Speech by Jerónimo de Sousa, General Secretary of the PCP, Public Hearing «Strengthening the NHS, ensuring healthcare for all»

«If we want to preserve the National Health Service we have to fight for it»

«If we want to preserve the National Health Service we have to fight for it»

The National Health Service, one of the main achievements of the April Revolution, is the main instrument for achieving an essential right of any human being – the right to access adequate healthcare, the right to a healthy life.

It is true that the NHS is experiencing challenging times, suffers from serious limitations, the result of decades of policies that have weakened it, but let no one be fooled by the propaganda of those who want to destroy it; the National Health Service is still the bedrock of healthcare. It is its healthcare centres and hospitals, it is its healthcare professionals who respond every day to most of the healthcare needs of the Portuguese and do so regardless of the economic and social condition of each one. 

The NHS has no customers or profit goals to achieve, but users and populations that have to be served whatever the disease, cost or complexity. Unlike hospitals owned by economic groups, whose aim is to bill as much as possible the treatment of diseases, the NHS is working not only to treat diseases, but to prevent them, to promote the health of individuals, families and the community at large. For private economic groups what makes a profit is the disease; for the NHS what is important is that everyone lives as healthy and with quality of life as possible.

But there is no point hiding that there are serious problems in the National Health Service. They do not happen by chance. They are the result of many years of disinvestment, underfunding and above all a degradation of the situation of healthcare professionals, while there has been a strong bet by private health groups in recent years in their capacity and facilities.

The various governments and the current one knew and had to know that by devaluing careers, by disrespecting professionals, by disorganising services they were helping to push them out of the NHS and to make public services less attractive for young professionals who are graduating every year.

Otherwise, how could private economic groups managed to divert so many health professionals from the NHS if they were not in a scenario of devaluation of pay, disrespect for their rights, high workloads and no prospect of a real career progression and valorisation of their professional status.

The Government passively witnessed the number of users without  family doctor increase from 700,000 to around 1,300,000 in less than three years without any action being taken to curb this situation. In the municipality of Sintra alone, there could be 120,000 people without a family doctor, a situation whose acuteness is repeated in other places, particularly in the Lisbon Metropolitan Area.

It witnessed the marked shortage of other medical specialties such as anaesthetists or obstetricians. It witnessed the increasing handing of emergency services to professionals hired to the task, through labour placement companies, earning per hour much more than the professionals from the hospital staff. 

Some of those who said they did not understand the PCP voting against the budget proposal tabled by the Government in October 2021 can now see the concrete reality of how right we were. The demand for urgent measures - namely the valorisation of healthcare professionals - to defend the NHS was one of the three essential issues we put to the Government at that time - without any positive response.

The Government witnessed it all and did not take the necessary steps to start reversing this serious situation. And the conclusion can only be one: the Government knew that the result of its inertia would be disastrous and wanted it to be so. It knew that the result would be the weakening of the NHS and a wide-open field for the private sector and wanted it to be so.

The announcements of measures made by the Government in the area of health, largely still quite undefined, show that it continues to sidestep the measures that are required and imposed. Moreover, what is already known about the Statute of the NHS approved by the Government is a clear setback in relation to the new Basic Law on Health adopted in 2019, including legislative options that are far from the solution to healthcare problems.

The problem of the shortage of family doctors is not solved by hiring undifferentiated doctors, devaluing the specialty of general and family medicine, but by the valorisation of this career in healthcare centres, such as that of nurses and other professionals.

The problem of access to primary healthcare is not solved by replacing face-to-face consultations with telephone consultations, but by ensuring the presence of family doctors and nurses; it is not enough to create more computer applications for administrative services, it is really essential to hire more workers in this area to serve the populations.

The problem of hospital emergencies is not solved by hiring more professionals by task, nor preventing people, who have no alternative when they are sick, even not very serious, from going there. Nor can it be solved by closing more emergency services, whether obstetric, paediatric or general, further distancing populations from the answers to which they are entitled. It is solved by ensuring the conditions to attract and retain more specialists in public hospitals and ensuring that populations have an  effective response to cases of acute but not serious health care.

The general problem of the shortage of doctors is not solved with a proposal such as the so-called "full dedication", with contours still little known, but in which it is already known that the possible increase in pay is at the expense of more working hours and the overload of the functions of these professionals.

By not taking effective action, the Government is deliberately allowing the degradation of the NHS and favouring private health groups. These groups not only guarantee much of their funding with transfers from the National Health Service (about 40% of current expenditure), but also prosper with the greater the difficulties of the NHS. And what the Government is preparing to do is deliver another slice of the NHS to the private sector, presenting this option as a false inevitability.

But there is no inevitability in this course. It is possible to strengthen the NHS and thus strengthen the right to healthcare of the population. 

If the Government wants to strengthen the NHS, what it has to do is put an end to its underfunding, clearly evident in the projected deficit of more than 1,100 million euros during the year 2022. 

If indeed it wants to valorise the NHS, what it has to do is improve the wages of its professionals, ensure effective career progression and implement urgent measures such as the PCP's proposal for exclusive dedication, with a 50% increase in basic pay, the bonus of service time for a faster progression in career and other support.

If indeed it wants to improve primary healthcare, it must first ensure that the entire population has access to a family doctor and nurse. It must put an end to the enormous differentiation between users (and also professionals) who are in Family Healthcare Units and those who are in the remaining units. In the Personalised Healthcare Unit which functions right here, 90% of the nearly 19,000 users do not have a family doctor which is unacceptable. 

If the Government wants to defend the National Health Service, it must ensure - as proposed by the National Health Council and the Commission for Public Health reform appointed by the Government itself - a real reform of the public healthcare area, the importance of which the covid-19 epidemic has underlined, effectively ensuring more resources and professionals for the strategic functions it performs. It would have been better if the PS Government had implemented the measures that since 2015 the PCP has been systematically proposing, many of them adopted in resolutions of the Assembly of the Republic or included in the State Budget, and which were consecutively not applied.

If the Government really wants to valorise the NHS, it cannot continue to postpone investments in the healthcare unit facilities and the necessary clinical equipment, thus avoiding more spending on the procurement of services to the private sector.

The case of this municipality of Sintra is, moreover, a unique situation. A new hospital unit is under construction, which in fact is not funded by the Ministry of Health, but which is already known will not answer the main needs. What is under construction, a unit with insufficient medical services and with only 60 inpatient beds, is totally misadjusted to the population of the second most populous municipality in the country. What is foreseen, of course, is that services will continue to be bought from private hospitals that exist here, rather than investing these resources in public hospitals.

One thing is for sure. If we want to preserve the National Health Service we must fight for it. If it is true that the Government increasingly aligns, with the strong support of the right, with the interests of private healthcare groups, it is the struggle of healthcare professionals and populations that can halt this objective and reverse the current situation of degradation.

Throughout the country there are initiatives of users, of the populations demanding what is their right. To be treated and monitored in healthcare centres and hospitals of the NHS. Professionals and their representative organisations too have been stressing their struggle for the rights of these workers, which is in itself a struggle to ensure better healthcare for the population.

The government must hear this outcry. It has to retrace its steps and bet on strengthening the NHS and ensuring healthcare for all. It is not only an essential human necessity, it is a necessity for the development of our country, of the whole society.

The populations and healthcare professionals can count on the PCP. You can count on our determination in defending this achievement of April – the National Health Service – which is an asset of our people that cannot be mortgaged to the interests of a handful of privileged people. The right to healthcare that the Constitution enshrines must prevail, but it will only prevail, it will only be guaranteed with our intervention and struggle. That is what we are here for. That is our determination!