Alfonso Gámez Poveda, at the entrance to the Costa del Sol Hospital. :: JOSELE-LANZA
The Costa Hospital
Budget. 160 million for the Costa del Sol Hospital.
Staff. There are 1,900 employees and another 500 workers from other companies.
Length of stay. 5.1 days, slightly less than in 2012 (5.4 days) and well below the SAS hospitals in 2012: 6.95 days.
Foreign patients. 37% of births, 25% of admittances and emergencies and 18% of consultations. At the HAR in Benalmádena, 19% of emergencies, 22% of admittances and 17% of the consultations.
The sight of the cranes and the fencing give little hope that things will change any time soon or that people visiting the hospital will be able to park there free of charge. For the hospital, the idea of raising the money for more beds and better services by offering a private concession for the car park and a shopping area has proven indigestible. Now it needs to admit the problem to intensive care. Getting the works started again is the priority for this expert in health service management who commands the largest budget in Andalucía as the manager of the health agencies (administrative areas) on the Costa del Sol and the Alto Guadalquivir area.
–You manage two health care agencies. Together, do they form the biggest public company in Andalucía? What is your budget?
–Yes, it could be the biggest structure within this legal format. Between the two agencies, the budget is about 290 million euros. The Costa del Sol hospital, which includes the centres in Mijas and Benalmádena, has a budget of about 160 million.
–And there have been cutbacks, I suppose?
–Of course. We have applied the latest general measures, like every other sector, and these have had an impact.
–The works to enlarge the hospital have been suspended since 2008 and this is not only a problem with regard to the future but must also affect the day-to-day services, surely?
–This has been a priority ever since I came here. Obviously, we talk to the concessionary, the hospital and the Town Hall and my position, faced with a problem which is caught up in the judicial system, has been that we must do everything we can to reach an agreement as soon as possible.
–Will that happen soon?
–I believe it will. Each side has been putting its point of view and the discussions should be completed before long. Our priority is to improve the services we provide.
–And also to explain to a patient why they have to go to Malaga for radiotherapy.
–Yes, that too. At the moment we are providing all the services we should, but it is true that new measures have to be introduced to shorten the waiting lists.
–When do you think the hospital will benefit from the 33 per cent more capacity it will gain as a result of the extension?
–We are in the final stages of negotiation now; the works will have to resume as quickly as possible. At the moment the project is 54 per cent completed and it will take another year and a half to two years.
–From the way it appears, linking the extension to a hospital to the concession for a car park and a commercial area for 40 years is an example of how not to do certain things in the field of health care.
–Well, it is easy to criticise with hindsight but when the idea was put into effect it seemed to be a viable project and the car park was expected to be successful. With time, that has proven not to be the case.
–When the Town Hall sends the Local Police, and they tell people “this is a public area and you can’t park here”...
–When the viability plan was drawn up, it was possible to use all that space. The concession holder has not requested that the sentence in its favour be carried out, because they are keen to reach an agreement and leave all this litigation behind.
–Outside, there is a big sign, discoloured by the sun now, referring to the extension costing 48 million euros. That was in 2008. Will the plans have to be changed now?
–Yes, and as soon as we came here we analysed the whole project that was planned four or five years ago. And we see that it would be possible to make adjustments so that the extension would meet present needs.
–Using what criteria?
We want to incorporate the new concept of ‘high resolution’, above all in the surgical and hospitalisation departments. This will provide greater flexibility, it will mean that people can undergo surgery without having to be admitted because there will be a recovery unit and a short-stay surgical block. This will give us a hospital which is more multifunctional, with nursing care which is provided by multi-skilled staff. With this plan, we will be able to reorganise the hospital, carry out more complex operations and meet the demands of those needing longer stays in hospital.
–What about the 160 new beds that were planned?
–We are changing the plans for those beds. In the future there will be 40 ‘boxes’ for two patients, which will give us more space. With the 375 beds we have now, we are never 100 per cent full; we have never been overcrowded. Even now, in July, we have 80 beds free.
–Some people would ask why the extension is necessary, in that case.
–The number of beds available does not always reflect the volume of activity and the complexity of cases. If we compare this hospital to another, we have to look at a number of things. We have the shortest stay in the health system. The average is 5.02 days. Our way of working makes this possible, with consensus, good planning and full guarantees. The concept of early release, premature release, was abandoned some time ago. Optimising the stay is also a type of guarantee for the patient because the greater the health problems, the longer the stay.
–How long are waiting lists?
–Less than 60 days for initial visits to all departments, 30 days for diagnostics, and 180 days for surgery, or 120 for priority cases. In Mijas and Benalmádena we carry out strict controls, but there can always be occasional delays, like now for example, with the holidays.
–How have staffing levels changed at the hospital?
–We opened with about 200 and now there are nearly 1,900.
-This is the biggest work centre on the Costa, after the airport.
–Yes, but that’s counting the agency staff. There are also about 500 indirect workers, in the laundry, cafeteria, security, maintenance...
–Do you use medical services from outside?
–No. We provide those services ourselves, other than the occasional test or treatment such as dialysis, so people don’t have to travel elsewhere.
–In Malaga, the Malaga Health Foundation has been set up, and also a business cluster, Malaga Tourism&Health, to attract health tourism. Are these projects based on real possibilities?
–From what I know, they can be a way of opening up collaboration between health providers.
–Not directly, no, but there are initiatives that can be considered. It is a question of analysing properly. Why should the public sector be closed off to initiatives which are being carried out in the private sector, if it wouldn’t mean fewer services for our patients? We can come to an agreement with another country and offer medical attention under the terms of the usual public service prices. We can’t say, like a private centre can, this costs 1,500 euros but I’ll give you a special price. What I can do is collaborate with the UK, for example, to handle certain pathologies for them. Why not? We need to keep looking at questions of this type because the situation also pushes us towards it.