Bloco de Esquerda presents a Manifesto for Health: If the NHS saves and protects us, then we have to invest in it
Bloco de Esquerda has always been an active defender of the NHS (SNS in Portuguese), as its national coordinator, Catarina Martins stresses: “At a time when the country is preparing, much like the rest of the world, for an epidemic, those who have always been attacking public hospitals and who even defended that they should be privatised, will not demand anything from private hospitals; they will demand everything from the public hospitals of the NHS”, adding that “If someone needed proof that we do need a strong public NHS, it is here, we depend on it”.
Today, more than ever, all over the world, the importance of public health systems is generally assumed and applauded, but they need more than that. Public health services must be strengthened in several areas in order to properly fulfil its main functions and needs. At the same time, access to health care should be one of the main tenets of any society, grounded on the ideas of universality and gratuity, essential for a true health system for all people.
Moisés Ferreira, Bloco de Esquerda’s MP and responsible for health matters, said “The health crisis showed how health is a public good”, emphasising that “We learned that in public health emergencies it is our NHS – one that is public, universal, and free – that saves and protects us. It is not private individuals who turn health onto a commodity, those who closed doors or who saw the epidemic as another business opportunity that the country needs”.
The private sector showed its intrinsic pursuit of profit, evident in the way it hibernated or even closed doors when the country needed it most or in the different moments, many of them successful, to generate revenue from the epidemic.
What has to come from this epidemic is a more robust and effective NHS as to continue to fight COVID-19 and, at the same time, recover the suspended schedule and the waiting lists that already existed before, as well as developing new responses to health needs that have now emerged or worsened.
For all the above, Bloco de Esquerda recently presented a Manifesto for Health proposing measures aiming at strengthening the NHS, which should be implemented with the utmost urgency
- More funding for a more robust NHS, with or without a pandemic
The NHS has been chronically underfunded, always surviving on funds way under the planned expenditure. Such scenario has created debt and limited the NHS’s ability to respond. Added to this is a strategy of transferring resources to the private sector, which has further mitigated its budget, the number of professionals and hospital beds and the capacity for complementary means of diagnosis. This is the time to significantly increase the NHS’s funding to meet all requirements. Investment in human resources, technology, innovative therapies and decent facilities is required.
- Retrieve scheduled activities and waiting lists
The NHS is for everyone, whether in the prevention and treatment of diseases or in the promotion of health and rehabilitation. After the emergency caused by the current pandemic, it is necessary to recover all the postponed activity as well as the interventions that were previously on hold, paying special attention to the chronically ill, so that no one is left behind. We also need to prepare the NHS for other unexpected situations that may happen.
- Strengthen the Public Health System
Public health is not an expense. As it has been proven, it is an investment. The worsening in public health observed in recent decades – the WHO placed Portugal among the four countries of Europe that mostly reduced investment in this area since the beginning of the millennium – must be quickly reversed, through the reinforcement of human resources in Public Health services and by deepening the multidisciplinary nature of its teams.
- Primary Health Care: more proximity and access
There are recurring references in the international press asserting that one of the key aspects to controlling the pandemic in Portugal was the involvement, from the first hour, of Primary Health Care (CSP). It has become clear, therefore, that the NHS should attain a more local and accessible Primary Health Care.
- Autonomy to hospitals and strengthening intensive care
In recent years, the NHS has lost hospital beds to the private sector, providing a number of intensive care beds significantly below the European average. It is now clear how dangerous such a set-up can be. We must reinforce the number of beds and equipment and increase the training of professionals and specific training for intensive care, with the aim of reaching the European average number of beds per 100,000 inhabitants. This can be achieved by maintaining the autonomy for equipment acquisition, hiring of staff and the internal reorganisation established during the pandemic. Hospital autonomy must always exist, and not just in times of exception.
- There is no health care without professionals
The importance of health workers has been immense during the pandemic. A modern and strengthened NHS needs not only to retain the best, but also to be an adequate and safe training environment. To this end, it is essential to 1) review the careers of all health workers, in particular those imposed unilaterally by the ministries, without the agreement of the respective union structures; 2) create a status of risk and pain for health professionals; and 3) assure the option of the exclusivity of functions in the NHS for all professionals, with the appropriate framework and remuneration.
- Immediate reinforcement of Mental Health in the NHS
There is no health without mental health. This fact has been persistently ignored over the years, but it must come to an end. Mental health must be a priority. Especially after an epidemic where physical distance, uncertainty, anguish, and socioeconomic determinants have led to the worsening of previously existing situations and the emergence of new ones that require help and intervention. The measures foreseen in the 2020 Portuguese State’s Budget, as proposed by Bloco de Esquerda, must be implemented as soon as possible, namely prevention and treatment programs for anxiety and depression, community teams and the free dispensation of antipsychotics. It is crucial to maintain local and national support telephone lines, with response flowcharts articulated with Primary Health Care and Local Mental Health Services and ensure the proximity and continuity of care to populations with the increase of human resources in different professional areas.
- Articulation of the NHS with the Academy and R&D
The response to the pandemic mobilised direct care professionals and services, but also the Portuguese academic and scientific community. In a matter of days, universities and research centres directed their resources towards epidemiological analysis and scenario mapping, as well as carrying out diagnostic tests or genetic material sequencing. The articulation with academia and R&D proved to be a winning bet to be strengthened and expanded. It is a strategic option for the development of the NHS and the health system, with advantages for the population, the economy and science. It is important to create partnerships, both financed and with reduced bureaucracy, between the NHS, public laboratories and universities for the development of research and development in the health area.
- Public production of medicines and health products
The relevance of a Military Laboratory, which produces medication that does not interest the pharmaceutical industry because it does not guarantee profit but rather guarantees autonomy in the production of basic equipment and material, has become increasingly evident. We have always defended its relevance to the population’s health and to the NHS, despite the attacks it has suffered. We propose to transform the Military Laboratory into a true National Medicine Laboratory, with enhanced skills and funding, to produce goods and equipment essential to the daily routine of the Portuguese NHS and to internalise, in the NHS, the performance of laboratory analysis and imaging tests, among other procedures.
- Technological and remote devices for the NHS
The use of teleconsultations proved to be an essential “tool” in providing prompt responses and improving access, without imposing travel and waiting for citizens who needed health facilities. As citizens and professionals learn how to use this tool, we should encourage the continuity of this practice. Some measures are fundamental, such as providing health facilities with technological resources that allow consultation by videoconference as a regular practice, redesigning the health information system, so that each citizen has a unique clinical process, accessible in all NHS health units, with a guarantee of confidentiality of personal data whilst ensuring the regular measurement and review of the algorithms used, hence increasing the effectiveness of the answers.