Marcelo Rebelo de Sousa, on Thursday, October 30, issued a diagnosis on the state of the Health sector, describing it as “complicated”. He accused the Government of the Democratic Alliance (AD) of a “piecemeal management”, with “short-term solutions” and “grey lines”. However, he ended up supporting the Minister of Health, Ana Paula Martins, who has been under constant pressure to resign.
The long-awaited moment came yesterday at ISCTE – Instituto Universitário de Lisboa, during the closure of a conference on the 50th anniversary of the Medical Service in the Periphery (SMP).
In his address on the topic, the President of the Republic considered that “piecemeal” management prevails in the health sector, with “short-term solutions” and “grey lines” between the responsibilities of the Government and the Executive Board of the National Health Service (SNS).
“After six months, a year, a year and a half, it is wise to have a general framework of reference, notwithstanding the constant emergencies,” said Marcelo Rebelo de Sousa.
According to the head of state, the current panorama “is a dispersion of decisions, it is a wear of decisions, short-term solutions, and then it remains undefined what the long-term objective is”, which corresponds to “the path of stones, which is the most difficult path”.
“A problem is solved occasionally, here today, another there, a solution is found, it doesn’t work, two months later there’s another one, then three months later there’s another one. Even for the health financing issue, which I deliberately didn’t talk about until now, life becomes very difficult, but for any health manager,” he added.
The President of the Republic, who had postponed an assessment of health management until after the local elections on October 12, chose to make it at this conference, suggesting a political agreement on the role of the SNS, the social sector, and the private sector for a medium-term framework.
“Problems were created such as, in a case-by-case basis, not knowing who should intervene and speak for the SNS. Is it the Government? Is it the executive management of the institute?”
Lack of definition of the “operation framework” and “management of SNS”
In a speech lasting nearly 50 minutes, Marcelo Rebelo de Sousa identified the “fundamental problem” as the lack of definition of the “operation framework” and “SNS organization and management”, following the creation of the Executive Board, during the final period of the previous PS government.
In his analysis, the creation of this structure “required very rapid action and very effective action, and above all, a clear delineation of what would belong to the State, read Government, and what would belong to the new managing entity, read executive management”, but it was left “in the middle of the bridge” in this change.
“Problems were created such as, in a case-by-case basis, not knowing who should intervene and speak for the SNS. Is it the Government? Is it the executive management of the institute?”, he pointed out.
The President of the Republic warned that without this definition, “everything becomes grey lines”, which means “the multiplication of problems and the difficulty of resolving them”.
“This is the great challenge,” in Marcelo Rebelo de Sousa’s view, “that any Government, regardless of its political, doctrinal, ideological orientation, must solve“.
“My admiration rises each day seeing that the path is this path, which is the path of stones, which is the most difficult, most complicated, for understanding that another prior path, of defining a general framework, is not desirable or opportune“, he commented.
“One should not lose this time”
Marcelo Rebelo de Sousa said that this is an analysis made “over time” about the constant postponement of decisions and problems that keep accumulating.
The head of state foresees that, “maintaining this lack of definition, the problems will be, somehow, similar to each other every day”, and piecemeal management remains, with “a patchwork here or there and increasingly more urgent or emergency plans, especially at the beginning of the various executives”.
For the President, it is necessary to “try to resolve the impasse, the middle of the bridge” concerning the transition of the SNS management model, otherwise “it will be the economic and social reality” that dictates the terms of evolution in the health sector.
In this intervention, Marcelo Rebelo de Sousa argued that “in politics, the most important factor is time – not doctrines, not ideologies, not leaderships”.
“What should be done and is done out of time can be the best thing in the world, and it becomes the worst thing in the world. And what was not so good in terms of principles, done reasonably timely, ends up being minimally acceptable. One should not lose this time“, he advised.
Marcelo supports Minister of Health and calls for “convergences”
Despite all these criticisms, the President of the Republic ended up supporting Minister Ana Paula Martins, preferring to appeal for a political agreement on the role of the SNS, the social sector, and the private.
The President of the Republic suggested today a political agreement on the role of the SNS, the social sector, and the private sector in health, so there is a medium-term framework.
Referring to the health sector, he lamented, “If the Government ends, another one comes in with a different health policy. Then another one takes over with yet another health policy. No health policy endures, no health service can withstand this.”
“It might be worthwhile considering that it’s not a good idea to change the health policy every time the government changes”, he advised.
For the head of state, “the issues on which convergence would be beneficial” are essentially two: “The vision of the national health system” and “the vision of SNS management”.
Primary care and doubts about the Private sector
The Head of State also called for attention to primary healthcare and raised doubts about resorting to private sectors at this level of the system, considering that, for now, it’s “idealistic, not to say unrealistic”.
Marcelo argued that the health situation in Portugal “demands a serious consideration of the primary care situation” and emphasized the importance of the SNS network at this level.
“In primary care, with all its problems, the SNS public network, even when it has deficiencies, due to various circumstances, has an experience and tradition that other sectors will find challenging to respond to immediately. This is not ideological; it’s reality,” he said.
According to the President of the Republic, “the idea of basic care being shared, without issues, like training, with other health sectors, is still today idealistic, not to say unrealistic”.
“The capacity of other sectors to train, basically, health professionals in certain specific areas, and with certain responsibilities or complexities, is still very limited, and will be for some time. It’s natural, not depreciative; it takes time”, he pointed out.
Earlier, Marcelo Rebelo de Sousa had already referred to the idea of “associating public and private sectors with primary care, granting concessions, forming partnerships”, and admitted that private sectors might be unwilling “because they don’t have the resources for it, they don’t have the size for it yet, they’re still at a preceding stage”.
The head of state warned that “without reinforcing primary care, always desirable and attempted in various ways, but without this reinforcement, adapted to the country’s demographic evolution and mobility, everything will fall onto other aspects of healthcare, notably hospital care”.
The Health Minister was notably absent from the conference audience, citing the need to prepare for the State Budget hearing in the Assembleia da República scheduled for Friday afternoon.
Carneiro says Marcelo highlighted that “Government failed” in health
Reacting to Marcelo Rebelo de Sousa’s speech, PS Secretary-General José Luís Carneiro stated that the President made it “more evident that the Government failed in its health policy” and “is unable to meet the sector’s needs”.
On Wednesday, it was reported that the SNS executive board ordered hospitals to cut expenses even if it means reducing consultations and surgeries.
In response, the Health Ministry argued that the State Budget for 2026 (OE2926) is “demanding in terms of efficiency and less waste”, but “this demand does not correlate to reduced assistance for users”.
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