Forty-three years after its inception, the National Health Service (NHS) has adopted a new Charter that aims to better organize its work, give hospitals more autonomy, and provide greater motivation for their professionals.
There are 106 articles that replace the previous Statute that was in force since 1993 – 29 years ago – but also adapt the SNS to the new Basic Health Law, adopted in 2019, which clarifies the role and relationship between the different actors in the Portuguese health system.
The new Statute comes into effect after the SNS has been pushed to the limit in its response to covid-19 for more than two years, while it is still restoring relief activities disrupted during that period, and when it is out of is trying hard to establish human resources. such as doctors and nurses.
Decree-law on the new Statute, approved by the Council of Ministers on July 7, was promulgated by the President of the Republic on August 1, 48 hours after its receipt in Belém, with Marcelo Rebelo de Sousa thinking that “it would be incomprehensible”. to the Portuguese” in order to delay its release, given the problems the SNS is currently facing.
In practice, the rules provide for changes in several areas of the social network, such as its organization and functioning, personnel policy and the autonomy of institutions.
How is SNS organized?
The SNS is organized at the territorial level through the medical regions of the North, Center, Lisbon and Vale do Tejo, Alentejo and Algarve, and at the functional level – by levels of care, while its institutions must lead the relevant work from the side of the proximity of provision, for the integration of care and inter-regional articulation of services.
The document gives hospitals more autonomy in hiring employees and investing, as Finance only has to approve amounts in excess of 2.5 million euros in projects envisaged in the Action Plans and budgets submitted for supervision.
What roles will the new executive leadership have?
The SNS is currently governed at the central level by an executive leadership whose decree-law governing it has already been adopted by the President of the Republic on 16 September and published this Wednesday in the Diário da República.
This new body, which will take office on October 1, will coordinate the activities of all medical institutions that are part of the SNS, as well as the National Network for Integrated Continuing Care (RNCCI) and the National Network for Palliative Care (RNCP). ).
Executive management must also ensure the functioning of the SNS network through national articulation of various institutions and services, integration of different levels of care and search for close answers, coordination of creation, review. and management of hospital referral networks.
In addition, it will need to ensure improved access to the SNS, management of the access and latency system and the operation subscriber system, monitoring the performance and response of the SNS through user and healthcare provider satisfaction surveys.
The executive board will also have other new tasks, such as appointing hospital boards and health center cluster executive directors.
According to the Regulation itself, the role of the executive leadership of the SNA is different from that of the Ministry of Health, which, in addition to implementing state health policy, has specific responsibilities regarding the SNA, but not the operational coordination of its responses.
What are Local Health Systems (SLS)
SLS, another innovation of the new Charter, are structures for the participation and cooperation of institutions that in a certain area develop activities that contribute to improving the health of the population and reducing health inequalities.
The SLS will inherently integrate the institutions and services of the SNS and other government agencies with direct or indirect health interventions, namely social welfare, civil protection and education, and municipalities.
What is the mode of full consecration?
This regime still applies to SNA doctors and is incompatible with the performance of technical management, coordination and leadership functions in private institutions and in the social sphere, with the exception of medical offices of individual specialists.
Full employment will depend on the signing of a letter of commitment for care between the doctor and the institution with which he is associated, and which will include within three years the goals and objectives to be achieved, which must be translated in favor of accessibility, quality and efficiency.
The full consecration regime is mandatory for physicians who are appointed on the basis of a service commission to perform the functions of managing a service or department in the NHS.
In order to implement this regime, the work organization model must also be defined in specific provisions, including but not limited to the addition of a regular weekly working period and a remuneration regime in the case of performance-based bonuses.
Starting with physicians, full-time work should be gradually and progressively extended to workers in other health care professions.
Created an exclusive recruitment regime
However, in the area of human resources, and in cases where a shortage of medical workers may jeopardize the provision of care, the responsibility for concluding fixed-term employment contracts lies with the heads of SNS institutions and services, for a period not exceeding six months, without the right to renew.
Thus, the supreme management bodies of the institutions and services of the SNA strengthen the autonomy in hiring workers, regardless of the type of contract, within the framework of the relevant management tools.
New exceptional overtime regime
In cases where functions are deemed necessary to provide health care and reduce the need to contact providers, NHS workers may, by agreement, perform additional work in facilities or services other than those to which the staff card belongs. .
In these cases, the employee is paid as overtime, but does not count towards the annual statutory overtime limit, and is paid by the organization with which the employee is associated.
Settlement of professionals in disadvantaged geographic areasWith
The new Statute also provides that the SNS may use financial and non-financial incentives to encourage the creation of health workers in disadvantaged areas to improve access, namely increased vacation days, training days, time devoted to research and telemedicine, and flexibility in mobility regimes.
To do this, social network institutions may sign protocols with public, private or social sector entities, in particular with local governments, to provide other benefits such as housing.
Groups of medical centers with more autonomy
Groups of health posts (AKOS) are undergoing a change in their legal nature, being considered state institutions of a special regime, endowed with administrative autonomy and their own property, with the obligation to conclude contracts for the provision of primary health care with the General Directorate of Health. The system is similar to what happens with hospitals.
What’s left to regulate
The regulation stipulates that within 180 days from the date of its entry into force, legislative and regulatory changes necessary for its implementation must be approved, in the event of an increase in the normal working hours and an increase in wages corresponding to full dedication, issues to be agreed with the trade unions.
The Statute also contains a transitional rule that provides that its entry into force does not determine the end of the term of office or the termination of existing commissions.
Author: Lusa
Source: CM Jornal
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