Representatives of PP, PSOE, Vox and En Comú Podem have agreed, ahead of the next legislature and the general elections of 29 November, on the urgency of reinforcing funding and of promoting screening for type 1 diabetes, also studying its possible gradual extension beyond first-degree relatives.
The debate was attended by the candidate for the Senate for Zamora and spokesperson for the PP in the Health Commission of the Congress in the past legislature, Elvira Velasco; the coordinator of Health Strategies of the Ministry of Health and PSOE representative, Pilar Aparicio; the Health spokesperson for Vox in the Assembly of Madrid, Raquel Barrero Alba; and the councillor for the Más Madrid Municipal Group in the Madrid City Council and a member of En Comú Podem, Miguel Montejo Bombín.
All of them took part in a day organized by Europa Press, promoted by the Federación Española de Diabetes (FEDE) and its platform "Crecer Sin Diabetes", under the title "Detectar antes para llegar a tiempo. El valor de anticiparse a la diabetes tipo 1", held in Madrid with the backing of the pharmaceutical company Sanofi. During the meeting, Velasco pointed out that the intention is to expand the early detection test of the disease "after the results that the study sets", a piece of work that she has described as "good work".
Specifically, she referred to the ongoing technical evaluation, on which Aparicio has stressed the need to have "scientific evidence". After Barrero Alba and Montejo Bombín showed their agreement on this point, the socialist representative highlighted the pilot projects that are being developed in different areas of Spain, in contrast to the inequity in screening noted by the rest of the speakers, since "many times, good experiences serve a lot to see or improve a program and adapt it".
"Keep working on what you are doing" is, in Aparicio’s view, the line to maintain when starting the new legislature, an approach that Velasco shares, who supports "extending the best pilot project that provides the greatest possible effectiveness". The PP leader considers it essential to incorporate diabetes "as a strategic pillar" into public policies, recalling that in Spain there are "more than 160,000 people with type 1 diabetes" and that "every year, about 6,000 debut".
Update of the strategy and budgetary reinforcement
For this reason, Velasco has defended the need to have coordination, “a stable budgetary framework” and “an updated strategy,” which has not been reviewed since 2012. Its goal is to reduce the current inequity, for which he considers it essential “a framework for understanding together with the autonomous communities” and that “so that the pilot programs can serve so that, at the level of the Ministry, they can be implemented in the national sphere.”
In this scenario, he referred to funding for the comprehensive approach to diabetes, calling for “defining specific budgets.” Barrero Alba has emphasized that “Funding in Health is a priority, but it is also true that there are decisions by the central Government that affect in a very important way the budgets of the autonomous communities,” an assessment that Aparicio has nuanced by recalling that “it corresponds to the autonomous communities.”
Velasco has returned to the proposal for an expanded screening of type 1 diabetes, insisting that it is key to extend the pilot studies in order to obtain the scientific evidence that supports it. For this reason, he has pointed to the Interterritorial Council of the National Health System (CISNS) as the appropriate forum to coordinate these initiatives.
In turn, Aparicio has reiterated that the early detection of type 1 diabetes is “fundamental” and has stressed that it is a “commitment” of the Ministry of Health, which intends to “keep improving” in this area. “We have new challenges thanks to research,” he said, while also recalling that “any screening program goes beyond carrying out a test” and requires “defining well the target population,” as well as the time and the way to carry it out.
Territorial differences in screening and the role of the communities
Despite this, Barrero Alba has stressed that the screening program, with current recommendations, is not applied in a generalized manner, even though its cost “is very low.” In his view, “There should be a policy at the level of the State, not only of the communities, (...) for early detection, as there may be for the early detection of colon cancer or cervical cancer,” he said, to add that although “it is true that the autonomous communities organize, manage, health policies,” there is “above all, a Ministry of Health that must provide scientific answers.”
However, it has denounced that "we are totally independent the autonomous communities; we do not share data, we do not have the same criteria, our vaccination schedules each go their own way", and it has emphasized that "screening programs and prevention each go their own way". In its view, it is essential "that all Spaniards have the same healthcare" and it has stressed the need to "screen first-degree relatives throughout the entire territory".
For its part, Montejo Bombín has put the focus on that the healthcare system must be "robust, well funded and well managed", and that this strength must start "from Primary Care". Regarding screening, he has stated that "there is general interest in going on incorporating these innovations, which are a change of paradigm". "The work is being done", he added, to ensure that, in his opinion, "it goes as fast as science goes".
"The commitment of the Ministry and that of some autonomous communities has been clear ", he continued. In his view, "We need to push other autonomous communities so that they keep incorporating, at least, in the screening of the people whom we already know have a genetic link to the disease and to other endocrinological diseases", pointing out that "there is already consensus on this".
In addition, he has indicated that the Government is "on it" and "the first step has been taken" to expand detection tests and to analyze "truly how universal screening works". For this reason, he concluded that "we encourage the autonomous communities to improve the financing of all the programs that have to do with healthcare assistance and to strengthen, in general terms, the healthcare system".