Emergencies and access to health care

It has been announced that the coming months, November and December, will be dramatic for the NHS. If it is true that this sentence must be viewed in the context of very difficult labor negotiations, the impact on emergency services cannot be ignored. It will be widespread.

This is one of the most personal and difficult texts I have ever written. At the end of this month, we were informed that the pediatric emergency room at the Hospital Fernando Fonseca (HFF) would close after 8 p.m. This situation is unacceptable. It harms professionals, it harms the institution, the prestige of SNS, and most importantly, it harms children and their families in immeasurable ways.

The Humanitarian Housing Fund responds to the health needs of approximately 600,000 people, of whom nearly 200,000 do not have a family doctor or nurse. The Pediatric Emergency Unit provides care to 115,000 minors in the municipalities served by HFF, a reference population that includes children from the Western Region or from the Loris area of ​​influence, and whose Pediatric Emergency is also conditional. For this reason, between January and September 2023, the HFF Pediatric Emergency Unit was responsible for 10.5% of visits in the Lisbon metropolitan area, an increase compared to 2022, which was responsible for 9% of cases.

This data shows that HFF Children’s Emergency Room is the second most used emergency room in the region. Its closure and the absence of alternatives will put additional pressure on the few services that will remain open. Contributing in this way to the deterioration of their working conditions and the quality of care provided.

The hospital serves a very needy population. With unemployment rates higher than the national average, alarming education rates, and low incomes, conditions that create and exacerbate social vulnerabilities exist in the region. The public emergency service does not only provide health care. It solves social problems, protects children, and represents a real safety net for society.

It is not uncommon for mothers who make the five-kilometre journey from Amadora to the hospital on foot, with their babies in their arms, to be monitored in the emergency department. It is common for the first buses in the morning to pick up parents who have sick children, some seriously, but who, due to lack of income and knowledge to seek other types of help, keep their children home until dawn. The state cannot fail these citizens. All children deserve guaranteed access to quality health care. We cannot undo this fundamental value.

The problem becomes even greater when we know that throughout the metropolitan area, there are also restricted access to many pediatric emergencies. The entire system, based on precarious work and little planning, which has not been subject to any kind of investment in recent decades, finds itself, on the eve of greater demand, at risk of not providing the necessary response to the population. The labor issue must be resolved fairly and quickly. But let us not fall under the illusion that this is the only problem facing this sector. Poor and ineffective distribution of responsibilities between doctors and nurses, lack of integration of care, and the fact that there are no dedicated and motivated medical teams to work in emergency situations are also relevant parts of the problem. Which, again, will not be addressed.

Anyone who tries to frame these shutdowns as part of a “grid reorganization” plan is wrong. True reorganization takes time and planning and starts at the bottom: with primary health care. On the contrary, what we are witnessing is an unplanned shutdown without any ready alternatives.

All the health professionals I have spoken to recently have given me the same message: confidence in the public health service and a desire to work to ensure access to quality healthcare. SNS problems will be solved with workers, not against them.

We all want and need a truly comprehensive National Health Service.