Waiting times for scheduled surgery in the Portuguese national health service will have only two priority levels starting tomorrow (Thursday), according to an order published today which doubles the wait for the most serious surgical cases.
Similarly, first specialist consultations for oncological diseases will shift to two levels: high priority (seven days) and priority (30 days) – replacing the previous three levels of 7, 15, and 30 days.
The order published today in Diário da República (official government gazette), signed by Health Minister Ana Paula Martins, specifies that only the wait for the first hospital specialist consultation referred by primary care – excluding Oncology and Cardiology – will maintain the usual three levels: high priority (30 days), priority (60 days), and normal (120 days).
First cardiology consultations previously set a maximum guaranteed response time (TMRG) of 15 days for priority patients. This now applies only to high priority patients. Priority patients now face a TMRG of 30 days – a limit previously defined for ‘elective patients.’
Scheduled surgery undergoes the most significant change, particularly in oncological and cardiac procedures.
Oncological surgery previously had a ‘high priority’ TMRG of 15 days. Under the new two-level system, priority and normal, the fastest response is now twice that (30 days). The second level has a TMRG of 60 days.
The provision for a 72-hour TMRG for “deferred urgency” cases disappears completely from scheduled surgeries for all cancers.
Scheduled surgery for heart disease will no longer follow the previous four-tier system, either. This structure included a TMRG of 72 hours for deferred urgency, 15 days for high priority cases, 45 days for priority, and 90 days for normal priority. The new system establishes only two levels: 30 days for priority patients and 90 days for normal priority cases.
In all other specialities, the 72-hour TMRG for “deferred urgency” also disappears. The remaining three tiers (15, 60, and 180 days) become just two: priority (30 days) and normal (180 days).
Institutions must ensure that all episodes with altered priority levels are adjusted within a maximum of 60 days after this order takes effect, according to the document published today.
The measure adapts TMRGs to the National System for Access to Consultation and Surgery (SINACC) and the current operating conditions of the national health service (SNS).
The ordinance regulating SINACC, published on Tuesday, states that the registration of patients for their first speciality consultation or surgery must be electronic to guarantee priority and compliance with deadlines.
Referral for a first hospital speciality consultation must now be made electronically. The system prohibits duplicate referral requests for the same patient, with the same speciality and primary diagnosis, across multiple provider entities.
The regulation establishes that the registration of patients on the list for a First Hospital Speciality Consultation (LPCH) must occur after clinical referral validation. This process must respect the TMRG applicable to the assigned clinical priority.
Medical staff must register patients on the Surgical Waiting List (LIC) after the responsible doctor validates the surgical proposal, provided the patient is available and clinically fit for the procedure.
“The ordering of patients on the waiting list follows the assigned clinical priority and, in the event of a tie, the registration date, with the oldest request prevailing,” the ordinance says. The proposing doctor holds responsibility for defining the clinical priority.
Clearly, these changes have been designed to help show the national health service performing better, on paper. As to whether it will be helping people who need timely treatment, the debate will no doubt begin. It needs to be remembered that TMRGs are rarely adhered to in normal practice: health service users have been known, for years, to have to wait years for a hospital consultation, not months.
Source material: LUSA
