Strikes and closures of maternity hospitals and urgent care centers mark 2023 in healthcare

A shortage of doctors and nurses marks the year 2023 in health care, which began with the closure of maternity hospitals, continued with strikes and ended with emergency restrictions, forcing patients to travel tens of kilometers.

The Born Safe plan, which began in December 2022 and began as a response to operational difficulties over the Christmas and New Year period and reorganized the response in obstetrics and gynecology, was eventually extended until 2023.

The changes have sparked controversy, with users challenging the closure in many situations. In the case of the country’s largest hospital, Santa Maria (Lisbon), the need to build a new maternity ward eventually dictated changes, transferring services to the San Francisco Xavier Hospital, despite strong opposition from professionals.

In Santa Maria, disagreements led to the removal of the leadership of the department of obstetrics, gynecology and reproductive medicine, which included Diogo Aires de Campos, who coordinated the work of the commission to monitor emergency measures in gynecology, obstetrics and maternity ward, while still in the post of Minister Marta Temido.

The reorganization of the emergency service began with obstetrics and was temporary, but was eventually extended to other specialties, which this Monday form part of the emergency services network response plan developed by the Executive Directorate of the National Health Service (DE-SNS). and which came into force in November.

In announcing the plan, which is reviewed weekly, executive management suggested the reorganization was prompted by a lack of funds to provide a full range of services, especially after protocols that thousands of doctors submitted throughout the year refusing to perform more than 150 overtime jobs. hours provided by law.

This protest has intensified with the emergence of the Médicos em Luta movement, which promises not to give up.

The need for this emergency plan has clearly demonstrated the limitations caused by decades of disinvestment in health care, lack of recognition of specialists and lack of investment in working conditions, forcing some to flee to the private sector and others to emigrate in the middle of the class from which they retire every year hundreds of doctors.

In fact, medical careers continue to be so unattractive that a record number of internship specialty openings went unfilled in November. There were more than 400, more than double the previous year, most of them in internal medicine, the central specialty of emergency services.

The medical association, which has a new chairman this year, insists on the need to value medical work and maintain the quality of medical training. In this regard, the president even criticized the diploma approved by the government to accelerate the recognition of the qualifications of foreign doctors, promising that the Order “will not make the task easier.”

It was a year of intense struggle among doctors, negotiations that had been going on since last year and only partially saw the light of day, and at the end of November – on the threshold of the approval of the state budget – when the government reached a “temporary agreement” with the Independent Union of Doctors. The National Federation of Doctors refused to sign, considering the agreement discriminatory.

As for doctors, the government approved the diploma of full dedication without the consent of the trade unions.

It was in this year, which ended with controversy over alleged political pressure regarding the treatment of two Portuguese-Brazilian twins in Santa Maria, that the General Directorate of Health changed hands: Graça Freitas left and Rita Sa Machado entered.

When DE-SNS became fully operational and finally received an approved charter, it was also the year that the organization of the SNS was redefined, which would see the disappearance of regional health departments and the transfer of operational functions to Local Health Services (ULS), which comprise hospitals and medical centers of the region into one institution with administrative and financial autonomy.

In terms of access to the system, this year the government decided to extend Model B (pay-by-target) to all family health departments.

However, the government’s proposals to regulate USF Model B are not peaceful, and in October more than a thousand family doctors already signed a letter of objection.

Currently, more than 1.5 million Portuguese do not have a family doctor, a figure the PS government has failed to reduce despite campaign promises.