The Madrid doctors cancel this week's stoppages after the railway accident

To call a healthcare strike in the Community of Madrid, a valid agreement is needed, it must be communicated in writing with the corresponding prior notice, and essential services must be guaranteed. To suspend or call off the strike, it is necessary to distinguish the decision of the organizers from a public intervention: the Administration cannot prohibit it simply because it affects healthcare.

1. Call agreement

The main framework is Royal Decree-Law 17/1977, interpreted in accordance with the Constitution and Constitutional Court ruling 11/1981. It can be promoted by legitimized unions, workers' representatives, or directly by workers through a majority agreement and secret ballot. The agreement must be documented; the requirements of the original text that were declared unconstitutional should not be applied.

A strike committee of up to twelve people must be formed, which will represent the workers in actions to resolve the conflict. It is advisable to expressly delimit centers, categories, shifts, territory, and duration, including the indefinite modality when appropriate.

2. Prior notice and communications

In public healthcare services, article 4 requires at least ten calendar days' prior notice, compared to five in the general regime. The written notice must be sent both to the employer — healthcare Administration or affected company — and to the competent labor authority. For a call limited to Madrid, it corresponds to address the regional labor authority.

The communication must contain:

• The objectives of the strike.
• The efforts made to resolve the differences.
• The start date and the temporal delimitation of the stoppages.
• The composition of the strike committee.

Additionally, the representatives must give it sufficient publicity before starting so that users are aware of the impact. It is important to keep proof of submission and receipt. In private centers, the nature of the service provided must be considered, not only the ownership of the center, to determine the applicable prior notice.

3. Minimum services and negotiation

The Health Department establishes by order the minimum services corresponding to the affected healthcare scope. They must be justified and proportional to the duration, extent, and care needs; there is no single percentage applicable to all strikes.

The Order 4/2026 illustrates the procedure: convening the committee to negotiate the minimums and subsequent administrative setting, even if there is no agreement. It especially protects emergencies, critical care, and non-deferrable treatments. Its allocations cannot be automatically transferred to another call.

From the prior notice and during the strike, the committee and the employer must negotiate to reach an agreement. Security and conservation services under article 6.7, distinct from minimum care services, must also be guaranteed.

4. Suspension or calling off

Article 8.2 allows workers to end the strike at any time, without needing to reach an agreement beforehand. The consulted regulation does not establish another general ten-day prior notice for this.

To formalize it securely, the organizers must document the decision and communicate it reliably to the employer, the labor authority, and, in the public sphere, the healthcare Administration, also informing workers and users. The document must specify whether it is definitively canceled or temporarily suspended, from what date and time, and which days are affected. A future resumption should not be automatically assumed if the initial call changes.

Finally, setting minimums does not equate to suspending the strike. Lawful exercise does not allow sanctioning participation; failing to comply with enforceable obligations may generate liability, depending on conduct and the applicable labor or statutory regime.

The Health Department of the Community of Madrid must reconcile two obligations: respect the right to strike of medical staff and guarantee essential healthcare. Its intervention includes healthcare organization and personnel management within its powers, but it does not allow prohibiting a strike or maintaining all ordinary activity through minimum services.

1. Legal framework and scope of intervention

Article 28.2 of the Constitution recognizes the right to strike and requires guarantees to maintain essential services. For statutory healthcare personnel, article 18 of Law 55/2003 expressly recognizes this right, guaranteeing essential services to attend the population. Article 15.c of the Basic Statute of the Public Employee contains an equivalent provision, as recalled by STC 45/2016.

The Department acts as the regional healthcare service manager, not as the holder of the right to call or call off the strike. It also cannot freely decide how much its impact should be reduced: any restriction requires justification linked to patient protection.

2. Minimum services: setting and execution

The decisive competence consists of guaranteeing indispensable care through motivated and proportionate minimum services. Their setting corresponds to the competent governmental authority, with political responsibility over the service. This decision should not be confused with the subsequent designation of the personnel who provide them.

Jurisprudence prevents leaving the substantive determination of minimums solely in the hands of managing bodies as employers. STC 310/2006 found a violation of the right to strike due to such delegation. The consulted sources do not specify which Madrid body currently holds the signature of each resolution.

• Justification: explain the care risks, duration and extent of the stoppage, and the services that must be preserved.
• Proportionality: differentiate centers, shifts, and activities according to their need, both in primary care and hospital care.
• Execution: organize designations and verify that the established services are covered, without expanding minimums through internal instructions.

It is not enough to claim that healthcare is a public service: the specific restriction must be justified. This is established by STC 8/1992.

3. Healthcare and conflict management

Before the stoppage, the Department can prepare continuity of care and maintain dialogue with staff representatives to address claims within its competencies. Negotiation does not allow it to dispose of each doctor's individual right to support the call.

During the strike, it must continue effective coverage of essential services and adapt the organization to that purpose. It cannot use its organizational powers to neutralize the strike through illicit substitutions of strikers, a limit established in STC 17/2017. Afterwards, it is responsible for restoring activity and managing healthcare consequences within its powers.

4. Discipline, coordination, and judicial control

Lawful participation in a strike does not constitute an offense by itself. Any sanction requires a typified conduct, individual accreditation, and respect for procedural guarantees; it cannot function as retaliation. STC 12/2018 emphasizes the limits of disciplinary power when it affects the exercise of this right.

Coordination with the Ministry of Health or other departments does not replace the competence of the responsible body nor allow altering the state framework of the right to strike by regional decision. Finally, resolutions on minimums are subject to judicial control, including urgent protection against excessive restrictions, a guarantee highlighted by STC 148/1993.

To establish minimum services during a healthcare strike, there must be a real need to protect essential care, a decision by the competent governmental authority, and justified and proportionate measures. Protecting patients does not allow annulling the right to strike or automatically maintaining all ordinary activity of the center.

1. Existence of a need justifying intervention

The general legal basis is article 10, second paragraph, of Royal Decree-Law 17/1977. When the strike affects public services or those of recognized and urgent necessity and there are circumstances of special gravity, it allows that "the governmental authority may agree on the necessary measures to ensure the functioning of the services."

Therefore, the purpose must be to protect services whose interruption would compromise the essential interests of the community. It is not enough to invoke the organizational convenience of the hospital or to avoid any inconvenience derived from the strike.

2. Decision by a competent authority, not the employer alone

The setting of minimums corresponds to the governmental authority, not to the hospital management acting solely as manager or employer. The decision on what care is guaranteed must be distinguished from its organizational execution and the identification of necessary personnel.

This guarantee has special healthcare relevance: Constitutional Court Ruling 296/2006 rejected attributing the determination of minimum personnel to the health service itself without intervention of a governmental authority. Ruling 58/2013 also annulled the attribution of that power to the managing director of the Murcian Health Service.

3. Necessity, proportionality, and concrete justification

Measures must be limited to what is essential. Royal Decree 156/1979, referring to public hospital centers, expresses this requirement through "minimum and essential measures, limited to the maximum," which ensure the functioning of the service without restricting the strike.

• Necessity: identify the services that cannot be interrupted and the risk intended to be avoided.
• Proportionality: adjust coverage and personnel to that need, without turning minimums into ordinary operation.
• Concreteness: explain why the required services and staff are essential in that call.

The reference in that decree to the center's management should not be read in isolation: the guarantee of governmental intervention established by subsequent constitutional jurisprudence must be respected.

4. Prior notice and participation of representatives

As a requirement of the call, distinct from setting minimums, article 4 of Royal Decree-Law 17/1977 requires, when it concerns public services, a minimum prior notice of ten calendar days to the employer and the labor authority, as well as sufficient publicity for users. Its article 5 recognizes the strike committee's participation in administrative actions related to the conflict. That participation does not replace the competence of the governmental authority.

5. Possibility of judicial review

The decision can be challenged judicially. Article 3.d of Law 36/2011 excludes from the social order the provisions that set guarantees, minimum services, and percentages, whose control corresponds to the contentious-administrative order. However, the specific designation of labor personnel can be discussed before the social jurisdiction and precautionary measures can be requested.

In summary, essential care must be protected, but each restriction of the strike must have legal coverage, competent authority, and strictly necessary scope.