Speech by Jerónimo de Sousa, Secretário-Geral, Public Hearing in defence of the NHS

«vital to make a strong bet on primary health care, the gateway to the NHS»

«vital to make a strong bet on primary health care, the gateway to the NHS»

Our public hearing is part of a more global initiative, carried out by the PCP during the last two weeks of clarification and mobilisation of workers and populations, for the defence and reinforcement of the National Health Service.

Here, in the municipality of Sintra, the populations are well aware of what it means not to increase the real potential of the NHS.

The more than 94,000 users without a family doctor who wait and despair for an appointment at the Health Centres know this; or those waiting for a specialist consultation in a Hospital that has long exhausted its possibilities of serving a population of two of the most populous municipalities in the country, with more than 600 thousand inhabitants, a situation that has long demanded a new public hospital, whose non-resolution means that thousands of patients wait for months, sometimes more than a year, for a surgery, often endangering people's safety.

Yes, after a decade of mismanagement of the public interest and of the populations of the two municipalities, by Grupo Mello, from Hospital Fernando da Fonseca, the government is now coming up with a solution for a hospital with 60 beds that does not solve any of the deadlocks known for a long time in Amadora/Sintra, a decision contrary to what the Master Plan of the Lisbon Metropolitan Area indicated, of a 300-bed hospital, which confirms that what was present in this decision was mainly the interest of economic groups.

The argument put forward to justify not building a hospital with 300 beds arises precisely when new hospitals from the CUF/Saúde group and the Trofa Group were being announced, with a few hundred beds.

It is this framework of difficulties, here in the municipality, as in the rest of the country, that justifies a strong investment in primary healthcare, the gateway to the National Health Service.

According to the World Health Organization, Primary Health Care is an integral part of the socio-economic development of the community and, with the creation of the NHS, it constitutes a central function and is its main nucleus.

Primary health care is the first element of a permanent healthcare process which, by bringing health care closer to the place where people live and work, is the first level of their contact with the National Health Service.

Primary care centred on health and its promotion, disease prevention and the provision of continuous and global care by teams, integrating doctors specializing in General and Family Medicine and other professions, guiding their action by principles of intersectoral collaboration, community participation and self-accountability.

The PCP has long advocated a serious investment in primary care with the guarantee of a family doctor and nurse for all, the inclusion of other medical specialties in areas such as paediatrics, eye care, oral health, among others, that create conditions for carrying out some diagnostic tests and thus guaranteeing that the vast majority of medical episodes have a solution at this level of care, unlike what happens today, where about 70% of these episodes are resolved at the hospital level with higher costs and with increasing difficulties in the management of hospital resources.

The basic and priority organisation of the NHS is based on the network of primary and proximity care, the main gateway to first-line assistance, while playing an essential role in preventing disease.

The concrete needs of citizens, in this context, are centred and oriented towards the provision of care in disease and health promotion, with quality standards that cannot be dependent on the spectre of “uncontrolled growth in public expenditure on health”.

The issue of public expenditure on health is not resolved with the municipalisation of the management of health centres, which sooner or later will pass into the hands of economic health groups that have long aspired to have a primary care network that will refer patients to their hospital units.

In the National Health Service that the PCP advocates, "Universal, general and free", the Public Administration assumes at the same time the role of care provider and the funding and regulatory function, which allows planning geared to the real needs of the populations and no, as advocated by the heralds of right-wing policies who advocate a healthcare system in which costs, from the perspective of profit maximisation, should be limited to the basic minimum. That is how the idea of health insurance was born at the end of the 20th century, with Portugal having, today, more than 2.6 million Portuguese people with individual health insurance. Difficulties that are the most visible consequence of the right-wing policy in health of PS, PSD and CDS.

The continuing attack promoted by successive PS, PSD and CDS governments on the NHS has taken on very different forms of underfunding, lack of coordination, fragmentation and privatisation of services and units: with loss of rights and guarantees of its professionals, leading to the departure of many of them, either for private groups in the disease business or abroad; increased costs for families; aggravation of chronic diseases and the probable degradation in the short and medium term, unless this offensive is stopped, of the macro health indicators, in particular the general and specific mortality rates of chronic diseases.

Problems that do not have their origin in the epidemic, but that have worsened in the last year and a half.

Today it is often heard and read, coming from those who advocate the primacy of private companies in health, that the NHS is not in a position to fight Covid-19 and accompany all those who suffer from other diseases and do it especially thinking about the business opportunity for economic groups.

But today, almost 16 months after the beginning of the epidemic, and when the irreplaceable role of the NHS and its professionals in combating Covid is recognised by the vast majority of Portuguese people, we ask what would have happened if the vast majority of Portuguese were dependent on a health and healthcare insurance in private units which, when the epidemic became more serious, reduced or even closed the activity?
The persistence of the epidemic raises the need for urgent responses to the problems. A response that, rejecting restrictive measures as a rule, creates the conditions to boost economic, social, cultural and sporting activities.

Measures that cannot be dependent only on epidemiological criteria, in which small fluctuations in relation to the number of incidences determine lockdown, unlockdown and lockdown again, in a succession of wrong options that are creating great difficulties in economic and social terms, when today one of the few certainties that exist about the epidemic and its evolution is that the most solid and most effective solution to fight the disease is vaccination.

And that is why we ask. How is it possible that in the current epidemic situation, in which the priority intervention must be to guarantee the health security of the Portuguese people, an objective in which vaccination assumes a decisive role, the European Union and the Portuguese government maintain a posture of rejection to diversified procurement of other vaccines already recognized by WHO, which is causing the vaccination process to accumulate successive delays?

The PCP insists on the need to vaccinate everyone and quickly; testing with a rigorous definition of criteria; tracking new cases and contacts made by them.

Measures that demand from the government, in addition to the acquisition of other vaccines, the hiring of more professionals with the aim of allowing the full functioning of the existing vaccination centres and others to be created; hiring more professionals of the more than 500 lacking in the public health structure to ensure the tracking of new cases.

Defending the NHS is to reverse this path that has been followed, recovering the democratic, universal and solidary sense of its original matrix.

A fight that we have to fight with the PCP, with all the progressive and left-wing forces, with the support of the people and the workers.

For a better health. For a better future. For a better country.