First state agreement to improve early care and reduce waiting times approved

Multisectoral conference meeting

Mónica García, Minister for Health, and Pablo Bustinduy, Minister for Social Rights, Consumer Affairs and 2030 Agenda, have met with the regional governments in a multi-sectoral conference in which they have approved, for the first time, a state-level agreement aimed at improving early care.

It is a document that establishes a common quality framework to ensure that children aged 0-6 years have the right to quality, effective and free early care, with rapid and equitable access. Therefore, the agreement includes that the deadline for early intervention should be a maximum of 45 days from the detection of a case with a developmental risk. This deadline is the benchmark set by the ECG (European Child Guarantee), a recommendation of the Council of the European Union that was unanimously approved in 2021.

Reducing waiting times in early care is therefore one of the fundamental objectives of the agreement that has been approved today, as this age group, from 0 to 6 years, is a crucial and critical stage and when the foundations of children's physical, cognitive, emotional and social development are laid. This period is key, according to scientific evidence, to guarantee healthy child development that prevents aggravated situations of disability or dependency. It also aims to improve the quality of life of children, as well as to promote their social inclusion, their capacities, their potential, their autonomy and the free development of their personality.

For this reason, Social Rights and Health warn of the serious consequences that can impact on children in need of early care if there is no quality public system. Consequences such as having their cognitive and social capacities compromised, developing health and nutritional problems, having educational difficulties, or having limited opportunities to be fully included in the community and to reach their full potential. Likewise, according to both ministries, the lack of an efficient and free system increases the risk of social exclusion for many families who are forced to make up for the shortcomings of the system with their own economic resources, time and energy. This, they add, leads to an imbalance that creates more unequal societies with fewer opportunities for these children and their families.

In addition to improving detention processes and reducing waiting times, the agreement approved on Monday provides that all Autonomous Communities should have an Early Intervention Network and that, to this end, the autonomous governments should have a regulation that specifically regulates the matter. This regulation should establish the mechanisms for coordination and sharing of documents and medical records. The system must also interconnect the departments that form part of the process, as well as order and regulate their participation: primary care teams, teachers, social services professionals, etc. This group of measures should also lay the foundations for the network to have a stable and sufficient workforce with quality jobs.

On the other hand, the document includes measures to guarantee comprehensive assessment and intervention, adapting all processes to the reality and rhythms of each child and their families, with whom a permanent dialogue will be established. In addition to this, there is a new focus on acting in children's natural environments (home, park, etc.) and on a biopsychosocial approach that takes into account all the conditioning development factors.

The agreement also includes a financial allocation of almost 42 million euros (41,874,524.17 euros) that the Ministry of Social Rights will distribute among the autonomous governments from the European Social Fund Plus, with the aim of ensuring that all children have adequate access to early care regardless of their place of residence and their family and social circumstances. According to GAT, the Spanish Federation of Associations of Early Intervention Professionals, in 2023 (the last year for which global data is available) almost 130,000 children (129,529) needed early intervention, which represents more than 5% (5.38%) of the population aged 0-6 years.

Lines of action

The commitments adopted in the approved consensus have been structured into nine lines of action, which are translated into concrete measures and 36 quality standards. The lines of action are:

1. Planning, structuring, organising and financing early care.
2. Improving the quality of early care services and actions.
3. Implementing effective inter-administrative coordination systems.
4. Implementing effective processes of collaboration and active participation of families.
5. Promoting primary prevention.
6. Facilitating equal and quality access to early care for all children, with waiting times reduced to a maximum of 45 days.
7. Ensuring comprehensive assessment and intervention.
8. Having professional teams and continuous training of professionals involved in early care.
9. Optimising information and registration systems.

At the same time, performance indicators are established to assess the degree of development of the commitments and their constant adaptation to the needs of the system.

Drafting of the document and timeframe for implementation

The document has been developed within the framework of the Early Intervention Technical Group with the active collaboration of the Communities and the Autonomous Cities of Ceuta and Melilla. It has also involved civil society actors specialised in children and disability, and has been coordinated by various ministries: Social Rights, Health, Education, and Youth and Children. This document also culminates the agreements reached in the Interterritorial Council of the National Health System and in the Interterritorial Council of Social Services of the Dependency Care System, which in a session in July 2023 approved a roadmap for improving early care in Spain based on a common framework of universality, public responsibility, equity, free of charge and quality.

The timeframe for the implementation of these measures will be 2030 and will coincide with the completion of the State Action Plan for the Implementation of the European Child Guarantee (2022-2030), given that within the framework of this plan, funds will be distributed to the Autonomous Communities to promote the implementation of the measures envisaged in the State Consensus. Likewise, the Early Intervention Technical Group will carry out a biennial monitoring of the implementation of the measures, based on the measurement of the foreseen indicators. A final assessment will be carried out in 2030.

Civil society participants

• Spanish Federation of Associations of Early Intervention Professionals (GAT)
• Platform for Early Intervention and Rights of Children with Functional Diversity (PATDI)
• Spanish Committee of Representatives of People with Disabilities (CERMI)
• Spanish Association for Early Childhood Intervention (AEIPI)
• Children's Platform
• General Council of Associations of Speech Therapists
• General Council of Occupational Therapists' Associations
• Spanish Association of Primary Care Paediatricians
• Spanish General Council of Physiotherapists' Associations
• Spanish Society of Rehabilitation and Physical Medicine (SERMEF)
• Spanish Society for Child Rehabilitation (SERI)
• SERI - Andalusia
• SERI - Galicia
• Centre for the Linguistic Normalisation of Spanish Sign Language (CNLSE)
• Spanish Centre on Autism Spectrum Disorder
• Confederation Autism Spain
• Confederation Full Inclusion Spain

Non official translation