The Ministry of Health and Social Policy has the responsibility for improving the quality of the health system as a whole, fulfilling the provisions of Law 16/2003, of 28 May, of cohesion and quality of health National Health System.

Health strategies are based on the principles of equity and territorial cohesion and their purpose is to ensure that all citizens have access under the same conditions to the actions and procedures they have demonstrated. effectiveness in improving health and quality of life and on which there is a consensus on their efficiency.

During the 2009 financial year, the Ministry of Health and Social Policy will support actions aimed at improving the health care provided to citizens in the specific areas of palliative care, patient safety, prevention of gender-based violence and normal birth care, all in the development of the Quality Plan of the National Health System.

The strategy in palliative care has among its objectives to improve the care of patients with prevalent diseases of great social and economic burden. The strategy was approved by the Interterritorial Council of the National Health System on March 14, 2007. In this regard, they point out as critical points, among others: the need for the universalization of palliative care, inequities in accessibility, insufficient support for the family environment, insufficient attention to emotional problems and grief, inadequate social knowledge of palliative care, generalized demand for training in palliative care, the need for specific training of professionals in palliative care teams, the need for training in aspects emotional, reduced number of funded projects and lack of evaluation and standards Unified.

The Ministry of Health and Social Policy through the Quality Agency has been developing, in coordination with the autonomous communities, since 2005 a strategy for the safety of patients whose objective is to promote a safer healthcare in the healthcare facilities of the National Health System. This strategy, which is based on the lines developed by the Global Alliance for patient safety and the recommendations of the Council of Europe. The strategy addresses all the elements identified as crucial in the patient's safety as they are: promoting and developing the patient's knowledge and safety culture among professionals and patients, through training and information, design and establishment of information and reporting systems for adverse events for learning, implement recommended safe practices in the National Health System centers related to the causes most frequently related to those of adverse events (use of medicines, infection related to the health care and procedures), promote patient safety research and promote the participation of patients and citizens in policies that are developed in patient safety.

In compliance with the measures and actions established by the Organic Law 1/2004, of 28 December, of Comprehensive Protection Measures against Gender Violence, with respect to health services and within the conceptual framework and The actions proposed for all public administrations in the National Plan for Awareness and Prevention of Gender Violence, the actions that are then specified become priority objectives within the framework of the National Plan for the Awareness and Prevention of Gender Violence. Strategy 4 to promote the equity of the Quality Plan for the National Health System: to promote the improvement of quality and equity in comprehensive health care for gender-based violence through the assessment of the impact of the actions implemented by the health administrations. It will be of particular interest to those related to the effective implementation of the Common Protocol for Health Action in the face of gender-based violence, both those relating to indicators that facilitate the understanding of its magnitude and the characteristics of women who suffer from it, as well as the planning of training and the professionals in this field and the evaluation of all these actions. Promoting collaboration and the exchange of experience and good practice between the administrations involved in health care for women suffering from violence is also a priority for the development of the objectives of the programme. raised.

The strategy for normal delivery in the National Health System, approved by its Interterritorial Council in October 2007, aims to improve the quality of care and maintain current levels of safety, It is necessary to promote the use of clinical practices based on scientific evidence, to take into consideration childbirth as a physiological process, with the active participation of pregnant women in informed decision-making, to promote training of professionals to be able to incorporate the recommendations of the strategy in clinical practice, to encourage research and the dissemination of good practice. To this end, through the updating of the protocols, it is necessary to redirect the current attention to one with less intervention and medicalization, a greater coordination between primary and specialized care that guarantees the continuity of the process. and participation of the pregnant women, and a new conception of the design of the spaces and the functioning of the maternities, more focused on the needs of each woman and creature.

The objectives indicated have a clear social and humanitarian interest, the recipients of the funds are singularized as they are all the autonomous communities and the cities of Ceuta and Melilla through the Institute of Health Management (hereinafter INGESA), in the field of whose health services are to be developed, all of which determines the need to approve this royal decree in accordance with the provisions of articles 28.3 of Law 38/2003, of 17 November, General of Grants, and 67 of its Rules of Procedure, approved by Royal Decree 887/2006, 21 of July.

Taking into account all of the above, the Ministry of Health and Social Policy intends to develop a coordinated initiative with the autonomous communities and the cities of Ceuta and Melilla through the INGESA in the context of strategies in palliative care, patient safety, prevention of gender-based violence, and care for normal delivery throughout the financial year 2009.

With the granting of the subsidies regulated in this royal decree, the aim is to promote the objectives set out for each of the strategies through the actions envisaged for each of them in the annexes.

In its virtue, on the proposal of the Minister of Health and Social Policy, prior to the report of the Minister of Economy and Finance and after deliberation of the Council of Ministers at its meeting of May 29, 2009,

DISPONGO:

Article 1. Object.

This royal decree aims to regulate the direct grant of subsidies to those autonomous communities and cities of Ceuta and Melilla, through the Institute of Health Management (hereinafter INGESA), which participate in the implementation of the strategies of the National Health System in palliative care, patient safety, prevention of gender-based violence and care for normal delivery in 2009.

Article 2. Concession procedure.

1. The subsidies regulated by this royal decree are singular in accordance with the provisions of Articles 22.2.c) and 28.2 and 3 of Law 38/2003 of 17 November, General of Grants, in the light of the special interest of the implementation of the strategies provided for in the previous article, and because of the impossibility of its public call, for being the autonomous communities and the cities of Ceuta and Melilla through INGESA the only possible beneficiaries.

2. The concession will be made directly by resolution of the Director General of the Quality Agency of the National Health System. The resolution shall establish the form of entry, where appropriate, of the amounts voluntarily returned by the beneficiaries.

Article 3. Legal regime.

The subsidies regulated in this royal decree will be governed, in addition to what is established by this rule, as provided for in Law 38/2003, of 17 November, General of Grants, and in the Regulations of Law 38/2003, of 17 of November, General of Grants, approved by Royal Decree 887/2006, of July 21, except in that it affects the principles of advertising and concurrency, as well as for the other norms of administrative law that result from application.

Article 4. Beneficiaries.

They will be beneficiaries of the subsidies regulated in this royal decree the autonomous communities and the cities of Ceuta and Melilla through the Institute of Health Management (INGESA).

Article 5. Obligations of the beneficiaries.

The beneficiaries will be subject to the obligations laid down in Article 14 of Law 38/2003 of 17 November, General of Grants and, in particular, the following:

(a) Carry out the action or actions which for the development of the activity or activities, from among those specified in the Annexes, Annex II activities subject to the grant relating to the palliative care strategy, Annex III activities covered by the grant on the strategy for patient safety, Annex IV activities covered by the grant concerning the strategy for the prevention of gender-based violence and Annex V activities covered by the grant on the strategy of care for normal delivery in the National Health System, the beneficiary has undertaken to carry out in the memories referred to in Article 9, the subject of the grants being fulfilled where the beneficiary accredits the destination of the funds received for those activities. Beneficiaries will be able to opt for all or some of the four eligible strategies provided, with as many reports as grants apply.

(b) Submit the relevant justification in accordance with the terms set out in Article 9 for each of the strategies for which they are intended.

Article 6. Funding.

These grants will be financed from the budget of the Ministry of Health and Social Policy for the year 2009, for which the appropriate budgetary changes will be processed, and its allocation will amount to 16,000,000 EUR 4,000,000 per each of the four eligible strategies is foreseen, with a maximum of EUR 4,000,000.

Article 7. Amount of the grants.

The amount of each of the grants related to strategies in palliative care, patient safety and gender-based violence prevention will be distributed according to the last population data of the Padron Council Regulation (EC) No 2124/2008 of 26 December 2008 declaring the population figures resulting from the review of the Municipal Register of 1 January 2008, as detailed in Annex I to this Royal Decree No 2124/2008 of 26 December 2008 decree. In the case of the normal delivery strategy, the distribution criterion will be based on the births that appear in the last data of natural movement of the population published by the INE and listed in the same annex.

Article 8. Procedure and time limits for the submission of applications.

The beneficiaries will present a memory of activity for each eligible strategy to which they choose, which will detail the activity or activities to which the funds will apply, from those listed in the annexes to this real Decree: Annex II palliative care, Annex III patient safety, Annex IV gender-based violence prevention and Annex V normal birth care. The presentation of the memory shall imply acceptance of the grant. The responsible declaration set out in Annex VI shall also be accompanied by such essential requirements for the concession. The documentation must be presented in the general register of the Ministry of Health and Social Policy within a maximum of 30 calendar days from the following to be published in the "Official State Gazette".

Article 9. Payment of the grants and justification scheme.

1. The payment of the funds by the Ministry of Health and Social Policy shall be made at one time, once the concession has been made, and on presentation by each beneficiary of a detailed memory of the activity or activities to which the apply the funds, from those listed in Annexes II, III, IV and V to this royal decree, which shall imply acceptance of the grant awarded.

2. The beneficiaries shall, before the General Directorate of the Quality Agency of the National Health System, justify the investments made during the year 2009 by the presentation of the supporting account, as provided for in Article 72 of the Royal Decree 887/2006 of 21 July, which will contain a statement of reasons for the implementation of the activities under grant and an economic memory of the expenditure incurred. Both memories will be signed by the top managers in each area. The expenditure incurred, for the purpose of these grants, shall be eligible as from 1 January 2009. In addition, for the purposes of the justification of expenditure incurred, the expenditure deficit in one activity with the excess expenditure of another may be offset.

The final deadline for the submission of the supporting account shall be 31 March 2010.

3. The beneficiaries may proceed with the voluntary return of the amounts received, as provided for in Article 90 of the Royal Decree 887/2006, of 21 July, by way of their entry into the Treasury, in writing by the granting body. identifying the corresponding expenditure file, the number of accounting transactions with which the payment was made, and the year and its budgetary implementation; and subsequently the Ministry of Health and Social Policy (Deputy Director General of Financial Management, Directorate-General for Human Resources and Economic and Budgetary Services, Paseo del Prado, 18-20, 28014 Madrid). When the voluntary return occurs, the Administration will calculate the interest for late payment in accordance with the provisions of Article 38 of Law 38/2003 of 17 November, General of Grants, and until the time when the effective return by the beneficiary.

Article 10. Refit.

The refund of the grant will be required, with the interest of the corresponding delay from the moment of payment of the grant, in the cases and in the terms provided for in Articles 36 to 43 of Law 38/2003, of 17 November, General of Grants.

Final disposition first. Competence title.

This royal decree is issued in accordance with the provisions of Article 149.1.16 of the Constitution, which gives the State exclusive competence in the field of basic and general health coordination.

Final disposition second. Entry into force.

This royal decree will enter into force on the day following its publication in the "Official State Gazette".

Given in Madrid, 29 May 2009.

JOHN CARLOS R.

The Minister of Health and Social Policy,

TRINIDAD JIMENEZ GARCIA-HERRERA

ANNEX I

Distribution of the amount of grants related to palliative care strategies, patient safety, and gender-based violence prevention

Cantabria

Autonomous Community	Population	Percentage of the total	Maximum Euro Grant Cuantia
Total	46.157,822	100.00	4.000,000.00
Andalusia	8.202.220	17.77	710.797.84
Aragon	1.326.918	2.87	114.989.65
Asturias (Principality of)	1.080,138	2.34	93.603.90
Balears (Illes)	1,072,844	2.32	92.971.80
Canary	2.075.968	4.50	179.901.73
582.138	1,26	50.447.61
2.557.330		5.54	221,616.18
2.043,100		4.43	177.053.41
Catalonia	7.364.078	15.95	638.165.12
	Valencian Community	5.029,601	10.90	435.861.21
Extremadura	1.097,744	2.38	95.129.62
Galicia	2.784.169	6.03	241.273.86
Madrid (Community of)	6.271.638	13.59	543,495.14
Murcia (Region of)	1,426.109	3.09	123.585.47
Navarre (Foral Community of)	620.377	1.34	53,761.38
	Basque Country	2.157.112	4.67	186.933.60
(La)	317,501	0.69	27,514.38
(via INGESA)	77.389	0.17	6.706, 47
(through INGESA)	71,448	0.15	6.191.63

Distribution of the amount of the grant relative to normal delivery care

Community	MNP O7	Percentage of the total	Maximum Euro Grant Cuantia
	Births
Total	492,527	100.00	4.000,000.00
Andalusia	96,387	19.57	782.800.00
12.912	2.62	104,800,00
Asturias (Principality of)	7,956	1.62	64,800,00
Balears (Illes)	11,871	2.41	96.400.00
Canary	19.667	3.99	159.600,00
Cantabria	5.286	1.07	42,800,00
y Leon	20,060	4.07	162.800,00
Castilla-La Mancha	19,980	4.06	162.400.00
	Catalonia	84.173	17.09	683.600,00
Valencia Community	54,520	11.07	442.800.00
Extremadura	10.172	2.07	82,800,00
Galicia	21,833	4.43	177,200,00
Madrid (Community of)	75,524	15.33	613.200.00
Murcia (Region of)	18.617	3.78	151,200,00
Navarra (Community )	6.616	1.34	53,600,00
Country Basque	20,876	4.24	169.600,00
Rioja (La)	3.269	0.66	26,400.00
Ceuta (through INGESA)	1,476	0.30	12.000.00
(through INGESA)	1,332	0.27	10.800.00

ANNEX II

Activities subject to the Palliative Care Strategy grant

Beneficiaries will be able to allocate funds to all or any of the actions specified in each of the following lines of activity, not being necessary to undertake actions in all the activities provided for in this Annex.

1. Information:

1. Activities and information materials for general population and professionals on resource maps.

2. Information to caregivers and family members of patients on the most frequent and predictable problems based on the diagnosis and stage of the disease.

2. Training:

1. Train healthcare professionals, both primary and specialty, in knowledge and skills to improve the quality of care for patients in the advanced or terminal stages of their disease.

2. Training in palliative care for caregivers.

3. Support: Implement systems of support and supervision in the emotional and group-relational aspects of professionals working with patients in advance/terminal phase.

4. Research: To include specific lines and finalists for research projects related to palliative care in the research calls.

5. Information Systems:

1. º Integrate and make accessible all information related to a patient in terminal phase.

2. Establishment of information systems for the measurement of indicators of the strategy especially oriented to clinical and process results.

ANNEX III

Activities that are the subject of the patient safety strategy grant

Beneficiaries will be able to allocate funds to all or any of the actions specified in each of the following lines of activity, not being necessary to undertake actions in all the activities provided for in this Annex.

1. Prevention of infection related to healthcare (IACS) with actions especially directed to:

1. Promote proper hand hygiene in care centers through actions recommended in the AMSP/WHO campaign.

2. Prevention of infection associated with the insertion of central venous catheters in the ICU through recommended actions in the "Bacteriemia zero" project, which is carried out in collaboration with the AMPS/WHO.

2. Preventing adverse events associated with:

1. Drug use (especially the use of antimicrobials and high-risk drugs) in primary care and specialized care.

2. Surgery and anesthesia, especially through the actions recommended by the AMSP/WHO in your campaign: "Safe surgery saves lives".

3. Care for chronic patients and those who need palliative care.

4. Nursing Care, especially prevention of falls in patients admitted, UPP and care for chronic patients.

5. Attention to the mother and the newborn.

6. Transmission of information between professionals and communication with patients and families.

3. Promote the formation of patients through the Training Patient Network.

ANNEX IV

Activities subject to the grant of the gender-based violence prevention strategy

Beneficiaries will be able to allocate funds to all or any of the actions specified in each of the following lines of activity, not being necessary to undertake actions in all the activities provided for in this Annex.

1. Training of healthcare professionals following the common quality criteria and educational objectives approved by the Interterritorial Council of the National Health System in December 2007.

2. The inclusion of the health indicators of gender-based violence in the service portfolio or in management contracts or similar figure, as well as the incorporation of the variables necessary for their production and implementation in history digital clinic.

3. Awareness of the fundamental lines of the Common Protocol for health action to gender-based violence between managers and managers of the management and management of health and health services health planning in their territories.

4. Intrananitary coordination plans in each autonomous community for comprehensive health care for gender-based violence (mental health, primary and specialized care, family medicine), and design coordination and monitoring of this care among the different health care levels of the health services of the National Health System.

5. The methodology and tools for the evaluation of health actions in the field of gender-based violence: evaluation of the implementation of the common protocol and the training programs of professionals.

6. Gender-based violence programs for the most vulnerable women (migrated women, women with disabilities, rural women).

7. Health Action Programs in the face of gender-based violence aimed at the daughters and children of women who suffer from gender-based violence.

8, "Plans and programmes and experiences of good practice of coordinated action between health services and local administration and civil organisation (women's and women's associations) for the health approach" psychosocial of women suffering from gender-based violence and their daughters or persons in their care.

ANNEX V

Activities subject to the grant strategy for the normal birth care strategy in the National Health System

Beneficiaries will be able to allocate funds to all or any of the actions specified in each of the following lines of activity, not being necessary to undertake actions in all the activities provided for in this Annex.

A) Training of professionals: It is considered a priority to carry out training actions that update the knowledge and skills of midwives, obstetricians, pediatricians and other health personnel, to base their practices on current scientific evidence and improve the quality of birth care and birth care. They will be as follows:

1. Develop the Forming Programme as established by the Technical and Institutional Committee of the National People's Congress (NPC) Strategy (agreed by the Training Working Group), disseminating its contents, training materials and support, with the objective of providing continuity and harmonisation to training in the whole of the National Health System.

2. To continue practical training through short stays in good practice centres.

3. To conduct meetings and training sessions, and coordination between AP and AE, to give continuity to the attention in the process, and to make the plans of Parto and Birth viable.

B) Realization of Good Clinical Practices: In order to implement the EAPN recommendations in an effective manner and to consolidate the good practices initiated, a relevant action is considered:

1. Adecuate the care protocols for delivery and birth care to the recommendations of the EAPN, to ensure the incorporation of clinical practices based on the best available knowledge and to eliminate from routine flagged as unnecessary or harmful.

2. Provide appropriate environments with privacy during labor, and the necessary equipment to ensure continued monitoring, the use of different methods and techniques for pain relief and adoption of the position the woman wants.

C) Monitoring and evaluation: With the objective to know and share information and to be able to carry out and evaluate the EAPN, it is considered necessary:

Implementation of indicators of clinical practices and systems of registry, as established by the Technical and Institutional Committee of the National People's Congress (NPC) Strategy (agreed by the Indicators Working Group), to collect the Basic and systematic information, monitoring and evaluation of the APN Strategy, and understanding and comparing the care that women and creatures receive in the National Health System, detecting good practices.

D) Dissemination and Awareness: To develop the EAPN and to achieve the Quality Plan of the National Health System, it is proposed to carry out activities focusing on the particular needs of women, the RN and the family, such as:

1. To provide adequate information to women and their partners on the maternity, paternity and care of the RN. The importance of knowing the physiology of childbirth, the physical and psychological changes in the process and actions to prevent the possible problems and risks associated with these situations.

2. Set channels for the participation and involvement of parents (couples) in the process of pregnancy, childbirth and puerperium, as well as in the co-responsibility in the raising of the RN creature.

3. To disseminate the EAPN to the general population, women's groups and health workers, through workshops, seminars, campaigns, dissemination brochures, the reissue of the APN strategy paper and other actions aimed at to provide a favourable social climate for understanding the importance and significance of the APN Strategy.

ANNEX VI

Responsible Statement

Don/dona. ......................................................., with ID number .............., as (the position of the maximum responsible for the economic area): ..................................................., of the Autonomous Community of ......................................................

In accordance with the provisions of Article 24 (6) of Royal Decree 887/2006, of 21 July, approving the Regulation of Law 38/2003 of 17 November, General of Grants,

Express and Responsible Statement Formula

That the Autonomous Community is aware of its tax and social security obligations imposed by the legislation in force, in accordance with the provisions of Law 38/2003 of 17 November, General de Grants.

It is also manifest that it complies with the requirements imposed by Article 13 of Law 38/2003, General of Grants, to obtain the status of beneficiary.

In ......................................, to ............... of ........................... of 2009

Fdo.: .........................................................