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  • Writer's picture@ Cynthia Adina Kirkwood

National Health Systems in Portugal, U.K. Carry On

Updated: Apr 13, 2023

Game Changer, by the anonymous graffiti artist Bansky, appeared in a foyer of an English hospital during the first wave of the pandemic. It sold at auction in March, earning more than £16 million for an NHS charity.


The pandemic has buckled health systems. The strain has been manifested in different ways in different countries, such as Portugal and the United Kingdom.

In Portugal, family doctors cited exhaustion at the extra weight of COVID-19 patients, according to SIC Noticias (July 24).

And in the United Kingdom, Prime Minister Boris Johnson raised taxes on September 7, arguing in a televised House of Commons session that the pandemic had unexpectedly increased costs for the National Health Service (NHS). Johnson, a Conservative breaking his 2019 campaign promise of not raising taxes, announced a new health and social-care levy of 1.25 percent on both employees’ earnings and employers’ payrolls, at first in the guise of an addition to national health insurance contributions (NICs) from April 2022.

“Everyone knows in their bones that after everything we have spent to protect people through the crisis, we cannot now shirk the challenge of putting the NHS back on its feet,” said Johnson in The Guardian (September 7).

Sajid Javid, the health minister, has admitted that it may take longer than three years to clear the backlog for NHS operations, reported The Guardian (September 7).

Most of the £12 billion raised will go to the NHS, reported The Economist (September 7). Since the start of the pandemic, the number of people waiting for treatment in England (alone) has grown by one-fifth – 5.3 million in May 2021 as compared with 4.4 million in February 2020, according to the independent research group, the Institute for Fiscal Studies (August 8).

The U.K. has a population of 68.3 million, according to Worldometer, an independent website of statistics in real time.

Javid has warned that the waiting list is “going to get worse before it gets better” and could grow to 13 million, reported the Institute for Fiscal Studies, which continued:

“The biggest change over the past 15 months has been in the number of people waiting longer than a year for their care. On the eve of the pandemic in February 2020, only around 1,600 people had been on the list for a year or longer. By May 2021, this had increased to almost 340,000—down from the March 2021 figure of 436,000 but, still, a 200-fold increase on pre-pandemic levels.”

According to Savanta-ComRes, a polling firm, the tax rise is even popular, according to The Economist. A plurality says it was acceptable to break the manifesto in order to fund social care.

The NHS faces its biggest challenge since its inception after World War II in 1948 by a popular Labour government as part of a far-reaching “welfare state” program. Aneurin Bevan, the health minister, modeled it on his hometown’s Tredegar Medical Aid Society, where residents paid a subscription to fund medical treatment. Tredegar is a town in the historically coal-mining South Wales Valleys.

When he was 13, Bevan went down the mines with his father, who died of miner’s lung, a disease that restricts breathing. Bevan was one of 10 children, four of whom died in infancy and one who died at age eight.

In his collection of essays, In Place of Fear, Bevan wrote:

“The field in which the claims of individual commercialism come into most immediate conflict with reputable notions of social values is that of health. . . . The essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability, and wealth is not advantaged. . . . The collective principle asserts that no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.”

“Society becomes more wholesome, more serene, and spiritually healthier if it knows that its citizens have, at the back of their consciousness, the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide. But private charity and endowment, although inescapably essential at one time, cannot meet the cost of all this. If the job is to be done, the state must accept financial responsibility.”

Clearly, the British still uphold this ethical code. In public opinion surveys, people over and over again identify the NHS as the one thing that makes them proud to be British, reported CNN (April 20, 2020). Folk memory, fairness and the fact that it says ‘national’ ensconce the NHS in the British psyche.

Portugal, like most European countries, also stands behind the principle of health care for its people. Two years after the Carnation Revolution overthrew half a century of the authoritarian New State regime, the Portuguese Constitution of 1976 guaranteed health as a right for all citizens. The National Health Service (Serviço Nacional de Saude, SNS) was created in 1979.

In this pandemic, Portugal is suffering a shortage of family doctors, or general practitioners. The minister of health, Marta Temido, admitted that the number of people without a family doctor is higher than desired and cited retirement of health professionals as a contributor to the problem, reported RTP Noticias (May 19).

“This morning, at the parliamentary Health Commission, the minister was confronted with the government’s promise that, at the end of the legislature, all Portuguese would have access to a family doctor,” reported RTP Noticias.

Family doctors released an open letter to the Portuguese asking the people to let them go back to being family doctors, according to Diario de Noticias (July 23). Health center professionals said that, for months, the pandemic has prevented them from attending to their non-COVID patients. They said that primary health care is lagging behind.

“They claim to suffer from the excess of tasks that include many weekends and holidays, and the voice of health workers is ignored by those with decision-making power. The family doctors say they are exhausted with the situation. . . (And) there are other ways to guarantee emergency care for victims of COVID-19, who need continuous monitoring, without abandoning other patients”

In the last open selection for 230 family doctors in the Lisbon and Vale do Tejo region, only 102 were filled unlike the North region, which managed to occupy all the places put up for competition, according to SIC Noticias (August 14).

“Family doctors admit that the cost of living in Lisbon affects choice”, reported SIC Noticias.

A total of 459 vacancies were opened in the country for family doctors, and 180 remained unfilled. In May, there were 950,000 without a family doctor. Now, about half will remain without one.

Portugal has a population of 10.3 million, according to the 2021 Census.

The Minister of Science, Technology and Higher Education, Manuel Heitor, wants to expand the teaching of medicine to Aveiro, Vila Real and Evora in 2023, according to Correio da Manha (September 3). He said that his goal is complex, but he aims to expand education and modernize the teaching of medicine.

Among Heitor’s critics was Carlos Cortes, president of the Central Regional Section of the Order of Doctors, who said in Correio da Manha:

“We don’t need more doctors, we don’t need more students, but, yes, (we need) a major investment in hospitals and health centers in order to have more specialists. Thousands of graduates in medicine don’t have access to a specialty because of a lack of vacancies.

“That the minister wants more generalists is serious because many don’t serve the country and follow the road of emigration.”

The number of doctors requesting certificates to work in foreign countries had been climbing unsteadily, according to Diario de Noticias (August 31, 2019). In 2014, there were 366 requests; in 2015, 475; in 2016, 198; in 2017, 182, and in 2018, 555. By August of 2019, 386 already had made the request. The total for those years is 2,162 and does not take into account the number of physicians from other countries coming to Portugal.

Cortes, who is also the director of the Faculty of Medicine at the University of Lisbon, said that expanding medicine courses is a fixation of the minister which would be useless to carry out. He said that it is a myth that there is a lack of doctors in Portugal, underscoring that the main problem is bad management of human resources.

There are 57,198 doctors in Portugal, according to Pordata (2020). The number of physicians per 1,000 (4.6) is substantially above the European Union average (3.5), reported the Organization for Economic Co-operation and Development in State of Health in the E.U.: Portugal 2017.

Waiting lists for care at NHS hospitals, consultations and surgery are the most visible face of the Service’s insufficiency, said Manuel Antunes, a heart surgeon, in an opinion piece in Diario as Beiras (May 19).

“There are no reliable data on the magnitude of the waiting list for surgeries. Before the pandemic, which greatly aggravated the problem, there were more than 165,000 patients waiting (ERS, 2018), but this number does not reflect the true situation: many patients are registered for the same surgery in more than one institution, some already have been operated on and others are no longer candidates.”

Manuel Antunes wrote: “In a survey carried out some time ago, the surgical services pointed out as the main causes of the waiting lists the lack of operative time (56%), doctors (18.7%) and beds (15.4%).

There have been measures implemented to reduce the numbers on waiting lists, said Antunes who, in 2020, became president of the Charities Diocese of Coimbra, which provides support to communities in the social, health, education and pastoral spheres.

In 1995, the Specific Program for the Resolution of Waiting Lists was introduced to reduce the numbers by purchasing services from the private sector. In 1999, the Access Program was launched to encourage the surgical services of public hospitals to carry out more procedures outside of normal working hours.

“For reasons not fully understood, but probably due to insufficient financial compensation, these programs had a limited degree of adherence and low execution rate,” said Antunes.

“In 2004, the SIGIC (Integrated Management System for Subscribers for Surgery) appeared, still in force, now including the Integrated Management System for Access to the NHS (SIGA SNS). The application of this program, therefore, covers not only the social and private sectors, under agreements or conventions, but also the entities of the NHS.

“I think that the results of this program were never evaluated, but hospitals in the social or private sector performed about 8.1% of the total scheduled surgical interventions in the NHS between 2014 and 2016 (TC, 2017),” said Antunes.

At the 23rd Congress of the Order of Doctors in Coimbra, according to the Central Regional Section of the Order of Doctors (June 21), Carlos Cortes said:

“I have immense pride in being a doctor, and I have immense pride in the doctors of Portugal who dignify the profession every day.”

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