Hospital 12 de Octubre, one of Spain’s largest public hospitals, has begun outsourcing thousands of diagnostic ultrasounds to private clinics. The decision comes less than three years after it opened a new building following a €300 million investment meant to boost its capacity and technology. Despite the upgrade, demand has surged beyond what the hospital can meet with its own resources, information from documents published on the Community of Madrid’s public procurement portal.
A new contract, valued at €139,700, will allow up to 6,350 ultrasounds to be performed externally over six months. Most scans are for patients referred from 19 associated primary care centers, with a focus on less complex cases such as musculoskeletal issues and chronic conditions. The contract requires the external provider to offer appointments at least three days a week, in the mornings and afternoons. Patients must travel to the private facility for their scans.
Hospital sources describe the contract as a backup measure to avoid delays when demand spikes, rejecting the characterization of it as outsourcing. The official tender documents, but, confirm that an external provider will handle a impressive share of routine ultrasounds, including scans of the neck and abdomen, urinary tract and pelvis, scrotum and testicles, as well as soft tissues and joints. The hospital’s radiology department currently covers only about 25% of these requests through an extraordinary management agreement. It has added two extra afternoon schedules to address the backlog.
Staff at several Madrid health centers have reported persistent problems scheduling ultrasounds for patients. Some appointments are never set, while administrative staff find appointment books closed. So, many patients leave without a scan date and are not officially added to waiting lists. The new contract requires the external provider to connect to the Madrid Health Service’s network to exchange appointments, images and reports. The hospital’s own resources will be reserved for more complex or inpatient cases.
The move has drawn strong criticism from opposition parties. Marta Carmona, health spokesperson for Más Madrid, called the decision “outrageous” for a hospital of such complexity and technical level, arguing that it reflects a broader pattern of neglecting core public health services. She pointed to similar situations at other hospitals, where radiology services have been allowed to deteriorate, leading to further outsourcing. Socialist assembly member Carlos Moreno linked the measure to a sharp rise in waiting lists and accused the regional government of preferring to contract out services instead of funding public hospitals to operate at full capacity, especially in the afternoons. He also questioned the cost-effectiveness and quality of outsourced scans, noting that private clinics tend to accept only the most profitable, straightforward cases.
Hospital 12 de Octubre serves more than 450,000 residents and is considered a reference center in Madrid. The recent infrastructure investment was intended to modernize its services and expand them, but the current situation highlights ongoing challenges in staffing and resource allocation. Outsourcing basic diagnostic tests has become a recurring solution in the region, raising questions about the sustainability of public healthcare funding and the balance between public and private provision.
In Spain, public hospitals are generally expected to provide core diagnostic services in-house. Demand has risen, staff shortages persist and budget constraints have driven greater reliance on private providers for routine tests in several regions. The debate over outsourcing in Madrid reflects broader national concerns about the future of the public health system, as waiting lists and resource pressures continue to grow.
