoriosaludmujeres.es/la-violencia-contra-las-mujeres-prevencion-y-deteccion-desde-los-servicios-sanitarios/

Both were carried out via streaming and are available (in open) on the OSM website in the links indicated.

Sexual Health Strategy:

The Technical Committee is scheduled to meet (scientific and professional societies, experts, and civil associations) and the Institutional Committee (CCAA and Ministry) of this Strategy, at the end of May, to present the work of situation analysis and research carried out within the framework of the Operational Plan 2019-2020 of said Strategy and create the Training Working Group, integrated by participants of both Committees, to work on the common contents of continuing training for professionals of the National Health System, in the field of sexual health of people, within the framework of the Sexual and Reproductive Health Strategy of the SNS (2011) as development of the Organic Law 2/2010 on sexual and reproductive health and voluntary interruption of pregnancy (Chapter IV, article 11 and Chapter II articles 7 and 8).

In 2022, the document that collects the documents has been published on the Ministry’s website. Comprehensive Sexual Health Training Criteria for Primary Care Professionals in the National Health System. The Health Promotion Department is currently working in collaboration with the HIV Division of the Public Health DG on the development of an online course for NHS professionals based on these quality criteria for the continuous training of health personnel in this field.

Women's Health Observatory (OSM):

Work has been done in this first quarter of 2021, from the permanent technical team of the OSM, in the creation of a Expert Committee working for the preparation of Health and Gender Report 2021, whose content focuses thematically on the impact of the COVID-19 pandemic on the health of people, treated from a gender perspective. Experts from universities, civil associations, ISCIII, etc. participate in this committee. Once prepared, it will be presented to the plenary of the Observatory of Women's Health, as a collegiate body constituted according to Order PCI/462/2019, of 17 April, in which both administrations and women's associations participate.

In 2022 it has continued with the cycle of webinars on the impact of COVID-19 on health taking into account the gender perspective, and in 2023 this cycle is being continued with other seminars in relation to the gender perspective in health.

It was also presented in June of 2022 Health and Gender Report 2022 (available on the web also your summary) that addresses the approach from a multidisciplinary perspective to the impact of the COVID-19 pandemic taking into account the gender perspective. Also available on the web, are the content videos of the speakers’ tables of the Day of presentation of this Report.

In 2023, the cycle of webinars in relation to the gender perspective in health has been continued.

In addition to the two webinars already mentioned in the area of Strategy health actions prevention and early detection of gender violence, has been held in 2023, another webinar In relation to cardiovascular health: “EQUITY AND GENDER in cardiovascular health” (25 May 2023).

The latter, like the two previous ones, was carried out via streaming and is available (in open) on the OSM website: https://www.observatoriosaludmujeres.es/equidad-y-genero-en-salud-cardiovascular/

On the days 20-21 September 2023 the “INTERNATIONAL MEETING HEALTH AND GENDER”, where leading health professionals and experts met with the objective

to address Route and the challenges ahead in the Gender equity in healthat both national and international level (with the participation of professionals from the different CCAAs actively involved in the inclusion of the gender perspective in the SNS Strategies, regional health plans and local health programmes, as experts belonging to international bodies such as the European Office of the WHO or the EIGE (European Institute for Gender Equality, as an EU institution). Reference available in the web

Different presentations were held in person and via streaming regarding the reason for the Meeting; all of them will soon be available (open) on the WSO website: https://www.observatoriosaludmujeres.es/encuentro-internacional-salud-y-genero-2023/

Likewise, within the framework of this International Meeting, the OSM supported the Student Residence of Madrid (Calle Pinar, 21-23) along with the collaboration of the CIMA Association to celebrate in the afternoon of September 21, 2023, the cultural event TOP IN SHORT. SHORT DISTANCES GENDER AND HEALTH, where a series of short films about Health and gender equity. All the screenings were followed by a colloquium and in open format for citizenship along with the presence of some and some professionals and experts present at the International Meeting who also attended n.El event was held in the main hall of the Student Residence of Madrid. http://cedros.edaddeplata.org/docactos/7606/Calendario_-_Invitacion/Calendario_-_Invitacion07606001.pdf

Rare Disease Strategy

In order to analyze the degree of compliance with the objectives set out in the Strategy, work is being done on the elaboration of a Evaluation Report of the Strategy on Rare Diseases of the SNS. This Infome provides an analysis of the situation in Spain with regard to the degree of compliance with the different actions included in the Strategy of EE.RR of the SNS. Generally speaking, the time frame covered by the report covers the period 2014-2023.

During the work of this Report we have maintained contact through email with the actors linked to the Strategy, that is, Scientific Coordinators, different areas of the Ministry of Health, Institutional Committee and Technical Committee that brings together scientific societies and patient associations.

The expenditure budget of the Ministry of Health for the financial year 2023 provides appropriations in budget application 26.07.313 B.454 “transfers to the Autonomous Communities (CAAC) for strategies against rare diseases and neurodegenerative diseases (including ALS)”

Strategy for Neurodegenerative Diseases

Finalization and approval of the Evaluation Report of the Strategy in Neurodegenerative Diseases by the Institutional Committee and Technical Committee on May 9, 2023. Approval in the CISNS of December 21, 2023.

• Join Action work programme 2023: EU4H-2023-JA-05: " Healthier Together " -Dementia and other neurological disorders (DP-g-23-33-01).
• Publication “ELA Resource Map”https://www.sanidad.gob.es/areas/calidadAsistencial/estrategias/enfermedadesNeurodegenerativas/docs/Mapa_recursos_sanitarios_ela_(27-12-2023).pdf
• The expenditure budget of the Ministry of Health for the financial year 2023 provides appropriations in budget application 26.07.313 B.454 “transfers to the Autonomous Communities (CAAC) for strategies against rare diseases and neurodegenerative diseases (including ALS)”
• Revision of the Protocol of care process "Mild cognitive impairment and dementia: care circuit, early detection instruments and recommended measures" in preparation by the Aragonese Institute of Health Sciences.
• First meeting on December 12, 2023 of the Working Group for the Elaboration of an MS Approach Document. A representative of the patients participates.

Strategy for addressing chronicity in the SNS

The evaluation of the Strategy for the Approach to Chronicity in the SNS, which was approved by the Interterritorial Council of the SNS in June 2012.

The evaluation of the strategy was based on the updating and selection of indicators agreed by the Technical and Institutional Committee of the same. The Patient Organizations Platform, the Spanish Patients Forum and the General Patients Alliance are part of the Technical Committee.

From this evaluation, the following 6 lines were prioritized: Health promotion, Prevention of health conditions and limitations in chronic activity, Continuity of care, Reorientation of health care, Health equity and equal treatment, and Research and innovation.

Regarding the priority line of “Participation and empowerment of patients in their care process”, the Continuity and strengthening of the Network of Health Schools for Citizens is promoted.

The Institutional Committee of the Network of Schools includes the Patient Organizations Platform, the Spanish Patients Forum, the General Patients Alliance, rural women’s associations and the Spanish Federation of Municipalities and Provinces, the representatives of all the Schools and Patient Programs of the CCAA regional, the Assistant Director of Quality of Care and the Director of Public Health.

This Committee met in February 2023 in person at the Ministry of Health with the aim of sharing the actions carried out in the different Schools and Patient Programs of the Autonomous Communities.

The General Directorate has attended different events organized by, for example, the Platform of Patient Organizations (POP) in the field of chronicity such as:

• September 2022, the Director General of Public Health attended the VI Congress of the Platform of Patient Organizations at a table on "Health policies and impact on chronicity"
• March 2023, the General Director of Public Health attended the “POP Breakfasts”, a project that promotes this Association with the objective of addressing issues of interest to people with chronic diseases, where it was discussed on “New public health challenges in the management of chronicity”

Within the framework of the strategy to address chronicity, the Director General of Public Health and the technical coordination of the strategy with the National Federation of Associations for the Fight against Kidney Diseases (ALCER) met in June 2023 to learn about the needs that they consider priority to address with respect to kidney disease.

On International Patient Safety Day, on September 15, the conference on “Patients and their families for patient safety” was held, to which members of the Network of Health Schools were invited.

Since the Chronicity Strategy, the VII National Day of Infant Pain has been organized on November 3, 2023 in the Ernest Lluch Assembly Hall, which has also been invited to attend the committees of both the strategy of tackling chronicity and the Network of Health Schools for citizens.

Strategy in Palliative Care

In the third quarter of 2023, on October 17, the Palliative Care Strategy Day was held at the Ministry of Health. Specifically on this day there was a space dedicated to a table of citizen participation constituted by the following patient associations that are part of the Technical Committee of the Strategy in Palliative Care:

• Spanish Patients Forum (FEP)
• Patient Organization Platform (POP)
• Spanish Federation of Parents of Children with Cancer (FEPNC)
• Spanish Association Against Cancer (AECC)

All of them were able to present their point of view on the situation of palliative care in Spain at the present time, showing their perspective on those aspects on which it is necessary to continue working to continue offering quality care to patients and their families.

Patient Safety Strategy

On the occasion of the PATIENT SAFETY WORLD on September 17, the Ministero of Health, within the framework of the Patient Safety Strategy, joined the WHO and shared the same motto “THE PATIENT’S INVOLVEMENT FOR HIS SAFETY”, celebrating a scientific day in the Ernest Lluch hall of the Paseo del Prado headquarters. ( https://seguridaddelpaciente.sanidad.gob.es/informacion/eventos/jornadas/2023/DiaMundialSeguridadPaciente2023.htm).A Patients' Table was held at which, under the moderation of journalist Antonio Manfredi, representatives of the Patients' Forum, the Paceintes Platform and the association of Crohn's and Ulcerative Colitis, had a voice to express their concerns and experiences about their safety during health care. A lecture by Susan Sheridan, leader of the United States movement (Patients for Patient Safety), was given as an example of learning.

Strategy in Ictus of the SNS

The patient associations that are part of the Technical Committee of the Stroke Strategy of the SNS (Spanish Federation of Brain Damage, Spanish Federation of Stroke, Spanish Patients Forum and Platform of Patient Organizations), participated in the review of the Evaluation of the Strategy Published in 2022.

Currently, taking into account the advances in knowledge on the management of the stroke, the European Action Plan for the Stroke 2018-2030 and the priority lines of work identified in the Evaluation, the updating of the Strategy is being carried out. To this end, several subcommittees have been created, consisting of the members of the Technical and Institutional Committees of the Strategy. Patient participation has been considered essential from the outset, so that representatives of patient associations have been included in the subcommittees of the strategic lines of Promotion and Primary Prevention, Secondary Prevention, Neurorehabilitation and Life after Stroke, and Research and Training. These representatives have attended the working meetings and have collaborated in the revisions of the corresponding chapters of the update. In 2023, the Curb the Stroke Foundation was incorporated into the four patient associations that were already participating in the Committees.

Recently, on October 27, 2023, a working day of the Stroke Strategy of the SNS was held at the Ministry of Health in which patient associations participated together with related scientific societies, stroke experts and representatives of the CC. AA.