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This article analyses the 2019 local, regional, European and April general elections in Spain. The constitutional crisis in Catalonia in 2017, the motion of no-confidence leading to the new Socialist government and the emergence of a radical right-wing party, VOX, all led to Spanish politics becoming more polarised. This paper also discusses polarisation from both the left-right and the territorial perspectives, intimately linked in Spain both for historical reasons but also because of agency decisions during the period analysed. Finally, the article shows the electoral results, government formation processes and political implications of polarisation in a non-institutionalised party system.

In this article I address the impact of decentralisation on the nationalisation of party systems. Many scholars have argued that when a country decentralises, candidates have greater incentives to compete locally and party system nationalisation is eroded. However, the empirical results are inconclusive, particularly in Western European countries, so it is necessary to revisit this causal link. My argument is that the impact of decentralisation on the nationalisation of party systems is conditional on the extent to which electoral law encourages personal voting.When electoral laws are candidate-centred, party labels are not very relevant in politicians' (re-)election; this makes candidates more likely to compete locally in a decentralised country and to weaken party system nationalisation. Through two different indices of nationalisation and statistical techniques, I test the robustness of this argument by drawing on data from national legislative elections held in seventeen Western European countries. The evidence confirms the main argument as well as the de-nationalising effect of ethnic fragmentation and district magnitude.

RESUMENLas organizaciones sanitarias han pasado de estar centradas en los profesionales a poner en el centro a los usuarios y sus expectativas. Las nuevas instituciones de salud quieren conocer la percepción de los pacientes sobre la calidad de la atención que reciben, en particular sobre la información recibida, el consentimiento y la toma de decisiones. Es necesario disponer de instrumentos de medida que exploren los distintos componentes del proceso de información, consentimiento y toma de decisiones.Fundamento. Identificar las dimensiones relacionadas con el proceso de información, consentimiento y toma de decisiones más importantes para los pacientes y susceptibles de ser evaluadas a través de un cuestionario.Sujetos y método. Personas mayores de edad que hayan estado hospitalizadas al menos dos días. Estudio cualitativo de entrevistas semiestructuradas.Resultados. Los participantes desean ser informados y participar en la toma de decisiones, no conocen el significado de la carta de derechos de los pacientes, desean compartir con la familia todo el proceso asistencial, la información escrita les resulta incomprensible y sienten que no se atiende convenientemente su dolor y malestar.Conclusión. Conviene incluir las siguientes dimensiones en los cuestionarios sobre satisfacción: a) posibilidad de aclaración de dudas, b) conocimiento real de los derechos y deberes de los pacientes, c) participación de la familia en el proceso asistencial, d) continuidad del mismo informador a lo largo de la hospitalización, d) grado de comprensión de la información escrita, e) implicación en la toma de decisiones y f) atención al dolor y al malestar. ABSTRACTThe health organisations have moved from being centred on the professionals and are now centred on users and their expectations. The new health institutions want to know patients' perception of the quality of the care received, with particular respect to the information received, consent and decision making. It is necessary to have available measuring instruments that explore the different components of the process of information, consent and decision making.Background. To identify the dimensions related to the process of information, consent and decision making of most importance to patients and susceptible to evaluation by questionnaire.