Ayuso’s Government Under Scrutiny: Internal Audit Reveals “Breaches” and “Errors” in Public-Private Hospital Management
Madrid, Spain – The economic and budgetary management of seven public-private hospitals in the Community of Madrid, under the administration of Isabel Díaz Ayuso, is riddled with “deficiencies” and “errors.” This is the damning conclusion of an internal audit report by the Regional Audit Office, to which EL PAÍS has gained access. The report, covering the period from January 2021 to August 2024, scrutinizes centers in Majadahonda, Parla, Coslada, San Sebastián de los Reyes, Arganda del Rey, Aranjuez, and Vallecas, which collectively billed the administration 563,894,273.65 euros between 2021 and 2023.
The “Tailored” System: How Public Funds Flow to Private Hands
These hospitals, built by private companies, are utilized by the public health system in exchange for an annual payment from the administration to the concessionaire, who also profits from commercial areas within the facilities. The audit reveals a troubling pattern of irregularities, including essential procedures not being followed when approving financial rebalancing requests from concessionaires, millions spent on works processed “contrary to legal provisions,” and invoices that should never have been paid by the administration.
Madrid boasts a dozen such public-private partnership centers, established during Esperanza Aguirre’s tenure (2003-2012). While some, like Valdemoro, Villalba, and Móstoles (managed by Quirón) and Torrejón (by Ribera Salud), involve private companies managing medical services, the audit focuses on the seven hospitals where the construction company solely manages non-healthcare services. These latter seven receive an annual payment and can request financial rebalancing if they believe service or infrastructure improvements disrupt the original agreement.
A Disturbing Lack of Accountability
The Audit Office’s summary of the internal report indicates that this formula is not functioning correctly. Crucially, the Díaz Ayuso administration did not contest the findings – a decision that deeply concerned the three auditors who signed the report. They lament the lack of response: “No statement of allegations has been received, nor is there any record that measures will be adopted to rectify weaknesses and breaches.”
The Audit Office highlights several “deficiencies in economic and budgetary management,” including:
- Errors in budgetary allocation for the canon and expenses unrelated to the contract (extraordinary services, COVID-19, etc.).
- Lack of prior processing for contractual modifications and economic rebalancing.
- Actions taken without prior expediente and subsequently validated.
- Deficiencies in the accounting follow-up of concession assets and inventory management.
- Insufficient control of guarantees, policies, and insurance required from concessionaires.
- Lack of sufficient control over commercial operations in the private management areas of the hospitals.
A History of Controversial Decisions
Esperanza Aguirre, the architect of this model, was known for her strong opinions on hospital design. Famously, she ordered the removal of 135 beds from the Puerta de Hierro hospital in Majadahonda to convert double rooms into single ones. A decade later, Ayuso’s government had to compensate the concessionaire for this change.
The opposition argues that this system of constantly revised payments disproportionately penalizes the purely public health system, which lacks the same decision-making and funding capabilities, making it impossible to ascertain the true public cost of each concession.
Overpayments and Legal Breaches
The audit confirms that the Majadahonda case is not an isolated incident. The Audit Office has raised numerous objections to expenditures made between 2021 and 2024, particularly concerning concessionaires’ requests for indemnification (economic rebalancing) for unforeseen expenses and improvements. The auditors found that in these cases, “no mandatory contractual modification file was initiated prior to the material execution of the actions,” meaning “essential procedures such as hearing the concessionaire or obtaining reports from the Legal Service and the Consultative Council were not complied with.”
Conversely, the auditors also discovered instances of overspending due to the Community’s actions, which altered the contract’s balance but were paid periodically without modifying the agreement. This practice, they state, “distorts economic-financial information and contract transparency.”
Furthermore, the auditing body detected that concessionaires invoiced for works not included in rebalancing files, amounting to at least 10.9 million euros. The report emphatically states: “At least a portion of the works paid for should have been executed, from a legal and contractual point of view, as an obligation derived from the contract or a risk and venture of the concessionaire companies, and therefore, remunerated through the concession canon without the right to additional compensation.” In essence, Madrid should not have paid any extra amount. Worse still, some of these works were carried out “omitting the mandatory prior fiscalization and other essential procedures… which may imply a reduction of the legal guarantees that must govern administrative action in public procurement.”
EL PAÍS has sought clarification from the Community of Madrid but has not received a response at the time of publication.
Unanswered Questions
The internal audit raises critical questions that demand immediate answers:
- Why were essential procedures for financial rebalancing requests consistently ignored?
- How were millions of euros spent on works that violated legal provisions?
- What measures will be taken to address the “deficiencies” and “errors” identified in the management of these seven hospitals?
- Why did the Ayuso administration fail to submit any allegations or commit to rectifying the identified weaknesses?
- Who is ultimately accountable for the apparent mismanagement and lack of transparency in these public-private partnerships?
The findings of this audit paint a concerning picture of financial irregularities and a systemic lack of oversight within Madrid’s public-private hospital model. The public deserves to know how their money is being spent and whether the current system truly serves the best interests of the community’s healthcare needs.
