Xavier Barreto is of the opinion that the current scenario “deserves reflection” on “what role we want primary care to have in the care of acute patients, whether we should continue to have a system in which these patients are seen according to existing vacancies or whether we want primary care to have another role in acute illness, eventually creating permanent open-door responses, as exists in Spain, for example.
However, he emphasizes, and regardless of “this reflection”, the SNS24 Line “must be reinforced with human resources capable of resolving situations, because if we are to have a line just to refer patients to health centers or hospitals, then it is not worth it”, highlighting: “The user is not stupid (excuse the expression). If he makes the decision to go to a hospital emergency right away, it is because he did not have an adequate response to his needs, either because it takes too long to answer a call or because he was misdirected, but in any case the responsibility is always ours. It is always the responsibility of those who are planning and creating the responses. In this case, it is the Ministry of Health’s responsibility.”
And he warns: “We are entering the cold season, the units will be in greater demand and it is very likely that waiting times will increase and it is also likely that the response from both the Line and the units will worsen”.
“What is What happens is a consequence of the system’s governance options.”
Two weeks ago, the Health Foundation launched the Manifesto “We want health centers back”, signed by 30 personalities from health and civil society, which had as its theme the Ligue Antes, Salve Vidas program and how it was removing users from proximity care.
Now, as José Luís Biscaia, family doctor at the Foundation for Health and one of the signatories of the Manifesto, says, this ERS report “confirms that the measures that have been taken in terms of health governance, in terms of centralizing access on a telephone line, have not been a success”.
In fact, and as he emphasizes, “it has generated a perverse effect, if we want, which should certainly not be the intention of the people who proposed them, because the essential thing about the existence of primary health care is the proximity and continuity of care”, maintaining that “what is happening is a consequence of the governance options of the management model adopted for Health – that is, the model of centralizing access management, which is a total mistake”.
The doctor even explains that the “initial concept of Ligue Antes, Salve Vidas was to minimize the excessive use of emergencies, especially hospitals, during peak periods, such as winter. The experience began in a unit in Póvoa do Varzim/Vila do Conde, where there was full coverage of family health teams for all users. And the measure cannot be expected to have the same results in an area, like Lisbon, for example, where there are almost a million people without a family doctor.”
Safeguarding ignorance of the ERS report, and only what was reported, José Luís Biscaia reinforces that, in his opinion, the measure was applied “without understanding local and regional differences”, and this has created “a perverse effect”. “The SNS24 Line may even be a measure that has an impact in some areas, but in others it does not, especially in those where there are no resources to respond in close proximity”.
And he asks: “Instead of continuing to hire resources for the SNS24 Line, why not hire professionals for the units themselves to respond in close proximity, as there is an algorithm that is clinically validated and adapted to local realities and is installed in the telephone exchanges of several health units? This is a concrete solution to solve the problem (of users being denied care) or to help alleviate it.”
For José Luís Biscaia, at this moment, “a fact has been created, people have to call the SNS24 Line to access healthcare. This is the gateway.
The communication campaign, carried out by the Ministry of Health, with public figures recommending this act, is brutal. Therefore, reversing this suddenly is not easy”, but if it is not done he also says that “everything will get worse”. “The reversal would have to involve clear measures of what is wanted at a regional level and involving the ULS in decision-making on which measures are appropriate, how can this situation be reversed? How can access responses be created in proximity?”
The doctor says that in this way decisions would be made based on “the ability to discriminate, but in the good sense of the word”, based on each local reality so that “equity in access to care is guaranteed. If we have different realities, we must have different and appropriate responses. The centralization of access has clearly removed proximity access and is tearing primary care apart and will make it even worse”.