Health Minister on spotlight for INEM failures
The Health Minister Ana Paula Martins shifted blame onto the previous PS-led government for INEM’s deterioration, particularly regarding staff shortages.
A report by the Health Sector Inspectorate (IGAS) has found that Portugal’s Ministry of Health failed to inform the National Institute of Medical Emergency (INEM) about strike notices, preventing it from arranging essential emergency services.
The findings have intensified criticism of Health Minister Ana Paula Martins, with Socialist leader Pedro Nuno Santos calling for “political consequences” for the Prime Minister and the Minister of Health for their “serious incompetence and negligence.”
“The consequences of this incompetence and negligence were serious, they are known, there are 11 deaths and what we need to know now is what the Prime Minister is going to do, what the Minister is going to do, what consequences she draws from this report,” Pedro Nuno Santos asked.
However, on Thursday, an internal inquiry conducted by INEM found no evidence of a “direct link” between potential shortcomings in emergency response and the 11 deaths allegedly connected to delays during the November strike by pre-hospital emergency technicians.
In a written reply to the Chega party, the Ministry of Health stated after consulting with INEM : “No facts or circumstances were identified that would lead to the conclusion that the deaths were directly related to potential delays in call handling by CODU [Centers for the Guidance of Urgent Patients].”
Background
The IGAS investigation focused on the emergency response failures at INEM during early November, a period marked by a strike on overtime hours by the Pre-Hospital Emergency Technicians’ Union (STEPH) and two public sector strikes.
According to the report, the Health Ministry received strike pre-notices but did not forward them to INEM in time for the institute to negotiate minimum services.
The delay meant INEM only learned of the October 31 strike on the same day it began, affecting 80% of scheduled workers. On November 4, despite no time to organize minimum services, only one shift—from 4 p.m. to midnight—failed to meet emergency response requirements.
The failure to prepare led to severe disruptions, with dozens of emergency vehicles out of service and long delays in handling urgent calls to INEM’s Coordination Centers for Urgent Patients (CODU).
Eleven deaths were linked to these response failures, prompting the Public Prosecutor’s Office to open seven investigations, one of which has since been closed.
The IGAS report calls for several reforms, including a formal review of staffing ratios at INEM, improved planning for emergency coverage during strikes, and stricter requirements for the Health Ministry to immediately forward all strike notices to relevant health authorities.
Health Minister’s Reaction
In a statement, Health Minister Ana Paula Martins said she is awaiting the final conclusions of the inquiry, emphasizing that there is still a phase for counterarguments.
At the same time, her office confirmed that the ministry will comply with IGAS’s recommendation for the Secretariat-General of the Health Ministry to review how strike notices are forwarded to relevant entities.
Martins shifted blame onto the previous PS-led government for INEM’s deterioration, particularly regarding staff shortages.
The Health Ministry’s statement highlights a “significant reduction in human resources” at INEM between 2022 and 2024 and references an April 2013 directive in which a former Socialist Secretary of State for Health approved a 308-position staff cut at the emergency service.
“When this government took office, ambulances were out of service due to a lack of maintenance, emergency medical vehicles had no crews, and pre-hospital emergency technicians were entering the profession without completing their training,” Martins’ office stated.
It also emphasized that Prime Minister Luís Montenegro’s administration has already begun reversing INEM’s decline.
Wave of Leadership Changes in Portuguese Hospitals
Meanwhile, this week, the administration board of Évora Hospital has submitted its resignation to the Portuguese government, citing disagreements regarding the management of the construction of the New Central Hospital of Alentejo (NHCA).
The NHCA project has experienced significant delays. Initially scheduled for completion within 30 months, with a target date in 2024, the project is now expected to extend to 2026 or even 2027. The hospital administration warned that without a revised management model, costs and delays would continue to accumulate.
The situation in Évora follows a recent controversy in which the hospital refused assistance to a man who collapsed just 20 meters from the emergency room.
The resignation in Évora is part of a broader pattern of hospital administration turnover in Portugal.
Since the government led by Prime Minister Luís Montenegro took office, 14 hospital administrations have been replaced through dismissals, non-renewals, or voluntary resignations. This accounts for 36% of the total 39 Local Health Units (ULS) in the country, alongside one of the three Oncology Institutes (IPO).
Some of the new appointees have political ties to the Social Democratic Party (PSD), sparking concerns about the selection process.
While the Minister of Health, Ana Paula Martins, has insisted that PSD does not influence National Health Service (SNS) appointments, critics, including the president of the Portuguese Association of Hospital Administrators (APAH), Xavier Barreto, have raised concerns about the qualifications and experience of some of the new administrators.
APAH has called for more transparent recruitment criteria, emphasizing that hospital management experience is crucial for leadership positions.
Barreto noted that while political appointments have always been part of the system, the current level of disparity in experience among appointees raises doubts about the effectiveness of some choices.