The National Health Service (SNS) has been, since its creation, one of the central pillars of Portuguese society, ensuring equity, universality and solidarity in access to health. However, the current model shows clear signs of exhaustion: costs rise, performance decreases and user experience deteriorates. The problems are not new, but the current context is more demanding, complex and marked by the chronicity of diseases. It is therefore urgent to rethink the care delivery model, before degradation becomes irreversible.
To truly transform the SNS, it is not enough to legislate and create new structures, extinguishing others, leaving institutions in an operational void. Reform requires more than decrees: it requires concrete results. It is not enough to reduce units or announce mergers. What is important is to understand: do these measures improve access? Do they increase the effectiveness of services? Do they create better conditions for patients and professionals? Do they generate sustainable savings? Without clear answers, there is no reform — only administrative change.
Transformation will only be possible with the involvement of everyone: health professionals, orders, unions and, of course, users. The reform only gains legitimacy if each party realizes the individual and collective benefits that arise from it. Today, we have exhausted and unmotivated professionals and dissatisfied users — a portrait of widespread dissatisfaction that we cannot continue to ignore. The SNS needs to be rethought in an innovative, structured way and adjusted to the country’s demographic and social reality. To achieve this, it is essential to invest decisively in primary health care, which must assume a central role in continuous and personalized monitoring, especially in an increasingly aging population with a high burden of chronic disease.
It is equally critical to concentrate resources where necessary to guarantee excellence and efficiency — such as in transplants, severe trauma or interventional radiology, among others — and, at the same time, decentralize whenever proximity is an indispensable condition to respond to people’s real needs. And we cannot ignore the obvious: in the coming years it will not be possible to guarantee a family doctor for everyone in the current model, which is why it is urgent to explore alternative and more flexible solutions.
Last but not least, it is necessary to invest in technology and proximity care, viewing telemedicine, artificial intelligence and telemonitoring as allies that can improve access, reduce hospitalizations and increase user satisfaction. At the same time, home care must gain expression, ensuring continuity, prevention and comfort for patients and families.
The new organizational model of Local Health Units (ULS), which accompanies citizens at all stages of life, now offers a unique opportunity to achieve this transformation. But this opportunity will only become a reality if there is political courage, commitment from professionals and clarity in objectives.
The SNS does not need announced reforms, it needs changes that translate into more access, more quality and more trust. Reforming the NHS is possible — but it will only be credible if it actually puts the focus on patients and professionals.