Reform (in Health) can (and sometimes should) be closed – Observer

At a time when “the hot potato” of the proposal to close maternity hospitals (6!) “scalds” in the hands of those responsible for the area, the end of the holidays and the return to a certain normality (probably until Christmas) allows the The theme “cools down” and diverse and often antagonistic opinions fill the space of non-decision.

First of all, it seems important to remember why this all started. And then there seems to be no doubt: for lack of doctors in sufficient number to fill the minimum scales suggested by the Ordem dos Médicos, which worsened during the summer vacation period. This phenomenon, having occurred in dispersed places in the country, did not occur in all maternity hospitals in the country, having had greater expression in the Greater Lisbon region. Seems like another important point not to forget.

This being the cause, the Government tried to attract more doctors to these scales, temporarily raising the value of overtime. Apparently, it did not solve the problem, as the emergencies continued to close.


On the other hand, it should be mentioned that these closures allegedly caused additional anxiety in pregnant women, some entropy/confusion in the system and more transport and greater distances for patients in an emergency situation. There are still cases of tragic outcome that may have been a direct or indirect consequence of these failures to be regretted.

So the situation was serious. And it is not healthy to deny it.

In the realistic impossibility of ensuring the scales through overtime, even if increased; to change the minimum numbers defined by the Portuguese Medical Association; to train doctors in good time; or being able to convince a doctor to change their situation in the private system for the current attractions of a medical career in the SNS, was considered by a group of experts, as an immediate solution, the closure of some maternity hospitals and the consequent concentration of human resources.

Let’s face it: this is the most obvious, most immediate, and probably the only potentially timely effective solution. Furthermore, it is normal in all areas of activity that periods of growth and expansion may be followed by periods of concentration of resources and closures, mostly temporary. Not only is this a “normal” strategy, it is often a matter of survival. It would, I think, be demagoguery to deny it.

It is different to say that any closure is valid. Particularly in areas where there are no problems of scale, where everything works well and/or where alternative access is too “burdensome”. Finally, it will be interesting to understand whether any of the closures to be considered will or will not bring gains to the system, namely if it will allow the supposed concentration of resources and, with that, the substantive improvement of the urgency scales. If not, it’s nonsense. With consequences.

In this way, and assuming that the temporary closure (until the SNS is able to better train the NHS, change the model by delegating part of the activity to specialist nurses or reviewing the watertight logic of the minimum numbers of teams), is essential, I would suggest a careful analysis of which services whose closure would result in greater gains than losses for everyone, but mainly for users.

Also because if nothing is done, it is certain that the situation will repeat itself and, probably, with greater dimension and intensity.

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