Direction to have five bodies
In a press conference today to present the new health service ‘executive direction’, Portugal’s new health minister Manuel Pizarro did a sterling job in conducting the exercise as if the dramas and confusion of the recent past had never happened.
And surprisingly, his words and enthusiasm were received by journalists who appeared to have every intention of giving these new government appointments the benefit of any and all doubts.
Lusa meantime has outlined the make-up of the ‘executive directorate of the Portuguese health service’ and everything that it entails.
Remember this is the ‘masterplan’ for rescuing Portugal’s terminally ill health service from multiple organ failure.
The new CEO to lead the executive directorate, Manuel Araújo, made a short statement today saying the job is a “great honour” for him. He will be starting in earnest on Monday.
So, what is this new body – composed of five parts – all about?
Lusa explains: “The Executive Directorate of the Portuguese health service will coordinate response in public health units and will have the status of a special public institute to ensure autonomy in issuing regulations and guidelines.
“According to the decree-law published today in State gazette Diário da República, the figure of “special regime public institute” serves to guarantee, on the one hand, “the superintendence and tutelage of the Government member responsible for the health area” and, on the other hand, “the autonomous exercise of its attributions and the power to issue regulations, guidelines, directives and generic and specific instructions binding on the establishments and services of the SNS”.
Readers may see in this relatively short paragraph where things look like they are going; in line with criticism already voiced by minority parties, even President Marcelo, there seem to be a great deal of words in this new ‘plan’, but whether it can really make desperately needed improvements to the SNS health system is what no-one can predict.
“The Executive Directorate (DE-SNS, I.P.), in addition to proposing the appointment and dismissal of members of the management bodies of health units or even appointing them, “if this power is delegated to it,” can issue regulations, guidelines, directives and generic and specific instructions that are binding on the entire SNS”.
It will also “coordinate the healthcare response of NHS health units, “ensuring their networked operation, continuous improvement of access to healthcare, user participation and alignment of clinical and health governance.
“The decree-law explains that the DE-SNS is composed of five bodies and is headed by an executive director, a body with decision-making powers in five areas: integration of care; network functioning and referral; access to care and users’ rights; participation of people in the SNS; and governance and innovation.
“In the exercise of his functions, the executive director is assisted by the management board.
“The executive board of the SNS also includes the strategic board – the body that coordinates the definition of SNS resource strategies – which is composed of the executive director, the chairman of the board of directors of the Central Administration of the Health System, I. P. (ACSS) and the chairman of the Board of Directors of the Central Administration of the Health System, I. P. (ACSS). (ACSS) and the chairman of the Board of Directors of the Shared Services of the Ministry of Health (SPMS).
“Other bodies of the DE-SNS are the managers’ assembly and the single auditor, the consultation and participation bodies, and the supervisory bodies, the decree-law said.
The government justified the creation of the executive board with the “organisational and management complexity” of the SNS, taking into account the diversity of the care it provides, the capillarity of its services, the high technical autonomy of health professionals, the growing costs in health and “the expectations of a more informed and demanding society”, Lusa continues.
It states that the DE-SNS “assumes a role that has proved necessary in the fight against the pandemic” and that it was felt “should be strengthened”, but also tasks previously assigned to other institutions of the Ministry of Health.
The document ensures that the DE-SNS “does not, however, prejudice the attributions of the health units that make up the SNS, in terms of responsibility for the provision of health care, with respect for their legal nature and specific competencies”.
“Nor does it remove the responsibility that falls to the member of the Government responsible for defining national health policy and, in particular, the SNS”.
It is also foreseen that the DE-SNS may have “territorially decentralised organic units in a decentralised perspective of training teams with technical knowledge and territorial sensitivity”.
“One of the critical factors for the success of the option to create this institute is its powers and the relationship with the establishments and services of the NHS and other bodies and institutions”, of the ministry of health recognises the document, says Lusa.
Regarding articulation with the ACSS, the decree-law states that the DE-SNS, together with primary health care and hospital units, “is a party to the programme contracts concluded, which it coordinates”. “It should be remembered that it is within the scope of the contracting process, and within the framework of the management cycle, that the care targets and the necessary financial, human and technical resources are negotiated and agreed upon,” stresses the document.
It also states that the executive board of the SNS, together with the ACSS, “will monitor the negotiation processes of collective labour regulation instruments” and that it will have the competency, together with the ACSS, “to define the priorities and responses to be ensured by information systems to be provided by the SPMS”.
On the other hand, the decree-law adds, “it is also recognised that access to care data is central to the fulfilment of the DE-SNS mission”.
The document says the creation of the DE-SNS occurs at a time when the transfer of competencies to municipalities in the field of primary health care is underway and when the program of the XXIII Constitutional Government envisages the integration of deconcentrated services of a territorial nature in the Commissions for Regional Coordination and Development.
“The conclusion of these processes makes the role of the DE-SNS, I. P., especially relevant as the ‘guiding thread’ in the operationalisation of a national health policy that never loses sight of the universal right to health that democracy has brought to every citizen”.
To reflect the impacts of the creation of the executive directorate, namely in the ACSS and in the regional health administrations, the organic structure of the Ministry of Health will be altered.
It is also foreseen that the coordination of European affairs and international relations of the Ministry of Health – until now in charge of the General Directorate of Health – will be ensured by the General Secretariat of the Ministry of Health.
At this point, one might feel one has read enough, but Lusa presents another slant to these sweeping changes:
Main points of new health service statute
“43 years after its creation, Portugal’s national health service (SNS) has a new Statute that aims to better organise its functioning, give more autonomy to hospitals and ensure greater motivation to its professionals”, the news agency finally goes to the nub of the issue.
“There are 106 articles that replace the previous Statute that had been in force since 1993 – 29 years ago – but also adapt the SNS to the new Basic Health Law, approved in 2019, and which clarified the role and relationship between the various actors of the health system in Portugal.
“The new Statute comes into force after the SNS was pushed to the limit in responding to Covid-19 for more than two years, at a time when it is still recovering the assistance activity damaged in that period and is struggling to keep human resources, such as doctors and nurses.
“Approved by the cabinet on 7 July, the decree-law of the new Statute was countersigned by the president of the Republic of Portugal on 1 August, 48 hours after receiving it in Belém, with Marcelo Rebelo de Sousa considering that “it would be incomprehensible for the Portuguese” to delay its promulgation, given the challenges currently facing the SHS.
“In practice, the regulation provides for changes in various areas of the SNS, such as its organisation and functioning, human resources policy and the autonomy of institutions.
HOW THE SNS IS ORGANISED
“The SNS is organised at a territorial level through the health regions of the North, Centre, Lisbon and Vale do Tejo, Alentejo and Algarve, and at a functional level, by levels of care.
“The document will give hospitals more autonomy to hire workers and invest, as the Finance Department will only have to approve amounts above €2.5 million in projects provided for in the Activity Plans and Budgets submitted to the ministry of finance.
What functions will the new executive board have?
“This new body will coordinate the care provided by all the health units that make up the SNS, as well as the National Network for Integrated Continued Care (RNCCI) and the National Palliative Care Network (RNCP).
“The executive board is also responsible for ensuring the networked operation of the SNS, through the national articulation of the different establishments and services, the integration of the different levels of care and the search for proximity responses, and coordinating the creation, review and management of the hospital referral networks.
“In addition, it will have to ensure the improvement of access to the SNS, manage the access and waiting times system and the surgery enrolment system, monitoring the performance and response of the SNS, through satisfaction surveys of users and health professionals.
“The executive board will also have other new missions, such as appointing the hospital boards of directors and the executive directors of the health centre groupings.
“According to the Statute, the function of the SNS executive board is distinct from that of the ministry of health, which, in addition to conducting national health policy, has specific responsibilities relating to the SNS, but not the operational coordination of its responses.
What are Local Health Systems (SLS)?
“The SLS, another novelty in the new Statute, are structures of participation and collaboration of institutions that, in a specific area, conduct activities that contribute to the improvement of the population’s health and the reduction of health inequalities.
“The SLS will inherently include the establishments and services of the SNS and other public institutions with direct or indirect intervention in health, namely in the areas of social security, civil protection and education, as well as the municipalities.
What is the full dedication regime?
“This regime applies, for the time being, to SNS doctors and is incompatible with the exercise of functions of technical direction, coordination and leadership in private institutions and the social sector, with the exception of the medical practices of individual professionals.
“The functions under the full dedication regime will depend on the signature of a letter of commitment to assistance between the doctor and the institution to which they are linked, which will set out, for a period of three years, the objectives and goals to be achieved, which should translate into gains in accessibility, quality and efficiency.
“The regime of full dedication is compulsorily applicable to doctors who may be appointed on a service commission basis to exercise duties of service or department management in the SNS.
“In order to implement this regime, the model of work organisation, including the increase of the normal weekly work period, and the remuneration regime, as well as performance bonuses, among other matters, must also be defined in specific regulations.
“Starting with doctors, the full dedication regime should be gradually and progressively extended to workers from other health sector professions”.
An exceptional hiring regime is created
“Also in the area of human resources, and for cases in which the insufficiency of health professionals may compromise care provision, the managers of SNS establishments and services are now responsible for signing fixed-term employment contracts for a maximum period of six months, which cannot be renewed.
“The top management bodies of SNS establishments and services thus strengthen their autonomy to hire workers, regardless of the type of contract, within the scope of their respective management instruments.
New exceptional overtime work regime
“In cases where the jobs prove to be indispensable to ensure the provision of healthcare and to reduce the need to resort to service providers, SNS workers may, by agreement, perform overtime work in establishments or services other than those to which they belong.
“In such cases, the worker is remunerated as overtime work, but this does not count towards the annual limit of overtime work legally established, and its payment is ensured by the entity to which the worker is linked.
Establishment of professionals in geographically deprived areas
The new Statute also provides that the SNS may use financial and non-financial incentives to encourage the establishment of health professionals in underprivileged areas in order to improve access, namely by increasing holiday time, training days, time dedicated to research and telehealth and making the mobility regime more flexible.
To this end, SNS establishments can sign protocols with public, private or social sector entities, especially local authorities, to award other incentives, such as accommodation.
More autonomy for health centre groupings
The legal nature of the health centre groupings (ACES) will be altered, and they will become public institutes under a special regime, endowed with administrative autonomy and their own assets, with responsibilities for contracting the provision of primary health care with the Central Administration of the Health System, similar to what happens with hospitals.
What is still to be regulated
“The Statute provides that, within 180 days of the date of its entry into force, the legislative and regulatory changes necessary for its implementation must be approved, such as the increase in the normal weekly work period and the remuneration increase corresponding to the full dedication regime, which are matters to be negotiated with the unions.
“The Statute also has a transitory norm that stipulates that its entry into force does not determine the end of mandates or the termination of service commissions that are underway”.
LUSA
