By Royal Decree-Law 36/1978, the National Institute of Health is established, establishing that, under the supervision of the Ministry of Health and Social Security, it will carry out the functions of management and administration of the services Social Security Health Care (Article 1, 1 and 2 of the Royal Decree-Law).

Since the date of the creation of the National Institute of Health, there have been a series of norms aimed at adapting the administrative structure of the health services of Social Security, managed by the aforementioned Managing body, in order to adapt it to the organizational changes of the State Administration, as well as to the process of transfers of services to the Autonomous Communities. To this end, the Royal Decrees 1855/1979 of 30 July 1979, 94/1984 of 11 January and 1726/1985 of 24 September 1979 are approved. Law 14/1986, of 25 April, General of Health, which aims at the creation of the Health Services of the Autonomous Communities, establishes a new management of health services, based on a comprehensive conception of health and health care, as well as the obligation to ensure their quality at the various levels of care.

The third paragraph of the General Health Law, paragraph 1, states that the National Institute of Health will continue to subsidize and exercise the functions it has attributed, as long as the the process of transferring them to the Autonomous Communities.

The final provision of the General Health Law authorizes the Government to adapt the structure and functions of the Agencies and Entities attached to the Ministry of Health and Consumer Affairs and, among them, the National Institute of Health Health to the principles set out in it. The second paragraph of Article 1 (2) of Regulation (EEC) No No 1 of the European Parliament and of the Council of the European Parliament and of the Council of the European Parliament and of the Council of the European Communities the provisions of the General Health Law.

Adapted, by Royal Decree 1943/1986, of September 19, the structure of the Central Services of the National Institute of Health to the ordination provided for in the General Law of Health, the peripheral organization of the managing entity.

This Royal Decree aims at the peripheral reorganization of the services managed by the National Institute of Health. Therefore, the scope of the standard only applies to health care services of social security which are not yet transferred to the Autonomous Communities. Its main objective is to adapt the spatial planning of the health services of the Social Security managed by the National Institute of Health to that carried out by the Autonomous Communities in development of the provisions of the General Law In the case of health, until such time transfers are made to the Communities. This will enable the effective articulation of the provisions of the third paragraph of Article 3 (3) of that Law to be made possible.

In addition, mechanisms for effective and efficient citizen participation in the control of the peripheral management of the National Institute of Health will be arbitrated.

In its virtue, on the proposal of the Ministers of Health and Consumer Affairs and for the Public Administrations, prior to the favorable report of the Interterritorial Council of the National Health System, according to the State Council deliberation of the Council of Ministers at its meeting on 27 April 1990

DISPONGO:

Article 1. º

1. This Royal Decree will apply to health services managed directly by the National Institute of Health.

2. The Sanitary Sectors mentioned in this Royal Decree will coincide, in terms of their territorial demarcation, with the Health Arcas demarcated by the Autonomous Communities, in compliance with the provisions of Article 56 of the Law 14/1986, General of Health.

3. In order to achieve an integrated operation of the health services within the territorial demarcations referred to in the preceding paragraph, the State may conclude agreements and agreements with the Autonomous Communities in accordance with the provisions of the established by the third paragraph of Law 14/1986, General Health, third paragraph.

4. By virtue of what is established in the conventions mentioned in the previous paragraph, the Autonomous Communities may collaborate in the management of the National Institute of Health, through the Commissions of Management that are regulated in Articles 3. 2 and 4. º 3 of this Royal Decree.

5. In addition, and in the framework of the conventions referred to in paragraph 3 of this Article, the Autonomous Community may be responsible for the management of those Health Sectors linked to a general hospital whose ownership and appropriate administration.

Art. 2. º

1. In the peripheral area, the management of the National Institute of Health will be carried out through:

The Territorial Addresses, existing one for each Autonomous Community that has not assumed the transfer of the health care services of the Social Security.

Sector Addresses, dependent on the Territorial Directorate, one for each Health Sector.

2. The Territorial Directorate, under the general coordination of the Government Delegation in the corresponding Autonomous Community, will assume the responsibilities of management, supervision and coordination of the National Institute of Health, representing the a body in the field of the respective Autonomous Community, as well as those delegated to it by the various bodies of the Ministry of Health and Consumer Affairs.

3. The Territorial Directors shall be appointed by the Minister for Health and Consumer Affairs, or the Autonomous Community concerned.

4. The Directorate of Sector shall perform the functions of management, management and evaluation of all the activities of the Sector, as well as those delegated by the different organs of the Ministry of Health and Consumer Affairs.

Art. 3. º

1. The management structure of the Territorial Directorate of the National Institute of Health will be adapted to the characteristics of each Autonomous Community.

2. The Territorial Director shall be assisted by a Management Committee, in which the Directors of Sector shall be integrated, and the representation of the Autonomous Community, as agreed in accordance with Article 1. 4.

3. The tasks of the Directorate-General shall be to provide advice to the Territorial Director at:

a) The coordination of the plans and actions of the National Institute of Health in the territorial area of the Autonomous Community.

b) The elaboration of the proposal for the preliminary draft budget of the National Institute of Health in the aforementioned territorial scope.

c) The proposal for the distribution of resources among the different Healthcare Sectors.

d) The coordination of personnel policies, concerts, purchases and supplies in the territorial area of the corresponding Autonomous Community.

Art. 4. º

1. The management structure of the Sanitary Sector will be adapted to the characteristics of the Health Sector and to the complexity of primary care and specialized care services.

2. Each Healthcare Sector will have a primary care and specialist care management team.

3. The Director of Sector will be assisted by a Management Committee, in which members of the management teams of the specialized and primary care assistance will be integrated, and the representation of the Autonomous Community, as appropriate. in application of Article 1. 4.

Art. 5. º

1. The management structure of primary care, under the top management of the Management or, failing that, of the Medical Directorate, will be adapted to the characteristics of the Health Sector and the complexity of the health care services primary located on the same.

2. The Primary Care Medical Director will organise the care activity of primary care health services, through the Primary Care Team Coordinators.

3. The Primary Care Team Coordinator will be responsible for the organization of health activities in the area of the Health Zone.

Art. 6. º

1. The management structure of the specialized assistance, under the top management of the Management or, failing that, of the Medical Directorate, will be adapted to the characteristics of the Health Sector and the complexity of the health services of specialized assistance located in the same.

2. The Medical Director of the Specialized Assistance will organize the care activity, both outpatient and interment, of the services of specialized assistance of the Health Sector, through the Heads of Service or units lower than the Service.

Art. 7. º

The Directors of the Sector will be appointed by the Minister of Health and Consumer Affairs, upon convocation to be published in the "Official State Gazette".

Art. 8. º

1. The Territorial Directorates of the National Institute of Health are created with the organic level of Subdirección General:

Castilla-La Mancha.

Aragon.	Extremadura.
Asturias.	Galicia.
Balearics.	Madrid.
Canary Islands.	Murcia.
Navarre.	Navarra
La Rioja.
Castilla y Leon.

2. With the organic level of Subdirección General, the figure of General Coordinator of the Territorial Addresses is created, which, under the dependency of the Director General of the National Institute of Health, will have as functions the following:

a) Coordinate the activity of the Territorial Addresses of the National Institute of Health with the policy and guidelines that emanate from the General Direction of the managing entity.

b) Canalize the problems of the Territorial Addresses to the functional units of the Central Services of the National Institute of Health.

c) Represent, if appropriate, the Directorate General of the National Institute of Health in the General Coordination Commissions with the Autonomous Communities for health care.

Art. 9. º

1. In order to articulate the participation of the Trade Unions and Business Organizations in the operation of the National Institute of Health, the National Health Institute's Territorial Executive Commissions will be created, which will be integrated by nine Vocals:

a) Three on behalf of the Ministry of Health and Consumer Affairs.

b) Three representing the most representative trade unions.

c) Three representing the most representative business organizations.

2. In accordance with the procedure to be established, the Territorial Executive Commissions shall perform the following functions:

Supervise and control at the level of the Territorial Directorate the fulfillment of the agreements of the General Council of the National Institute of Health.

Propose the measures that are considered suitable for the improvement of management, including how many plans and programs are considered necessary for this purpose in the field that is proper to them.

3. He will be President of the Territorial Director of the National Institute of Health.

The Territorial Executive Committee shall meet monthly or, with extraordinary character, at the request of its President or at the request of one-third of its components, at the time they require it.

Art. 10.

1. At the Sanitary Sector level, the Citizens ' Participation Commissions are created, as a body for community participation in the programming, control and evaluation of the management and quality of the assistance provided by the National Institute of Health in the health sector.

2. The composition of the Citizen Participation Commission in the Health Sector will be as follows:

a) The Director of Sector, who will be its President.

b) Two representatives of the management teams of the Sanitary Sector, one of primary care and one of specialized assistance.

c) Three Vocals designated by the Autonomous Community.

d) Three Vocals designated by the Health Sector Councils.

e) Three Vocals appointed by the Health Sector Staff Board.

f) In case of a University Hospital in the area of the Sanitary Sector, a representative appointed by the University Government Board.

g) A Vocal designated by the Trade Union Organizations represented in the Territorial Executive Committee of the National Institute of Health.

h) A Vocal designated by the Business Organizations represented in the Territorial Executive Committee of the National Institute of Health.

i) Three Vocals designated by the Health Sector Consumers and Users Organizations.

3. The following functions are the responsibility of the Committee on Citizens ' Participation in the Health Sector:

a) To know and elaborate proposals on the programs of assistance of the National Institute of Health in the Health Sector.

b) Know and elaborate proposals on the economic programs of the National Health Institute in the Health Sector for each financial year.

c) Know and report the Annual Report of Management of the National Institute of Health in the Health Sector.

e) Receive information and raise proposals on personnel policy, the general policy of concerts of services with other entities, public or private, as well as the relative to purchases and supplies of the National Institute of Health in the Health Sector.

f) To propose to the management bodies of the Sanitary Sector the adoption of all measures considered appropriate for the adequacy of the activities of the National Institute of Health to the sanitary needs of the Sanitary Sector and, in general, those related to improving the quality of care.

4. When the two-thirds of the members of the Citizens ' Participation Commission agree, the proposals drawn up by the Commission on the points mentioned in the report will be raised to the National Health Institute's Territorial Directorate. Previous paragraphs, as well as others that refer to the management of the Sanitary Sector.

5. The Committee on Citizens ' Participation in the Health Sector will meet four times a year in an ordinary session, as well as, in extraordinary session, as many times as is necessary in the opinion of its President or at the reasoned request of the majority of its members. members.

The Secretary of the Commission, who shall not have a voice or vote in his meetings, shall be appointed by the Director of the Sector among the staff assigned to him.

TRANSIENT PROVISIONS

First.

The implementation of the management structure of the Health Sectors shall be carried out in accordance with the provisions of Article 1 (2) and (3) of this Royal Decree, progressively by means of the Ministry of Health and Consumer Affairs, prior to the mandatory report of the Ministry of Economy and Finance, as soon as it represents an increase in public expenditure, in which the management structure of the Sectors and the management teams of primary care will be fixed and specialised assistance.

Second.

Once the structure of management of the Health Sectors, as provided for in the first article of this Royal Decree, has been established, the Provincial Directorates of the National Institute of Health will be abolished. corresponding territorial, as well as their employment relationships.

As provided for in the transitional provision of Law 37/1988 of 28 December 1988 of the General Budget of the State for 1989, the staff who are providing services in the Provincial Directorates delete will remain in the active service situation and will proceed to perform them in the Territorial Directorate or Sector Directorate, as appropriate. Such staff shall be paid from the same budgets until the templates of the Health Sectors and the employment relationships of the Territorial Directorates are approved.

Third.

1. The Primary Care Teams will be constituted and put into operation in a progressive manner, as provided for in Royal Decree 137/1984 of 11 January, of Basic Health Structures.

2. Once constituted, the places of the Primary Care Teams will be provided by offer of incorporation to the same to the staff of the corresponding Health Zone. In the event that the number of people exercising the option is higher than that of the team, and if the needs of the service are advised, they will be able to offer to this staff, for voluntary transfer, places in Primary Care Teams other Health Areas or Health Sectors, provided that they correspond to the same locality. The number of staff members who, belonging to the National Institute of Health, will be integrated into such equipment will be automatically amortized.

3. Staff who do not opt for incorporation will continue to provide services in the Health Zone, under the direction of the Primary Care Team Coordinator. Their remuneration will be adjusted, or the corresponding trade union representation, to those provided for in Royal Decree-Law 3/1987, of 11 September, and their seats will be amortized so soon they become vacant.

4. The places of Primary Care Equipment which are not provided by the system set out in point 2 above, and whose functions cannot be performed by the staff referred to in point 3, shall be provided by the procedures regulentarily established.

Fourth.

1. The seats of the Specialized Assistance Services will be provided through the offer of incorporation to the specialists of the corresponding Sanitary Sector. In the case of higher the number of people exercising the option than the specialist service, and if the needs of the service advise it will be available to this staff for voluntary transfer of services specialised in other health sectors, as long as they correspond to the same locality. The number of staff members who are integrated into the Specialized Assistance Units shall be automatically amortised.

2. Staff who do not opt for incorporation will continue to provide services in the Health Sector under the direction of the Chief Medical Officer, through the Head of Service or responsible for the relevant Specialized Assistance Unit. Their remuneration will be adjusted, or the corresponding trade union representation, to those provided for in Royal Decree-Law 3/1987, of 11 September, and their seats will be amortized so soon they become vacant.

3. The places of specialised care services which are not provided by the system set out in point 1 of this provision, and whose functions cannot be performed by the staff referred to in point 2, shall be provided by the regulatory procedures established.

Fifth.

Staff who are in a situation of excess in the quota places referred to in the previous two provisions may qualify for re-entry, with the requirements laid down in the corresponding Statutes, in accordance with Article 1 (2) of the Treaty. a vacant post of Primary Care or Service Equipment, or lower unit than the specialist assistance service, as appropriate.

REPEAL provisions

First.

In accordance with the provisions of the second paragraph of Article 3 of the Royal Decree-Law 36/1978 of 16 November 1978 on the institutional management of social security, health and employment, and with the provisions of the The second and final provisions of the General Health Law of 25 April 1986 are hereby repealed in the field of management of the National Institute of Health not transferred to the Autonomous Communities:

1. Articles 104.2, 110.1, 1 10.3, 110.4 and 121 of the recast text of the General Law on Social Security, adopted by Decree 2065/1974 of 30 May.

2. Articles 111 and 122 of the recast text of the General Law on Social Security. The effectiveness of this derogation is delayed to the effective establishment of the organic structure provided for in this Royal Decree, and to the approval of the General Regulations for the Health Sector.

Second.

Are repealed in the field of management of the National Institute of Health not transferred to the Autonomous Communities:

1. Section 1 of Chapter II, Articles 21 to 27, and the first transitional provision of Decree 2766/1967 of 16 November 1967 laying down rules on the provision of health care and the management of medical services General System of Social Security.

2. Section 2. of Chapter II, Articles 28 to 48, of Decree 2766/1967 of 16 November. The effectiveness of this derogation from the effective establishment of the organic structure provided for in this Royal Decree and the approval of the General Regulation for the Health Sector is delayed.

Third.

Articles 9 and 10 of Royal Decree 1855/1979 of 30 July 1979 on the structure and powers of the National Institute of Health are repealed. The effectiveness of this derogation is delayed by the effective establishment of the organic structure provided for in this Royal Decree.

Fourth.

Are repealed in the field of management of the National Institute of Health not transferred to the Autonomous Communities:

The Order of July 7, 1972, on the option of Specialists of Open Health Institutions of Social Security.

The Order of 24 July 1984, for which rules for the exercise of the right of option to integration in hierarchical services are given for non-medical specialists with a place of property in Sanitary Institutions Social Security Open.

Fifth.

1. Articles 8. º, 14.1 and 14.2 of the Regulation on the Structure, Organisation and Operation of Hospitals managed by the National Institute of Health, approved by Royal Decree 521/1987 of 15 April, are repealed.

2. Articles 18, 19.1 and 20 of the Regulation on the Structure, Organisation and Operation of Hospitals managed by the National Institute of Health are also repealed. The effectiveness of this derogation is delayed by the effective establishment of the structure provided for in this Royal Decree.

Sixth.

There are also, and for the management of the National Institute of Health, not transferred to the Autonomous Communities, repealed as many provisions, of equal or lower rank to that of this Royal Decree, object to the set to the same.

FINAL PROVISIONS

First.

The management of health services managed by the National Institute of Health will be regulated through a general regulation of the sector.

Second.

The Minister of Health and Consumer Affairs will dictate the precise provisions for the development of the provisions of this Royal Decree.

Third.

This Royal Decree shall enter into force on the day following that of its publication in the "Official Gazette of the State".

Given in Madrid to April 27, 1990.

JOHN CARLOS R.

The Minister of Relations with the Courts and the Government Secretariat.

VIRGILIO ZAPATERO GOMEZ