New government struggles to pull floundering SNS health service into shape
Portugal’s state health service (SNS) is having yet another ‘impossibly challenging’ winter: enormous demands on A&E departments, insufficient healthcare staff, doctor shortages, lack of available beds … We have heard it all before: waiting times into the afterlife; mistakes that send exhausted parents to ‘closed’ paediatric departments; pregnant women being transported hundreds of kilometres to give birth. But this time round, the centre-right government has a plan.
The ‘Emergency and Transformation Plan for Health’ (Plano de Emergência e Transformação na Saúde), which aims to “transform” the SNS health service, is hugely ambitious, and constantly under attack. Every single measure is being met with ‘outrage’ and resistance.
Thus, the latest efforts to bring the numbers of people descending on the state health service under control have seen left-wing politicians “pressuring President Marcelo to consult the Constitutional Court”.
Instead of accepting that the health service must be remodelled in order to survive, left-wingers are citing the constitutional rights of every person to be treated in a Portuguese health unit by healthcare staff who themselves are at constant loggerheads with the government over pay and conditions.
Before Christmas, parliament approved a government proposal to limit free access to the SNS to non-resident foreigners, or those foreigners in an “irregular situation”. PS Socialists have been particularly critical of this, saying every foreigner, legalised or not, deserves free treatment – and the party has stressed that if President Marcelo does not refer the measure to the Constitutional Court before promulgating, they will appeal to the court themselves, as a parliamentary group.
Since Christmas, the government has announced that émigrés and resident foreigners on the lists of family doctors (médicos de família) in Portugal will lose their ‘right’ to this family doctor if they have not availed themselves of his or her services over the past five years.
On the face of it, it sounds ‘drastic’, but then the fact that these SNS ‘users’ are not using the health service shows that removing the right to a ‘family doctor’ may make little difference to their lives – and it might benefit the well over a million citizens without a family doctor who appear to be among the majority clogging A&E departments on high days and holidays.
The government has to start somewhere – albeit this is proving a thankless task: unions battling for ‘respect, decent pay, dignified conditions’ are forever calling for the resignation of the health minister, Ana Paula Martins. Remarkably, she has shown persistence, even brokering an agreement (just before Christmas) with the smallest union representing doctors (on a 10% pay rise up to 2027), which has nonetheless been described as “a betrayal of all doctors in the SNS health service” by the largest.
Ms Martins has consistently said she is ready to negotiate with all unions. She has even said she perfectly understands that some national health staff will want to boycott the new limits on what the government terms “abusive use of the Portuguese public health service” – but her role, she explains, is that of ‘the minister tasked with trying to fix a broken system’.
That said, reports have wasted no time in pointing out that “only nine of the 24 priority measures” set out in the Emergency Plan are on the ground and “producing results”.
The situation means that the plan’s deadlines will need to be revised. But perhaps the principal question has to be – will it ever be allowed to work? Will the opposition ever give the government space to act, or will parties always be running behind it, complaining and throwing out challenges and obstacles? Bearing in mind it is clear the SNS ‘could do so much better’, is there hope for improvement, or is it all just hopeless? Will Portugal, very much like the situation in the UK where ‘national health’ is in constant crisis, always have a miserable public health system, full of failings and labyrinthine bureaucracy?
The Emergency Plan was presented back in May and promised the “long-term and structural changes necessary for a better functioning healthcare system”.
“Valuing healthcare professionals is one of the fundamental principles of this plan, which aims to ensure the SNS’s mission as a pillar of the healthcare system. In exceptional cases, when the SNS’s response capacity is exhausted, the plan relies on partners in the social and private sectors as a complement in providing healthcare services,” the government said in a statement.
The plan consists of a total of 54 measures, of which 24 are considered priority, and were to have been implemented in full by the end of December 2024. Among the most urgent reforms were:
- Creation of a special regime for admitting doctors into the SNS with more than 2,200 vacancies, of which about 900 are for new family doctors;
- Elimination of the surgery waiting list for cancer patients;
- Creation of a surgical programme for non-oncological patients;
- Priority at A&E departments for the most severe cases and referral of less urgent cases to clinical care centres;
- Monitoring and referral of pregnant women through the SOS Pregnant Line (Linha SOS Grávida);
- Financial incentive system to increase the capacity for childbirth and strengthen existing agreements with the social and private sectors;
- Revision of the price list for agreed complementary diagnostic tests, particularly obstetric ultrasounds;
- Hiring of 100 more psychologists for health centres;
- Creation of a Mental Health Program for Security Forces;
- Freeing up beds occupied in hospital wards mainly by social cases.
And, according to the SNS website, 27 of the 54 measures have already been successfully concluded. But say that out loud, and there will no doubt be a thundering of hooves to attest to the contrary.
In August last year, President Marcelo appealed for a pact between the country’s two main parties (PSD and PS) to allow reforms within the health service – and reforms in the wider country – to be allowed to move forwards. He referred to the wealth of ‘unknowns’ in the wider world, and the fact that citizens here really only want a country that ‘works’.
“It is really fundamental that there is stability, political continuity,” he said – yet the chorus through the nation’s media is forever one of complaint and dissatisfaction, suggesting this government doesn’t have the answers, when all the governments before it didn’t have them either.
By NATASHA DONN
