Under the successive presidencies of Esperanza Aguirre of the Popular Party [Partido Popular] (2003-2012), the Community of Madrid has seen a wave of privatisations under legislation which promotes both privatisation and types of indebtedness which do not appear in calculations of the public deficit. In this way, instead of making optimum use of public hospitals ervices have been contracted out to third parties, diverting public funds to the detriment of public hospitals.

Starting in 2004, seven new hospitals were built under the Private Finance Initiative model and four as Public-Private Partnerships. In fact, in 2008 healthcare authorities in the Community of Madrid openly stated that public healthcare was a “business opportunity for private companies”, in the words of Juan José Güemes, Head of the Regional Health Department from 2007 to 2010.

During these years, mandatory Regional Health Department inspections have been systematically circumvented, with avoidance of parliamentary control and the suppression of information. This has led to undemocratic management, resulting in elevated additional costs and strong evidence of illegitimate debt. We are facing a conflict of interest in which public servants are acting in the interests of private companies, both domestic and international, to the detriment of the population of Madrid.

In this way, the concession of a considerable portion of healthcare management and service provision to the private sector coupled with an absence of oversight deliberately enables the politicians and civil servants involved to systematically plunder the public healthcare sector.

As a consequence of this, public hospitals and healthcare centres are underfunded, leading to the deterioration of facilities and staffing cuts. This then favours the diversion of resources to private hospitals which then absorb the patients who originally attended public hospitals. This demonstrates connivance between political powers and economic elites to convert public healthcare into a business niche, a process with is not free of corrupt practices.

At the same time, financial actors interested in moving into public healthcare are spreading a narrative which discredits public healthcare and aggrandises private healthcare, without the support of rigorous, evidence-based comparative evaluations.

In addition, Madrid’s public administration is avoiding carrying out appropriate comparative studies (preliminary studies required by current legal regulations) through a lack of transparency in data management: private hospital funding is fragmented into various budget headings which are settled in different financial years, whereas public hospital accounts are settled every financial year. This hides the higher costs of private care and the unjustified special treatment given to private hospitals contracted by Madrid’s public administration.

The objectives of this report are to:

1. Undertake a citizen audit of the agreement or agreements signed between the Madrid hospitals owned by Fresenius Helios and the Servicio Madrileño de Salud (Madrid Health Service, SERMAS), in particular the Jiménez Díaz Foundation.

2. Understand the services and activities which these carry out for the SERMAS and their economic value.

3. Expose the role which the company Fresenius-Quirónsalud plays in healthcare in Madrid, now and in the future, and the way in which the Community of Madrid healthcare administration (the SERMAS in particular), are handing over chunks of the public healthcare system to private healthcare companies and investment funds, undermining the SERMAS’ duty to determine public healthcare strategies, development plans and targets.

4. Identify the debt generated by the Fresenius Helios hospitals contracted by the SERMAS and integrated into the Single Public Healthcare Network (Red Sanitaria Única de Utilización Pública) and assess whether there are features of illegality or illegitimacy in this debt.

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