El Zendal, a public complex of multipurpose pavilions in the northeast of the capital inaugurated by Isabel Díaz Ayuso in December 2020, will comply with Madrid hospital regulations for the first time thanks to a custom standard that the Community of Madrid is preparing.
EL PAÍS has had access to the 52 pages of the draft of a new order from the Ministry of Health, which lowers the requirements that health centers must meet to be considered hospitals, including the requirement of natural light in the rooms or the reduction of the number of nurses.
The project, which contains a typology of health centers and their requirements, plans to repeal another similar Madrid order from 1986 and contains for the first time the definition of emergency hospital, an expression that does not exist in Spanish regulations.
The new draft of the health order being studied by the Community of Madrid has been prepared by the General Directorate of Health Inspection, Planning and Strategy, whose general director is Elena Mantilla.
Ayuso appointed Mantilla the PP's Secretary of Health in May, after winning the war with Pablo Casado, the national leader of the popular, and becoming the PP's regional president.
In an email, to which she has also accessed this newspaper, Mantilla describes the 1986 law as "obsolete."
The state hospital legislation does not include the definition of “emergency hospital”.
The norm that regulates these health establishments is Royal Decree 1277/2003, which divides the centers with hospitalization of patients into general hospitals, specialized hospitals, medium and long-stay hospitals, mental health and drug addiction treatment hospitals, and other centers with internment.
El Zendal belongs to this last category and was cataloged at the time by the Ministry itself in its registry of health centers, services and establishments, the official book where the operating authorizations in the region are registered.
To obtain an opening license, public and private health centers in Spain must comply with state legislation and that introduced by the autonomies.
Zendal's problem is its non-compliance with Madrid hospital regulations.
The 1986 order requires that, when building a public or private hospital in the region, all rooms have natural light in the patient hospitalization area.
However, the new text says that this internment area will have "preferably natural light."
It will no longer be mandatory.
The draft also lowers requirements such as the ratio of toilets required in nursing controls, lower standards that could favor low-quality private clinics that do not meet the current requirements to be considered hospitals, according to hospital architects consulted by this newspaper.
In any case, the benefit of calling itself a hospital would be merely reputational, say the experts.
A spokesman for the Ministry of Health has declined to comment on the project: "We do not comment on drafts."
Isabel Díaz Ayuso, during the inaugural act of Zendal in December 2020. Chema Moya (EFE)
“It is a draft typical of third world countries.
It seems like a bad joke”, criticizes José León Paniagua, an architect professor at the Carlos III Health Institute, with whom this newspaper has shared the text.
“I understand that they are looking for two objectives.
On the one hand, to legalize that pavilion called Zendal, which is valid both for welcoming the sick and for hosting a craft exhibition.
On the other, they want to legitimize very low-quality private clinics, because there are some in Madrid that are out of the question”.
Antonio Morales, architect of the HM Hospitales Group, says after consulting the draft that, no matter how much they change the definition, it is a lie to consider Zendal a hospital.
"If a submarine does not have a periscope or is submersible, you cannot call it a submarine," compares this expert.
"If the Zendal belonged to a private company, it would not have been classified as a hospital," says the hospital architect Emilio Sánchez Horneros, general director of the Madrid workshop Tash.
The experts consulted consider it especially serious that natural light is no longer required in hospitalization areas, a requirement that has great benefits for patients.
A scientific study from the University of Michigan showed last year that mortality is higher in patients who do not have a window.
This is because sunlight activates serotonin in the brain and keeps patients calmer and in a better mood.
“The importance of natural light is such that, nowadays, in the construction of housing it is mandatory that the bedrooms have sunlight”, says the professor of the Carlos III León Paniagua Institute of Health.
On the other hand, the draft reduces the staff in nursing controls from 0.20 per current bed to 0.13.
In addition, it allows the number of beds in these checkpoints to be increased.
Psychiatric hospitalization goes from the maximum of 30 to 45 and cardiology hospitalization, from 20 to 25. The draft also contains surprising details because it introduces an already outdated element such as the obligation for rooms to have bedpans, metal urinal cleaning machines.
Currently, patients who cannot go to the bathroom use disposable paper bedpans.
Despite the large dimensions of its pavilions, the Zendal lacks the basic functions of a hospital such as operating rooms or treatment and diagnostic areas and even the Emergency Room.
Its design, with heights of 12 meters, makes its conversion into a hospital difficult.
Its three hospitalization wards are an open, cavernous space through which hardly any sunlight penetrates.
It occupies 80,000 square meters, equivalent to 15 soccer fields.
The Community of Madrid has announced that it wants to build six operating rooms so that it can be one of the centers that receive patients from the Hospital de la Paz, when a reform that does not yet have a date begins.
Since its inauguration in December 2020, the Zendal has received covid patients, people who wanted to get vaccinated and refugees from Ukraine.
Recently, it has been a relief for hospitals overwhelmed by the flu season.
The Community continues to look for uses: it has announced the opening in the complex of the future Regional Public Health Laboratory, the new central warehouse of the Madrid health service and the new headquarters of the Summa 112 switchboard, which was located on Calle Antracita, in Legazpi.
The draft comes at a key moment for Madrid's healthcare.
Two weeks ago, more than 250,000 people from Madrid took to the streets for the second time in less than three months in criticism of Ayuso's health management and in support of health professionals, who have already accumulated 12 weeks of strike.
New plans for the Zendal
The region's Minister of Health, Enrique Ruiz Escudero, attended a talk with PP militants in the Salamanca district two weeks ago.
For the first time, surrounded by trusted people and as revealed by EL PAÍS, he openly proposed a change in the model in primary care based on nursing and video consultation.
"It's a model problem, let's not fool ourselves," Escudero explained to one of the militants.
"It is thought of in the eighties, with certain derivatives of a model that came from the Cuban health model, which had its reason for being, but now has to evolve."
Where?
Escudero spoke for the first time about a new healthcare model, in which nursing will play a key role.
"In the UK, the primary care model is a pure nursing model and here we are evolving into that model for logical reasons."
In this same talk, another PP affiliate asked Escudero about the Zendal.
"What horizon does it have for the future?" asked the militant.
“Above all, so that it does not become a double-edged sword for us,” he said.
The counselor explained that right now there are 100 hospitalized patients, that around 800 people from Madrid come daily to be vaccinated against the coronavirus and that, looking to the future, and for "after the elections", it will be an "innovation and simulation center". , without giving more details.
“Zendal continues to be active, but it is true that less than in the pandemic.
Life goes on, but have no doubt that you will have operating rooms and a functional plan that will be fulfilled, ”he announced.
An investment of 189 million euros
How much did the Zendal cost?
Ayuso's star project has already consumed more than 189 million euros.
The infrastructure has not only become a point of reference for vaccination.
It has also been transformed into a huge television set that the president has visited repeatedly.
Promoted as one of Ayuso's great electoral claims in the 4-M elections, no expense has been spared.
The press room cost 369,759.83 euros, according to the recruitment portal.
The crisis room, 323,958.14.
Some expenses decided by hand that include 40,000 euros in a wall of screens, 4,540 in a table or 1,197 in three flags, according to documentation that EL PAÍS accessed on February 9.
The cleaning service for 2022 was granted on Wednesday for 4,466,569.03 euros.
For the same period, the food and vending
(vending machines) contract was signed
, which reached 3,095,396.37 euros, and the waste management contract: 873,574.68 euros.
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