Health prepares a Royal Decree to avoid "makeup" in waiting lists

As of today, the so-called “draft Royal Decree on waiting lists” from the Ministry of Health is not at the parliamentary processing stage. It is still in the governmental phase of regulatory development: it has gone through prior public consultation and has been politically debated with the autonomous communities in the Interterritorial Council of the National Health System (SNS), but it has not been sent to the Cortes because ordinary royal decrees are not processed as laws.

1. What regulation it is and at what point it stands

The text identified in the official databases is:

“Draft Royal Decree establishing measures for the homogeneous treatment of information on waiting lists in the National Health System”, intended to update and, presumably, replace Royal Decree 605/2003, of May 23, which currently regulates the common criteria for information on waiting lists.

• On February 16, 2026, the Ministry of Health opened the prior public consultation on this draft, with a submission deadline until March 8, 2026, according to the official file and the Moncloa press release (Moncloa note).
• This move was covered by various media, explaining that the objective is to standardize definitions, criteria, and indicators on waiting lists throughout the SNS (Redacción Médica, Gaceta Médica).
• In July 2026, Health brought to the extraordinary Plenary of the Interterritorial Council of the SNS new common indicators that should serve as the basis for the royal decree. The autonomous communities requested more time to analyze them and submit objections, so the decision was postponed and it was agreed to resume the text in September in the Delegated Commission of the CISNS and again in Plenary (Infosalus, Gaceta Médica, Demócrata).

In the parliamentary initiative databases, there is no bill or royal decree-law on waiting lists corresponding to this text. There is, in parallel, a audit report from the Court of Auditors on hospital waiting lists processed in the Senate ((15)771/000116), but it is a financial control, not the processing of the royal decree.

2. Why there is no “parliamentary phase”

The instrument being used is a regulatory Royal Decree, that is, a government regulation without the rank of law. Unlike:

• a bill, which does go through Congress and Senate; or
• a royal decree-law, which must be ratified by Congress,

an ordinary royal decree does not have parliamentary processing. It is prepared within the Executive (competent ministry, consultations, reports, Council of Ministers) and published directly in the Official State Gazette (BOE). Parliamentary control is exercised by other means (appearances, questions, non-legislative motions), but there are no “stages” of committee, commission, or plenary sessions on the text, unless the Government opts to transform the matter into a bill, which in this case is not recorded.

3. Steps remaining until its final approval

Based on official and press information, the draft is currently at an intermediate stage within the Government:

• Finalize the indicators and technical criteria with the autonomous communities in the Delegated Commission and the Plenary of the CISNS, where decisions have already been postponed pending further technical analysis.
• Complete the formal hearing and public information procedures on a draft articulated royal decree (the prior public consultation has already been carried out).
• Obtain the mandatory reports (Technical General Secretariat, Ministry of Finance if there is budgetary impact, and, presumably, Council of State, given the national scope of the regulation).
• Submit the text to the Council of Ministers for approval as a Royal Decree.
• Once approved, proceed to its publication in the BOE and set the date of entry into force (often 20 days later, unless the decree itself provides otherwise).

Until these milestones are met, the current framework remains Royal Decree 605/2003 and the new royal decree on waiting lists remains within the governmental sphere, without legislative procedure in Congress and Senate.

Waiting lists in the National Health System (SNS) are regulated within a framework where the State, through the Ministry of Health, sets the bases and general coordination, while the autonomous communities organize and manage the services. The Ministry's competencies are supported by the Constitution, the General Health Law, the Cohesion Law, and two specific royal decrees on waiting lists and maximum time information.

Basic constitutional and legal framework

The starting point is Article 149.1.16ª of the Constitution, which grants the State exclusive competence over the bases and general coordination of health care. On this basis rest:

• Law 14/1986, General Health Law (basic state regulation), which designs a decentralized health system and assigns the State coordination and high inspection functions, as well as the creation of health information systems and statistics of general interest.
• Law 16/2003, on cohesion and quality of the SNS, which specifies citizens' rights regarding access times and establishes that, within the Interterritorial Council, framework criteria for maximum access times are agreed upon, later approved by royal decree.

Based on these laws, two key regulatory norms have been developed:

• Royal Decree 605/2003, which establishes measures for the homogeneous treatment of information on waiting lists in the SNS.
• Royal Decree 1039/2011, which sets the framework criteria to guarantee a maximum access time to certain SNS services.

What the Ministry of Health can legally do

Based on these norms, the Ministry's main competencies regarding waiting lists are:

• Set basic regulations on waiting lists and maximum times The Ministry, by virtue of the State competence on bases and coordination and as provided in Law 16/2003, can:
  • Propose to the Government royal decrees establishing framework criteria for maximum access times (such as RD 1039/2011).
  • Regulate, through royal decrees or ministerial orders, the criteria, indicators, and minimum common requirements for information on waiting lists (RD 605/2003 and its possible update).
• Create and manage common state information systems RD 605/2003, supported by Article 40 of the General Health Law, assigns the Ministry:
  • The implementation and maintenance of a state information system on SNS waiting lists.
  • The ability to define definitions, counting criteria, indicators, and minimum data sets that the communities must use when submitting information.
  • The periodic publication of homogeneous and comparable information on delays throughout the SNS, based on data sent by the autonomous communities.
• Establish framework criteria for maximum times Article 25 of Law 16/2003 foresees that the Interterritorial Council agrees on framework criteria for maximum access times, approved by royal decree. RD 1039/2011:
  • Defines the concept of maximum access time and associated guarantees.
  • Sets reference maximum times (listed in its annex) for certain interventions and procedures.
  • Empowers the Ministry to develop and apply the norm within its scope (e.g., INGESA and state mutual societies) and to periodically review these times, subject to agreement by the Interterritorial Council.
• Planning, evaluation, and transparency at the state level The General Health Law and the Cohesion Law allow the Ministry to:
  • Prepare general reports and statistics on the functioning of the SNS and its waiting lists.
  • Promote state plans, strategies, and working groups on waiting lists, whose agreements are submitted to the Interterritorial Council.
  • Exercise high inspection to verify compliance with state bases and basic equality conditions.
• Coordination through the Interterritorial Council Article 71 of Law 16/2003 assigns the Interterritorial Council – chaired by the Minister – functions to:
  • Know, debate, and issue recommendations on framework criteria for maximum times.
  • Agree on common criteria on information and prioritization of patients on waiting lists.

What corresponds to the autonomous communities

Within this basic state framework, the autonomous communities are competent to:

• Organize and manage health services, including resource planning, surgical and consultation scheduling, and direct management of waiting lists.
• Define their own maximum access times within the state framework approved by royal decree (e.g., specifying or expanding the guarantees of RD 1039/2011).
• Regulate, through their own regulations, the internal procedures for prioritization, referral, and follow-up of patients, always respecting the basic criteria and homogeneous information set by the State.

In summary, the Ministry of Health does not manage the waiting lists of each hospital, but it has the competence to set the basic rules of the game (homogeneous information criteria, maximum time frameworks, state information systems, and coordination through the Interterritorial Council) and to ensure that the right to health protection is exercised with basic equality throughout the territory.

In Spain, Royal Decrees are regulatory norms approved by the Government exercising its regulatory power. Their drafting and approval are subject to a detailed legal framework, centered on the Constitution, Law 50/1997 of November 27 on the Government, and Law 39/2015 on the Common Administrative Procedure of Public Administrations, as well as its development by Royal Decree 931/2017 on the regulatory impact analysis report.

1. Competence and nature of the Royal Decree

The Constitution (art. 97) assigns the Government the direction of internal and external policy and regulatory power. Law 50/1997 specifies that:

• Royal Decrees agreed in the Council of Ministers are the typical form of regulatory norms within the Government's competence (art. 24 Law on Government).
• Regulations are hierarchically ordered: at the top, Royal Decrees of the President or Council of Ministers; below, Ministerial Orders (art. 24.2 Law on Government).

A Royal Decree does not have the rank of law: it develops and executes prior laws and cannot modify them nor regulate matters reserved for law (e.g., types and amounts of sanctions, essential elements of taxes, fundamental rights, etc.). When the Government acts with the rank of law, it does so by legislative royal decree (delegation from the Cortes) or royal decree-law (extraordinary and urgent need), distinct figures regulated in arts. 82 and 86 CE.

2. Legal authorization and material limits

Generally, the Royal Decree must be based on:

• A sufficient legal authorization: a law that entrusts the Government to develop certain aspects.
• Respect for the normative hierarchy and the distribution of State–autonomous community competences (art. 9.3 CE, constitutional doctrine). Regulatory excess (going beyond the law or invading autonomous competences) is a typical cause for annulment in administrative litigation.

3. Drafting procedure

The basic procedure is in Law 50/1997 (arts. 25 and 26, among others) and is complemented by art. 133 of Law 39/2015 and Royal Decree 931/2017.

• Initiative and technical drafting: a promoting ministry drafts the Royal Decree and a Regulatory Impact Analysis Report (MAIN), which justifies the opportunity, compliance with good regulation principles, the competence title, economic and budgetary impact, administrative burdens, social and gender impacts, etc. (art. 26.3 Law on Government and RD 931/2017).
• Prior public consultation: generally, before drafting the text, a consultation must be opened on the ministry's website to gather opinions on:
  • The problems intended to be solved.
  • The need and opportunity to regulate.
  • The objectives and possible alternatives, including not regulating.
  It is foreseen in art. 133.1 of Law 39/2015 and art. 26.2 of Law 50/1997. It may be omitted in specific cases (organizational or budgetary norms, absence of significant impact, urgent processing, etc.), but the omission must be justified in the MAIN.
• Hearing and public information: on the draft Royal Decree, a hearing and public information procedure is opened (art. 133.2 LPAC and development in the Law on Government), where citizens, organizations, and, if applicable, other administrations can submit specific objections to the text. The ordinary minimum period is fifteen working days, reducible to seven in urgent processing.
• Mandatory reports: the file includes reports from the ministry's Technical General Secretariat, Finance and Public Function when there is organizational, personnel, or budgetary impact, and Territorial Policy if there are competence implications, among others. All these steps and their results must be documented in the MAIN.
• Opinion of the Council of State: in cases provided in its Organic Law (e.g., executive regulations of laws of special relevance, development of state bases with autonomous projection…), the opinion of the Council of State is mandatory. It is not always binding, but its absence when required may compromise the validity of the Royal Decree.
• Urgent processing: the Council of Ministers, at the proposal of the competent minister, may agree on urgent processing (art. 27 Law on Government). In such case:
  • Deadlines for procedures are halved.
  • Prior public consultation may be omitted, maintaining at least an abbreviated public hearing.
  Urgency must be justified in the MAIN and in the agreement itself.

4. Approval, signature, and publication

• Deliberation and approval in the Council of Ministers: the draft, once processing is complete, is submitted to the Council of Ministers, usually after passing through the General Commission of Secretaries of State and Undersecretaries, which examines all matters to be presented to the Council (art. 8 Law 50/1997).
• Signature and countersignature: the King issues the Royal Decree, which is countersigned by the President of the Government and, if applicable, by the competent minister (art. 64 CE and art. 26 Law on Government). The King's signature is formal and regulated: it cannot be refused if the procedure has been correct.
• Publication in the BOE: the Government Secretariat ensures correct insertion in the Official State Gazette. Publication is a condition for general effectiveness.
• Entry into force: as a general rule, the vacatio legis period of art. 2 of the Civil Code applies (20 days unless otherwise provided), although the provision itself may set a specific date. The Law on Government also foresees that when the Royal Decree imposes new economic or professional obligations, its entry into force is, in principle, the following January 2 or July 1, unless specifically justified.

5. Difference with ministerial orders

Ministerial Orders are lower-rank regulations issued by one or more ministers (art. 24.1.f Law on Government). They share much of the procedure (prior consultation, hearing, MAIN, reports), but:

• They do not require deliberation by the Council of Ministers.
• They are not issued by the King, but by the signing minister.
• They must respect both the law and the Royal Decrees that develop them.

Overall, these requirements seek to ensure that each Royal Decree is legally sound, respects normative hierarchy, and results from a transparent and participatory procedure, subject to internal controls (reports, MAIN) and external ones (Council of State, judicial review).