Health minister Manuel Pizarro has been keeping a very low profile this summer, despite issues with the SNS health system. Image: António Pedro Santos/ Lusa
Health minister Manuel Pizarro has been keeping a very low profile this summer, despite issues with the SNS health system. Image: António Pedro Santos/ Lusa

Government challenged over ‘reform blueprint’ for health sector

CHEGA accuses executive of secretism; Doctors’ official body speaks of “greyness”

Quite apart from the government’s “great reform of the health service” coinciding with yet another investigation into inexplicable tragedy, there is a distinct lack of enthusiasm being demonstrated since it was announced yesterday.

Right wing party CHEGA is accusing the government of ‘secretism’ – saying none of the leading parties in the country have been made party to the “principal orientations and characteristics of the reform” – while the Order of Physicians (Ordem dos Médicos) fears it could all end up being “an absolute disaster(see below).

In Ovar, PS Socialists are so up in arms by what they understand the reform means for their area that they are demanding the health minister’s resignation (see below).

Taking concerns voiced so far one by one, CHEGA’s main reservations seem to be that this is a blueprint for a form of commercialisation of the State health sector. 

Leader André Ventura refers to the health units that will receive more money depending on the number of patients that have with chronic illnesses, stressing the whole format is a “disgrace; not what the country needs”.

Ventura has stopped short of calling for the health minister’s resignation, but he wants Manuel Pizarro “to be obliged to come to parliament”, and explain why his (Ventura’s) impression that this new model will only “delay consultations and surgeries” even more is not correct.

Mr Pizarro, it should be said, has been singularly lacking, in terms of a presence, throughout the summer – even when an elderly man was left to die on a stretcher waiting for a transfer which ambulance drivers available at the time say they were being prevented from doing.

He has still not even made any kind of statement over the pregnant young woman who died after being given the ‘all clear’ from Guimarães hospital on Sunday.

One could argue that the ‘reform of the health service’ is not even his work. It is the work of the ‘second tier’ of management, created last year, under the auspices of former Porto hospital administrator Fernando Araújo, who is now the CEO of the ‘SNS executive direction’.

In presenting his efforts this week, Mr Araújo has said: “This is a great reform of the SNS health service, let there be no doubt. We are effecting a reform that will cover the whole country and alter healthcare, in a profound way, from a point of view of organisation”.

In this new management model, due to come into effect on January 1, 2024, “the financing of healthcare provision has been changed and will now be based on the needs of the patient, rather than the number of medical procedures carried out. Financing will be done on a per capita basis and by risk stratification, i.e. according to the number of patients and their illnesses”, explain reports.

Fernando Araújo has stressed nonetheless that health service users “will continue to have total liberty to choose where they want to be treated”, given the fact that if they belong to one local health unit (ULS) they are not limited to that health unit. 

In situations where patients choose to be treated outside of their ULS “the money accompanies” them, he has explained, bringing, in his perspective, “more justice to the process”.

In all, the SNS is to be divided into 39 ULS’s made up of all the health centre groupings, a large part of the functions of the five regional health administrations and the country’s State hospitals. Left out of the management system will be the country’s three oncology institutes.

Says Correio da Manhã today, “the creation of 39 ULS means implies the transfer of workers. Fernando Araújo guarantees that this will be done “in a very simple way and without the loss of rights”.

It is a solution, he assures, that will “facilitate the management of people”.

CM’s report today, listing all the ULS’s by the hospitals and health centres that will be part of them, explains that the reorganisation of the health service seeks to “increase the participation of local authorities in definition, accompaniment and evaluation of health policies”.

It quotes the Socialist mayor of Matosinhos, where the country’s first ULS was created in 1999, saying she believes the model will being benefits, by dint of its inclusion of municipalities.

But talking to CM, the president of the Order of Physicians Carlos Cortes has a very different view.

He says if the new ULS’s are replicas of those already in existence, the reform will be an “absolute disaster, because the hospitals with most difficulties in this country are precisely those that are part of ULS’s.

“We continue working in the greyness; the twilight in the secretism of the Executive Direction of the SNS because we do not know how these ULS’s will work.

“I hope in this reform that the executive direction has called ULS 2.0 there is the perspective of correcting everything that is going wrong in the ULS’s that exist. I (want to) believe that if there is a dissemination of ULS’s across the country it is because this is a completely different model. If they are seeking to disseminate the same model, it will certainly be a failure announced…”

In Ovar, there is not even this level of ambivalence: in a statement put out yesterday, the PS/ Ovar (the local PS party, but not the party in charge of the municipality) seems convinced the reform represents a “disastrous decision” and for this reason, it is demanding Manuel Pizarro’s resignation.

“Politically, as we have done from the outset, we distance ourselves from the government and the national PS in this matter, as well as from the current municipal executive, for not having had the courage and will to confront central and district political power with vigour, under the obedience of unknown interests,” said the branch in a statement.

“That’s why the PS/Ovar council is calling on the government and the PS to dismiss Manuel Pizarro, as well as the mayor and deputy mayor of Ovar, Salvador Malheiro and Domingos Silva, respectively, “for their inertia in defending the people’s access to healthcare“.

“We don’t accept the Ministry of Health’s decision, but much less do we accept the incapacity and ambivalence of Ovar City Council executive, accepting the unacceptable and agreeing to positions that do nothing for the interests of Ovar.”

PS/ Ovar’s main complaints is that people in their municipality will be absorbed into a ULS for Aveiro, further north.

[email protected]