Salvador Illa at Esade: “Managing a pandemic does not allow for partial solutions. It requires us all to get organised and pull together”

“The coronavirus pandemic revealed the importance of public matters because managing it does not allow for partial solutions. To ensure an effective response we must all get organised and pull together”, said Salvador Illa, PSC leader and Spain’s Health minister (2020-2021), during the talk “Managing the pandemic: lessons from a challenging year” held by the Esade Centre for Public Governance (EsadeGov). During his conversation with Nekane Murga, the Basque Country Health minister (2019-2020), they spoke about the lessons learnt from the experience of managing the pandemic and some of the key organisational factors arising from the challenge they faced. One of the lessons emphasised by Illa was “the importance of vocational professions, loyalty and humility”, whilst Murga underlined that “it is essential for us to support and care for professionals if we want to make our public health system stronger”.

Governance and collaboration

“The pandemic put all governance systems to the test”, said Salvador Illa. He believes that Spain’s response has been “reasonably good” and that “firstly, it called for the implementation of a mechanism to centralise competencies and then, as we began to learn more about coronavirus, to return to a system of co-governance”. He emphasised the part played by the Interterritorial Council of the Spanish National Health System and the “great competence of and cooperation between all the colleagues in the different autonomous regions”. Nekane Murga was also positive about the “cooperation with public health teams in other autonomous regions and the central government”: “We put forward proposals and took joint decisions, and we felt we had support because of the problems we shared”, although “we also had to take local decisions because of the different circumstances in each region”.

As regards public-private co-operation in managing the pandemic, Salvador Illa pointed out the “admirable behaviour of the private sector which, like all the State resources and private healthcare entities, made themselves available to public-sector services”. He was also grateful to industry for “behaving so responsibly, both pharmaceutical companies and the manufacturers of products such as face masks, ventilators and PPE.” Murga explained that “private entities adapted to become a seamless part of the public health service under one governance, making it possible to respond to the numbers of patients.”

Management in times of uncertainty

One of the dilemmas inherent in managing the pandemic concerns the impact of restrictions upon health and the economy. According to Illa, “the main aim was to save lives, although we must remember that the economy is the most decisive health factor. In terms of health, there was no doubt that we had to tackle the pandemic, although we always applied criteria of great caution to our decision-taking. Likewise, Nekane Murga mentioned that on many occasions “the fallout of certain measures to stop the pandemic was unknown, so before implementing a measure with a considerable economic impact, we would carefully weigh up how effective it would be from a health point of view.”

Challenges and opportunities for public health services

Illa believes that “this crisis has increased the appreciation of Spain’s universal healthcare, and it must be improved by providing more human resources and the right technology.” As Murga said, “everyone knows that the health system has managed to provide a first-rate response despite intense internal pressure” and also, “networking between and particularly within the autonomous regions has increased, and now work is conducted in a more corporate manner”. As regards primary health centres, “the necessity of incorporating them into social services has been demonstrated; this will all strengthen the system, it will be made ready for future crises”, she added.

This talk was moderated by Francisco Longo, professor in EsadeGov, with the participation of Koldo Echebarria, director general of Esade.