Country’s deep-seated public sector issues have not gone away in government turmoil
Emergency services will now prioritise the admission and triage of patients transported by ambulance and referred by INEM, according to the Executive Directorate of the health service.
In a note released yesterday, in which it justifies the need to reorganise emergency services with the refusal of many doctors to work overtime, the executive directorate warns of the possibility of “increased constraints” in A&E, appealing to patients to call the SNS24 Line (808 242 424) in case of acute illness.
In urgent or emergency situations, people should dial 112, which will forward the call to INEM.
“Given the constraints of the current situation, there may be increased constraints on access to emergency services, with the main impact on less serious cases,” warns the health service’s management entity, citing “the unwillingness shown by a significant number of doctors to work more overtime than legally stipulated”.
This issue is the crux of negotiations that have ‘gone nowhere’ with the health ministry for well over a year. What doctors’ see as government intransigence has resulted in more than 2,500 doctors in the State health service submitting ‘excuses’ (which they are legally entitled to submit) not to work beyond the statutory 150 hours of overtime per year.
In a note released on yesterday, the executive directorate “recognised that the health service is going through a ‘critical period in its existence’, saying it has been following the situation “with concern“.
The temporary reorganisation plan defined by the directorate, which foresees that until the November 18 more than 30 emergency services in various specialities will operate with limitations, is to be reviewed every week.
The directorate has also said that primary healthcare should “reorganise itself and ensure periods of unscheduled care for patients with acute pathologies, namely those sent by SNS24” and that hospital healthcare should reinforce responses to cases of “acute chronic patients”, who are already being followed up in respective hospital units, whether in unscheduled consultations, day hospitals or home hospitalisation.
When the teams of a particular speciality are limited, the directorate says they should prioritise assistance in internal and external emergencies, “contributing to the guidance of patients with greater severity/priority”, namely with regard to diagnostic strategy, therapy, prognosis definition and follow-up.
In the note, the SNS Executive Directorate also says that hospital units should “prioritise contributing to pre-hospital emergency scales”, guaranteeing the operation of 24-hour Emergency Medical Vehicles.
For its part, INEM must ensure that the roster of doctors at the Urgent Patients Guidance Centre (CODU) is reinforced, resorting, if necessary, to the cancellation or postponement of ‘non-essential activities’, the document states. Quite what these non-essential activities are is not explained.
The directorate also states that, exceptionally, under its coordination and in coordination between INEM, the Shared Services of the Ministry of Health (SPMS), hospital units and primary health care units, Health Line 24 and the CODU can refer less serious patients directly to health centres that guarantee an “adequate response to unscheduled care”.
It also advised hospitals to work intensively on referring patients to integrated long-term care, to social responses in conjunction with Social Security, to home hospitalisation solutions, day hospitals, home visits or other alternatives to improve the institution’s inpatient capacity.