The Andalusian Government of Juan Manuel Moreno, which is facing a judicial investigation into the hand-picked awarding of 243 million to private clinics with emergency contracts covered by a law repealed after the pandemic, resigned a few months ago to return to the open contracting system this year. and with advertising in the Andalusian Health Service (SAS). But in reality it has not maintained that criterion for the entire health field, and in mental health it has a public tender open right now to send patients to private clinics with which it contracts hand-in-hand and whose dealings are now being investigated by a court in Seville.
More specifically, it involves contracting hospital medical stays for mental health patients for adults, which is being arranged, and, for the first time, also for adolescents with severe chronic mental disorders, with a base tender budget of 15.3 million and a maximum estimated value of 42.9 million, including all possible annuities and extensions. It is an open procedure, to which any entity that meets the requirements can apply, although in practice only a few have the capacity to participate, as elDiario.es Andalucía has been reporting and which results in the large healthcare groups dividing up the tenders. of the Board while they also monopolize the hiring by hand.
Precisely one of these groups, the Hospital Order of San Juan de Dios, has had the contract for 70 adult beds for several years with the Andalusian administration in its healthcare center and has submitted an offer for one of the lots that are being tendered, the of adults, for an estimated value of 28 million euros for two years.
The contracting of care for adolescents between 12 and 18 years of age with serious mental disorders, for its part, is divided into two lots: one for referrals from the Mental Health Clinical Management Units linked to public health centers in the provinces of Huelva , Cádiz, Seville and Córdoba, with a capacity equivalent to 25 beds, and a second batch for the centers in the provinces of Almería, Granada, Jaén and Málaga with the same characteristics.
The Hospital Sisters of the Sacred Heart have presented themselves to take charge of the care of adolescents in eastern Andalusia while, according to the documentation accessed by this media, no offers have been submitted for one of the lots. Specifically, the Hospital Sisters have arranged 45 adult acute care beds for a couple of years for the Virgen de la Victoria Hospital. That is to say, the same private entities with which health care has been arranged, in this case mental health, are the same ones that are going to win million-dollar contracts with patients derived from public health.
A “change of strategy”
Returning to the contracting systems, it is worth remembering that last December the Board had opted for a framework agreement on mental health with several companies to arrange with private healthcare the referral of patients of this type as the “most suitable system” to deal with “care needs” and offer “agile response times.”
Thus, as this newspaper reported a couple of months earlier, it authorized the initiation of an administrative file in that regard with a maximum value of 35.2 million, including possible extensions. In parallel, and given that at the expiration of the contract a new one had not been formalized, a negotiated contract was signed with the aforementioned San Juan de Dios center in Malaga, which has been taking care of adults with serious mental disorders, since the SAS “lacks its own resources” for this type of care, according to the information contained in the administrative file.
The team that designed the framework agreements to alleviate the waiting lists for surgery and for diagnostic tests in the Andalusian health system was dismissed, along with the entire leadership of the SAS, between December 2023 and January 2024, and the Board put it in a drawer the plan to return to open contracting. At least in that sense because in June, seven months later and after the Board authorized extending one-year contracts with private clinics and doubling spending to 275 million, the update of the supporting report of the framework agreement for referrals mental health already indicated that he had “changed circumstances.” Now it was considered “more appropriate, due to its procedural agility, to process a service contract through an open procedure” for “complementary health care for SAS users.”
The subsequent resolution, also from June, finally authorized the restart of the administrative file after “the change in strategy”, as stated therein, to an open procedure to contract the aforementioned hospital medical stays for up to a maximum of five years, with a budget bidding base of 15.3 million and a maximum estimated value of 42.9 million, including all possible annuities and extensions.
Already in July, just a few days before the departure of Catalina García as director, the general auditor of the Board signed the inspection report in accordance with the hiring.
SAS sources point out regarding this issue that the negotiated procedure was discarded because before only one company offered that type of service and now, as there were more on the market, it had been decided to make it open “to improve attendance” and also because It was “more agile” than with a framework agreement. According to the latest documentation, there are two bidders as has already been said, and these days the opening of the envelopes by the Contracting Board is taking place.
Deficiencies in public mental health for children and adolescents
The deficiencies in public attention to the public mental health of minor adolescents in Andalusia, which led to cases such as that of that 13-year-old girl from Córdoba who had to seek care far from her home, at the General University Hospital of Ciudad Real, were forcing more and more adolescents to be referred to private healthcare also due to the increase in demand derived from the pandemic and other causes.
Now, the Government Council has authorized renewing the 73,000 stays for chronic adult mental health patients and having 36,500 for adolescent mental health patients. The contract will involve, as the Board summarizes, “the provision of health care services, complementary to that provided in its own centers, to users of the Andalusian Health Service”, that is, referrals to private health care with public funds. . It is the same language that has been used for this issue, for example in the tenders negotiated without advertising that it put out to tender last spring to alleviate waiting lists, as has already been said.
This is the permanence of patients over 18 years of age who require medium-long stay hospitalization to be treated for presenting one of the disorders included in the Integrated Care Process for Severe Mental Disorder; those with personality disorders not included in this Process with serious behavioral disorders, difficulties in coexistence and adaptation to their environment, family dysfunction and poor therapeutic connection, who are referred from public structures authorized to provide health care; as well as those patients who need an Individualized Treatment Plan.
“A temporary solution or the model to follow?”
“For a long time there have not been enough beds in the public health system of Andalusia for child and adolescent mental health,” comments the head of the analysis and studies office of the Federation of Health and Social and Health Sectors of CCOO of Andalusia, Daniel Gutiérrez, regarding these tenders. . Almost two years ago, the president Moreno announced in Parliament that all Andalusian provinces would already have short-stay child and adolescent mental health hospitalization units by 2023, which will be completed with these contracts that now “patch” health care through private centers for long stays, says Gutiérrez.
At the public level there were two units, in Jaén and Almería, and one has been added at the Virgen de las Nieves (in the former eating disorder unit), another at the Muñoz Cariñanos in Seville (with “half of the beds working), another in the Campo de Gibraltar (“they are staffing”) and in the Regional of Málaga, which “is pending”, according to Gutiérrez. The Board reported on the status of the matter in a recent information on the matter.
“Do the new hires respond to a temporary solution or is it the model to follow?” Gutiérrez asks. “The solution is for public health to assume it,” he adds, appealing to the presence of the Andalusian Public Foundation for the Social Integration of People with Mental Illness (Faisem).
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