Speech by the President of the Government at the event marking the 40th anniversary of the General Health Act

SPEECH BY THE PRESIDENT OF THE GOVERNMENT OF SPAIN, PEDRO SÁNCHEZ

Thank you very much Marta. It's always a pleasure to hear from you and to share this event with you. Francina, president; dear ministers; dear Monica; representatives of the health staff, authorities; ladies and gentlemen. It is a pleasure for me to be able to speak after this great friend from Spain - who is also a personal friend of mine - because we both faced many challenges during the pandemic, as did the Director-General of the WHO, my friend Tedros.

As the Minister for Treasury, Arcadi España, reminded me earlier, Ernest Lluch used to say that health has a cost, but it has no price. I think this is something we can all relate to, given the stories we have heard this morning. And that is what I want to talk to you about: what happens after the question we have discussed here and that many people ask, about the illnesses we or our loved ones suffer from, and how to respond to them.

I believe that Spain had the answer 40 years ago. The proposal was very clear, very straightforward and very inclusive, and it was to put forward a universal, free public health system. Forty years ago, therefore, all that changed. On 25 April 1986. And it changed because there were people who refused to accept the reality we had previously faced, and because there was also a minister, Ernest Lluch, who had a clear conviction: that progress, if it is not shared, cannot be called progress. We can call it something else, but not progress. And so, the fact that we failed to establish that public healthcare system was a collective failure.

I would also like to remind you that Lluch was an economist. At times, it seems as if the economy is at odds with the development of the welfare state and the consolidation of such key pillars of the welfare state as the National Health System. But the opposite is true. And I would also like to emphasise this point, because Lluch was, as I said, an economist, and as such he knew something that many people forget, which is that universal health care does not ruin a country, it strengthens it. He knew that health is not an expense, it is an investment in people. Also in social cohesion, in territorial cohesion and in what economists call productivity. He defended this with data, with arguments, with reasons and with that serene conviction he always showed of someone who knows he is on the right side of history.

And so was born what we are commemorating today, the General Health Act. With this, I believe Spain has made a very clear commitment to something which, when put into words, may sound simple, but which took a great deal of effort and decades to achieve: that health should be a right and not a privilege. That it should be universal, that it should be equitable, as has also been discussed here, and that it should promote territorial cohesion. That Spain, therefore, should make a definitive commitment to what we have called dignity. The dignity of the people, the dignity of the counties, the dignity of the territories, the dignity of a whole country. Forty years on, I want us to fully appreciate what we have built, because since 1986 we have gained eight years of life expectancy, eight years of life expectancy in these 40 years, eight more years to spend with the people we love, eight more years to see our sons and daughters grow up, to hold our grandchildren, to do what we did not have time to do before. And so I believe there is no statistic that sums it up better.

We have been world leaders in organ donation and transplantation for more than 30 years, as the minister said earlier. This also speaks to the solidarity of our country. It also speaks of our healthcare system, a system we have, incidentally, strengthened since the first day we came to government. As has been said here, we have strengthened the system in an area that came to the fore during the pandemic: primary care, by expanding the range of diagnosed procedures; we have restored the right of all women to assisted reproduction; we have expanded neonatal screening programmes, as Monica said earlier; we have launched the Plan Veo - as we saw in the video - an aid scheme consisting of 100 euros to finance glasses and contact lenses for children and adolescents; we have allocated no less than 180 million euros to oral health, and approved, of course, the ALS law.

We have also made a commitment to personalised medicine through this initiative - I'm not at all keen on the acronym PERTE, which stands for the strategic project linked to the Next funds for cutting-edge healthcare - investing almost 268 million euros over the last five years. We are leaders in clinical trials in Europe - we are well aware of that - and we have taken these trials to hospitals all over the country; but, above all, I would like to focus on the drive for innovation in the fight against cancer that we have been pursuing in recent years, because it is one of the great battles of our time. The data, moreover, are there. Before the end of today, more than 700 people will be diagnosed with cancer in our country, and 316 people will die of this disease; that's 9,500 people a month, 115,000 a year. These are the figures and, as we have already reminded you, behind the figures there are people. In the face of this, it is not enough to just hold out; we have to move forward. But what does move forward actually mean? Moving forward means the public health sector and the scientific community working together as never before, because cancer is the arena where everything is put to the test, where research becomes treatment and, therefore, where innovation becomes life.

I recall that we also launched - without having the authority to do so, but with a clear commitment - what we called the INVEAT Plan for investment in new technology and new machinery for the National Health Service, under which we allocated no less than 800 million euros to replace much of the high-tech medical equipment currently in use, including, and particularly, in the fight against cancer.

We are developing advanced therapies such as CAR-T, which have already saved lives, but I am pleased to announce that we are going to go one step further by investing an additional 30 million euros in digital equipment for pathological anatomy - in other words, in modernising the equipment that analyses cancer samples in hospitals.

What is this for? (For those of us who are obviously not specialists, like many of the professionals who are here with us today). Above all, it is to improve how the disease is diagnosed, and how the best treatment is decided for each patient.

Ultimately, each investment will achieve three key things that I would like to share with all of you. First, doctors should be able to combine information about the tumour with the patient's genetic data. And what will this allow? Well, it will allow for the fine-tuning of the diagnosis and the most appropriate cancer treatment for each individual to be decided. The second thing this will achieve is that knowledge will no longer depend on where you live, because specialists will be able to share that information and their expertise between hospitals, so that any patient, wherever they are, has access to the best possible care. And last, let us continue to transform the way we practice cancer medicine, thereby moving from an isolated system to a much more connected network, where all this information and expertise can be shared, and where cases, and particularly complex cases, are analysed collaboratively, follow-up is ongoing, and the most advanced science is placed at the direct service of those who truly matter: the patients, the people.

In short, it is about investing in technology to get there sooner, to get it right, and to provide better treatment. The fact is that when we invest in and fund public health care, from the smallest health centre to the largest hospital, we can say loud and clear that our lives depend on it.

And here, I would also like to offer some thoughts, because I think it is important that we recognise the value of the Interterritorial Council. Of course, it is important that we talk about territorial loyalty or institutional loyalty, but we also need to not mince our words. And I believe we need to focus on certain autonomous communities, governed by certain political forces, because since 2018 the Government of Spain has increased spending on health by 30%, and has transferred to the autonomous communities - Elena Salgado, who was also Minister for Treasury during a very difficult period - has transferred 30 billion euros to the autonomous communities over the last eight years. Thirty billion euros more than the previous administration did, to be spent on strengthening the welfare state - which, naturally, falls within the remit of the regional governments, particularly in the area of healthcare.

And so, given that healthcare is one of the main concerns cited by the public whenever they are asked, the question we must ask is: where have those additional resources we transferred to the autonomous communities gone? How is it possible that despite having transferred 300 billion euros more than the previous administration, the state of the healthcare system and the quality of care it provides are now among our fellow citizens' main concerns?

I believe the public deserves an answer, because the National Health Service is one of our country's greatest collective achievements and, therefore, what we cannot do is put it at risk through misguided decisions, ideological dogmatism or a failure to set the right priorities.

And we must do this if not for humanitarian reasons, then at least for the sake of efficiency - returning to that aspect, that perspective of the great socialist politician Ernest Lluch, as an economist. Health is not an individual struggle; it is a collective battle against disease. I remember, for example, when the principle of universal public healthcare was undermined - now that some are once again highlighting or reviving the issue of the breakdown of the National Health Service's universality depending on one's status as a migrant - that many people spoke out, many professionals argued that it was a matter of public health that all migrants should be able to receive care in health centres, in our hospitals.

So it is not just an individual fight, it is a collective fight against disease. Protecting the system is an act of justice, and also an act of wisdom, which I believe is what Ernest Lluch also demonstrated. It is an act of solidarity, of cohesion, of humanity, but also of wisdom. And to illustrate the point, let us look at other parts of the world - and I am not talking about countries with a lower income level than Spain, but even those with a higher GDP.

In 2018, one of the first decisions we took - and of which I am very proud - was to restore the universal nature of healthcare, which had been eroded by previous administrations. And that is why in 2021 we were able to provide care for thousands of Ukrainians who came to our country as a result of Putin's war in Ukraine. And that is why, as recently as 10 March, it guarantees access to public healthcare for everyone, including foreign nationals living in our country who do not yet have resident status. Because it all boils down to the same question and it is not one that is being asked by any of these governments. It is not where the patient was born; it is not how much money they have in their account, or how many years they have paid social security contributions. No, it is not that either. The question that defines our healthcare system - and which we must protect because it is under threat - is what kind of country do we want to be, what kind of country do we want to be?

Today, 40 years after the General Health Act, I believe we have the answer, and we have heard it here as well. And, of course, we are full of enthusiasm - surely we should be keen to preserve, and indeed consolidate and strengthen, one of the key achievements of our democracy, precisely now that we are reclaiming that path towards democracy, namely the welfare state and, in particular, the National Health Service? I think there is huge enthusiasm. Nostalgia, of course, is something to cherish, but when it comes to looking to the future, there's certainly a sense of excitement. And, at 54 years of age, I have all the enthusiasm in the world to strengthen, expand and defend public health. Not everything in the past was better; on the contrary, the future can be much better, and that is why we need to organise events like this one, full of hope and a sense of purpose.

We are a country where when you wake up with a fever at three in the morning there is someone to take care of you; where a family that does not have to choose between the father's medical treatment and the child's school fees, and can get by; where getting sick is not the beginning of financial ruin, as it is in other advanced societies. And, if not, let's look at the United States, where they spend more on healthcare - which is privately run - in relation to GDP than we do, guaranteeing a right and not turning healthcare into a commodity and a business.

That, and I will finish here, did not just fall from the sky. It was built by people who believed it could be different. Today, of course, the person mentioned most has been Ernest Lluch, because of his history, for the example he set with his life, his commitment, his wisdom: but, without doubt, we have also seen here many people who have played a part not only in the genesis but also in the development and strengthening of this right. What's next for us? Well, it is up to us to look after it, defend it and improve it, not out of habit, but out of conviction and, without a doubt, with great enthusiasm. Because healthcare, if it is to be anything, is a right, not a privilege, and certainly not a commodity. Because the state of our public health service - and I believe this is particularly true now that we are discussing it so much - is also a barometer, one of the best barometers, of a country's democratic health. And this is where we must underline that by investing in public health, investing in healthcare and in all the policies linked to the welfare state, we are building democracy; and I believe there is no greater commitment than that. For us, for our generation, but undoubtedly also for future generations - I don't remember who said this before, I'm not sure if it was Rosa or Elena or the minister herself - so that in 40 years' time, when we are also commemorating this vital piece of legislation that made our country a better one, people will say "the generations that were here 40 years ago did what they should have done, which was defend our rights".

That is all; thank you very much and congratulations.

(Transcript edited by the State Secretariat for Communication)