Changes

The graphs on ''[[:File:Evolution in the number of Conferences of Presidents |Evolution in the number of Conferences of Presidents]]'' and the ''[[:File:Evolution in number of Health Sector Conferences|Evolution in number of Health Sector Conferences ]]'' show the scant relevance of these mechanisms prior to the pandemic, and highlight a relevant institutional and political deficit. These mechanisms did not have for decades the prominence that would have been necessary to provide good internal governance, as evidenced by the fact that more Conferences of Presidents were held in the few months that the first wave of the pandemic lasted than since this mechanism was founded back in October 2004. Moreover, the way these mechanisms are put into action is far from desirable, they have only had muted results, and the Spanish sharp political polarisation makes difficult to forge crucial agreements. Proof of this institutional deficit is that the Conference of Presidents ceased to convene short after the end of the first wave of the pandemic, in October 2020, whilst it should have continued to operate with the frequency required by the exceptional situation of the whole pandemic. By contrast, the Health Sector Conference, the Social Service Sector Conference as well as some other sector conferences have continued to operate regularly showing good results.

Some lessons have been learned so far from how the pandemic was managed: a) it has tested the ‘autonomous state’, which has emerged stronger, using the instruments of internal governance as never before. A more polycentric, more horizontal, more decentralised Spain has taken root in the collective imagination, and all levels of administration have been seen to act as such; b) there are different ways of organising the public health service in each region, as highlighted by the map on ''[[:File:Primary healthcare areas|Primary healthcare areas]]''. However, this is compatible with sending aggregated information to the national administration; c) it has served to highlight the deficit in multilevel internal governance and the shortcomings in basic pillars of the welfare state. Nevertheless, serious issues caused by COVID-19 have been solved and collective learning has taken place; d) the importance of public services as a pillar of the welfare state and a basic responsibility of the regional authorities has been perceived by the population; e) it has opened a new stage of dialogue in drafting agreements and strategic alliances between different regions to address common issues and challenges that may entail relevant political symbolism as they are promoted bearing in mind the whole country; f) the agenda for the immediate future has been made clear, i.e. Spain shall improve the funding mechanisms for the welfare state so that territorial equity is provided and welfare standards may catch up with northern and central Europe, a regularity in celebrating the Conference of Presidents and the Sector Conferences shall be introduced, and founding a national Health Office would be praiseworthy.

The regional administrations had to cope under very challenging conditions with the social emergency caused by the pandemic. First, because levels of poverty and social exclusion stood amongst the highest in the European Union. Second, because public spending on social protection and health services stood 4.5 points below the EU average before the pandemic and had not yet caught up the levels observed before the double recession registered back in 2008-2013, when severe cuts were introduced. For example, Amnesty International pointed out that spending on public health fell from 70.7 billion euros in 2009 to 62.8 in 2018 (i.e. -11.21%), whilst the population over 65 years of age clearly increased in this period. Third, because the Spanish model of public services shows sharp differences between regions, as may be observed on the map on the ''[[:File:Evolution of total public spending by the regional administrations|Evolution of total public spending by the regional administrations]]'', and are a consequence of a funding model of the regional administrations that happens to be unable to provide similar services in the different territories. It is therefore urgent to agree on a new funding mechanism for the regional administrations that may tackle social and economic problems that are likely to worsen over the coming years.

How the national regulation of this Minimum Subsistence Income fits in with the Regional Minimum Income policies raised dysfunctions from the outset. Firstly, because the national regulation sets a difference between the Basque Country (Euskadi/País Vasco) and Navarre (Navarra) and the rest of regions due to the different tax collection system of these two regions as well as to the attribution of powers by an agreement on the National Social Security Institute. This was seen by the other regions as an unequal treatment. Secondly, although the regulation also envisaged the possibility of promoting an agreement with the rest of regions and/or local authorities, the fact is that the national Minimum Subsistence Income began developing in parallel to the Regional Minimum Income policies of all regions except for these two (which were set decades ago). This postponed ''sine die '' the agreements between administrations. The national government argued that it had better information than the regions to implement these policies (e.g. data on personal income and Social Security), but did not consider the lack of employees of the national administration to deal with deploying this mechanism. Thirdly, it led to confusion amongst regional authorities, beneficiaries and potential beneficiaries. Finally, it filled social service departments in local councils that were already understaffed. This last aspect, which has perhaps received less attention than it should, is essential and explains to a large extent the failure in implementing a policy to all citizens that are subject to benefit from it. This is also stated by social services from municipal level as well as by regional Ombudsmen.