The Andalusian government of Juan Manuel Moreno, which faces a judicial investigation into the handpicked allocation of 243 million to private clinics with emergency contracts covered by a law repealed after the pandemic, resigned ago a few months to return to the open contract system. this year and with advertising in the Andalusian Health Service (SAS). But in reality he has not maintained this criterion for the entire health field and, in the field of mental health, he has launched a public call for tenders to send patients to private clinics with which he made contracts hand in hand and whose relationships are currently under investigation by a court in Seville.
More specifically, it involves contracting hospital stays for mental health patients for adults, which is in progress, and, for the first time, also for adolescents suffering from serious chronic mental disorders, with a basic budget of call for tenders of 15.3 million and an estimated maximum value of 42.9 million, including all possible annuities and extensions. This is an open procedure, to which any entity that meets the required conditions can apply, although in practice only a few have the capacity to participate, as reported by elDiario.es Andalucía, and which results in large healthcare groups sharing out calls for tenders. of the board of directors while they also monopolize recruitment by hand.
One of these groups, the Hospitaller Order of San Juan de Dios, has for several years signed a contract for 70 beds for adults with the Andalusian administration in its health center and has submitted an offer for one of the lots in the running, the adults, for an estimated value of 28 million euros for two years.
The care contract for adolescents between 12 and 18 years old suffering from serious mental disorders, for its part, is divided into two lots: one for references from mental health clinical management units linked to public health centers in the provinces of Huelva, Cadiz. , 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 Hospitaller Sisters of the Sacred Heart came forward to take over the care of adolescents from eastern Andalusia although, according to the documentation consulted by this media, no offer was submitted for one batches. Concretely, the Sisters of the Hospital set up 45 acute care beds for adults for several years for the Virgen de la Victoria hospital. In other words, the same private entities with which health care was organized, in this case mental health, are the same ones who will win million-dollar contracts with patients from public health.
A “change of strategy”
Returning to contractual systems, it should be remembered that last December the Commission opted for a framework agreement on mental health with several companies to organize with private healthcare the referral of patients of this type as the ” most appropriate system” to treat “. care needs” and offer “agile response times”.
Thus, as this newspaper reported a few months earlier, he authorized the opening of an administrative file on this subject with a maximum value of 35.2 million, including possible extensions. At the same time, and given that when the contract expired no new contract had been formalized, a negotiated contract was signed with the aforementioned San Juan de Dios center in Malaga, which cares for adults suffering serious mental disorders since the SAS “lacks its own means” for this type of care, according to the information contained in the administrative file.
The team that designed the framework agreements to reduce waiting lists for surgery and diagnostic tests in the Andalusian health system was made redundant, along with the entire management of the SAS, between December 2023 and January 2024, and the Council put it in a drawer. the project to return to open contracts. At least in this sense, because in June, seven months later and after the Council authorized the extension of one-year contracts with private clinics and the doubling of expenditure to 275 million, the update of the supporting report of the framework agreement for mental health referrals already stated that he had “changed circumstances”. It is now considered “more appropriate, due to procedural agility, to process a service contract through an open procedure” for “additional healthcare for SAS users”.
The subsequent resolution, also from June, finally authorized the resumption of the administrative file after “the change of strategy”, as indicated, towards an open procedure to contract the aforementioned hospital medical stays for a maximum duration of five years, with a base of budget submission of 15.3 million and a maximum estimated value of 42.9 million, including all possible annuities and extensions.
Already in July, a few days before the departure of Catalina García as director, the general auditor of the Council had signed the inspection report in accordance with the hiring.
SAS sources emphasize on this subject that the negotiated procedure was abandoned because before, only one company offered this type of service and now, as there were more on the market, it was decided to open it “for improve attendance” and also because It was “more agile” than with a framework agreement. According to the most recent documents, as has already been said, there are two bidders and, these days, the opening of bids by the Works Commission is underway.
Public mental health gaps for children and adolescents
The lack of public attention to the public mental health of minor adolescents in Andalusia, which has led to cases like that of this 13-year-old girl from Cordoba who had to seek treatment far from home, at the general hospital university of Ciudad Real, forced more and more adolescents to be referred to private health care, also due to the increase in demand due to the pandemic and other causes.
Today, the Government Council authorized the renewal of 73,000 stays for chronically ill adults in mental health and the granting of 36,500 for adolescents. The contract will involve, as the Commission summarizes, “the provision of health services, complementary to those provided in its own centers, to users of the Andalusian Health Service”, that is to say the orientation towards health care. private health with public funds. This is the same language that was used on this issue, for example in the negotiated calls for tenders without advertising that it launched last spring to alleviate waiting lists, as has already been said.
This concerns the permanence of patients over 18 years of age who require medium-long term hospitalization to be treated for presenting one of the disorders included in the integrated care process for severe mental disorders; those who present personality disorders not included in this process, with serious behavioral disorders, difficulties in coexistence and adaptation to their environment, family dysfunctions and poor therapeutic bond, who are referred by authorized public structures to provide health care; as well as 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 the mental health of children and adolescents,” comments the head of the analysis and studies office of the Federation of Sectors health and social services of the CCOO of Andalusia, Daniel Gutiérrez, about these calls for tenders. Almost two years ago, President Moreno announced in Parliament that all Andalusian provinces would have short-term hospitalization units for children and adolescents in mental health by 2023, which will be supplemented by these contracts who now “patch” health care through private centers for long stays. , said Gutiérrez.
At the public level, there were two units, in Jaén and Almería, and one was added to the Virgen de las Nieves (in the old eating disorders unit), another to the Muñoz Cariñanos of Seville (with “half of the beds work). , another in the Campo de Gibraltar (“they are hiring”) and in the Regional of Málaga, which “is on hold”, according to Gutiérrez. The Council reported on the progress of the case in a recent information on this subject.
“Are new recruits responding to a temporary solution or is this the model to follow?” asks Gutiérrez. “The solution is for public health to take it on,” he adds, calling on the presence of the Andalusian Public Foundation for the Social Integration of People with Mental Illness (Faisem).
