Until the summer of 2023, a small but vital chronic pain management team operated at Infanta Leonor Hospital in Madrid’s Vallecas district. Here, doctors from various specialties—from anesthesiologists to rheumatologists—helped patients suffering from post-surgical pain or those who couldn’t find relief through other treatments. But one day, the treatment schedule disappeared, the doctors stopped coming, and the facility was once again used exclusively for routine surgical procedures. The pain management unit all but vanished from memory for nearly two years.
It was recently revealed that Madrid authorities have put out a tender to find a private company to take over chronic pain treatment for Infanta Leonor patients. Official documents state that the hospital lacks both the specialists and equipment needed to continue running the unit on its own. As a result, management sees outsourcing this service as the only viable option.
Public reaction
This decision sparked an outcry among hospital staff and opposition politicians. Unions and representatives of left-wing parties argue that this is a step toward the gradual privatization of the region’s healthcare system. According to them, such moves reduce the number of public sector jobs and increase private healthcare companies’ profits at the expense of the public budget.
The pain management unit at Infanta Leonor required minimal investment—just three or four specialists were enough to operate it, and patients were seen only once a week. There were virtually no waiting lines, and care was provided quickly and locally. Union representatives are puzzled as to why officials claim there are not enough resources to support such a small department.
Contract details
The authorities are prepared to allocate just under 88,000 euros per year for operating the pain management unit. However, if the contract is extended and modified, this amount could rise to 450,000 euros over five years. Lawmakers point out that the regional health ministry has discretionary funds available that could be used to resume the unit’s operations in-house.
In response to the criticism, health ministry officials state that outsourcing the service to a private company fully complies with the law and is not unusual for Madrid hospitals. According to them, this practice is used in other facilities as well, particularly for specialized services that are not included in the standard package of hospital care.
Hospital operating model
Infanta Leonor is a public hospital where several services have long been outsourced to private contractors, including cleaning, food, and security. Now, chronic pain treatment may be added to this list. Authorities stress, however, that they are not transferring all medical services to a single company—they are specifically seeking a provider for this specialized area.
Some lawmakers believe that the winner of the tender will be a large private healthcare group with experience working on government contracts. In their view, such companies can offer more competitive terms because they receive significant funding from the regional budget. The opposition fears that as a result, patients with chronic pain may be left at a disadvantage, since private firms may seek to minimize treatment costs.
Alternative solutions
After the pain unit was closed, some Infanta Leonor patients had to seek help at other facilities. Some were seen at the Vicente Soldevilla center, but it is not equipped for complex procedures. Others were referred to Gregorio Marañón hospital, where overcrowding often led to refusals. As a result, many patients were left without the support they needed.
Madrid authorities insist that outsourcing the service to a private company is the only way to guarantee quality care given the current level of resources. Documents indicate that the hospital lacks both the necessary number of specialists and the equipment required for complex procedures, and that the level of specialization demanded calls for a tailored approach.
Incidentally, Infanta Leonor is one of Madrid’s largest public hospitals, opened in 2008. It serves more than 300,000 residents of the city’s southeastern districts. The hospital operates under a mixed model: some services are provided by public employees, while others are handled by private contractors. In recent years, the institution has repeatedly been the subject of public debate due to changes in management practices and attempts to optimize spending.
