State health service chaos: “Problem is not new”
Health minister Marta Temido during a press conference to address the chaos of Portugal’s state health service Photo: MANUEL DE ALMEIDA/LUSA

State health service chaos: “Problem is not new”

The ‘Portugal Day’ long weekend was celebrated with promotional visits by President Marcelo Rebelo de Sousa to the UK and Andorra while nationally the SNS state health service took another dismal plunge into chaos.

“This problem is not new,” health minister Marta Temido told a posse of reporters who had been waiting all day on Monday for some kind of government response to issues that had been hitting the nation’s television screens for 72 almost surreal hours.

Ms Temido had been in meetings all day with representatives of the doctors’, nurses’ and other professional bodies – and was still due to meet representatives from health entities in the Algarve and Alentejo in the early evening.

Her appearance in the middle of Monday night’s news bulletins was, the country was told, to finally give the long-awaited government response to gathering issues that unnerve the most vulnerable: people who cannot afford private health care.

There were to be no questions allowed, said news anchors. What transpired was at best shambolic: Ms Temido did indeed ‘answer’ journalists’ questions, which came thick and fast – albeit with a huge amount of empty sentences.

She described two plans to be implemented: a short-term plan and a medium-term plan. The short-term ‘contingency’ plan was to start right away, she insisted.

But beyond offering staff €40-€50 for overtime, instead of the €12 currently paid – and agreeing on the need to open new vacancies for doctors – there was very little concrete for people to hold on to. The summer contingency plan, running through July to September inclusive, will be aimed at “doing everything to avoid situations like those we have seen in recent days in terms of disruption to the social tranquility regarding the functioning of the public health service”.

“Less than 24 hours after announcing to the country in the messy press declaration devoid of substance that she was going to advance with a contingency plan, news arrived of the closure of A&E departments in three hospitals”, commented one of Correio da Manhã’s lead columnists.

“It is no good” saying the problems currently assailing hospitals “are not new”, explained CM’s Paulo João Santos. “This would be an acceptable excuse if Marta Temido had not been in government since October 2018. If, in all that time, she has not managed to resolve the problems of lack of health professionals and organisation of the SNS health service, it is legitimate to think she won’t be able to solve them now – particularly as the situation has become even worse…”

So, what has happened?

The worst of the problems have been centred around the capital, with emergency obstetrics teams operating on such skeleton crews that many have simply closed their doors, particularly through the night – giving women arriving in childbirth the added stress of trying to find anywhere/somewhere to have their babies.

Hospitals sending out ‘communiqués’ have said words to the effect that “all other services are fully operational” – but this too has been a relatively hollow declaration as ambulance crews report long waits to unload patients for any kind of attention, which, in turn, compromises emergency cover generally.

In the Algarve, Portimão’s obstetrics unit is not accepting any mothers in labour until next Monday. It means the region has only one port of call: Faro. This may not pose much of a problem for people living east of Portimão, but for those living west of Lagos, it adds at least another hour to journeys which, when they need to be made, usually need to be made quickly.

Former health minister Adalberto Campos Fernandes has dubbed this moment in the SNS health service’s history as a “perfect storm” that is transforming it into a service purely for the poor – and a supremely inadequate one at that.

Miguel Guimarães, president of the general medical council (Ordem dos Médicos), has said simply that “the SNS is not prepared to respond to the needs of 10 million Portuguese”.

Public-private partnerships have been mooted (arrangements where the private sector takes in demand the public cannot meet), but the government’s response is so far balking at this option – in spite of the fact that it spent over €34 million in agency staff just in the first three months of this year, at the same time ‘prohibiting’ hospital bosses from hiring much-needed personnel.

Worst possible outcome in Caldas da Rainha

 With all political parties “united against the government, but divided over the solutions”, the truth is that the worst possible outcome has already happened – and it happened before the long weekend, in Caldas da Rainha, where the hospital did not even tell its population that obstetrics emergency was not accepting any new patients.

A 34-year-old woman suffering late complications in her second pregnancy turned up at the hospital, was kept waiting longer than she should have been – and when she was finally given an emergency caesarean, the baby died.

The hospital almost instantly sent out a press statement “guaranteeing there was no causal link established between the death and limitations in completing staffing rosters”.

Miguel Guimarães responded that the hospital “will have to explain their claim and be held accountable for it.

“Responsibilities are usually assigned to the health system and those who lead it,” he said. “(This declaration) gives me the impression the administration is trying to de-dramatise the situation, suggest everything was fine. I do not have this information.”

Since then, a number of inquiries have been opened into what led to this baby’s death, including an inquiry by the Public Ministry.

Adding to the surreality of events seemingly spiralling ever more into confusion, PSD’s Rui Rio has commented on the drama … from Mozambique, where he was apparently celebrating ‘Portugal Day’.

He told reporters that “the Socialist Party has been openly against public-private cooperation, insisting more on the public” to the point that “what we have now is a public health service that has completely degraded”. There are “fewer and fewer staff: the doctors tend to move to the private sector, due to the lack of resources”, and this, in turn, “leads to the problems we are all seeing now”.

“No one can tell what the government’s contingency plan consists of…but one thing is certain,” concludes a column in Correio da Manhã entitled ‘Fearing the worst’, “if the plan doesn’t work, we already know the answer: this isn’t a new problem…”


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