The National Institute of Medical Emergency (INEM) saves lives every day, often in absolutely extreme situations. The relevance of its role does not deserve any dispute and has deserved the recognition and sympathy of Portuguese society, which trusts the Institution and its professionals.
Together with the entities that make up the Integrated Medical Emergency System (SIEM) – fire departments, units of the Portuguese Red Cross, Public Security Police and the National Republican Guard – it is truly a pillar fundamental aspect of the National Health Service (SNS) itself. Whoever writes these lines to you does so with knowledge of the facts: I have been a member of INEM since 2001 (currently on unpaid leave), I have been a leader in that house more than once and have dedicated , with great pleasure, thousands and thousands of hours of work.
It is therefore with great sadness that I have witnessed, in recent years, the degradation of the service provided by INEM. A situation of a kind of “minimum services†was reached, with a level of service below the standards of other timesrequiring an urgent refoundation and the definition of a medium/long-term vision of what is intended for the pre-hospital medical emergency and for the Institute itself.
But how was it possible to reach the current state? The answer is simple: the perfect storm has come together, caused by:
Lack of leadership and vision
Since 2011, no government has been able to claim innocence in the state that INEM has reached. The famous “going beyond the troika†of the PSD/CDS government between 2011 and 2015 also caused damage in the medical emergency, with cuts in the operational structure and investment. An example of this was the reduction of the Board of Directors to the current two members (a situation of doubtful legality), clearly insufficient for an Institution of national scale and for the demands that places it at the highest management body. Another example was the extinction of the Algarve Regional Delegation.
The governments that followed (with the honorable exception of Dr. Fernando Araújo as Secretary of State for Health) also demonstrated a painful lack of vision about what is intended for pre-hospital medical emergencies in the context of the SNS. The serious problems of (dis)investment also remained unresolved. As well as the clarification of the role of the various SIEM stakeholders and the clarification between the dual role of regulator and service provider that INEM currently has.
Inadequate internal structure
The internal structure of INEM is inadequate in relation to the requirements. To achieve this, we must accept the obvious: the reconfiguration of the organization, with the adaptation of services to the technical specialty of the various sub-areas that INEM deals with on a daily basis and with the strengthening of the management structure, whether at the level of the Board of Directors or at the level of departments and offices. Tal implies increasing the number of directors, increasing expenditure, and is therefore a highly unpopular path from a political point of view.
I would even say that this need is doomed to failure. A shame, because it would result in a more operational INEM, with more and better internal critical mass and with much more capacity to develop in such fundamental areas as Information Systems and Technologies, the capture of European financing for structuring projects and even the review of its medical algorithms for action in emergencies.
Lack of Human Resources
The number of INEM professionals is clearly insufficient to meet the needs. The result of the lack of attractiveness of careers and low salaries. Professions in this area of medical emergency are relatively poorly paid. Take the case of Pre-Hospital Emergency Technicians (Portuguese paramedics, to make things easier) who risk their own lives to save those of others and at the end of the month take home little more than their living room. minimum…
Current efficiency gaps largely result from a lack of professionals. In order for the ambulances to be operational (as they are supposed to), so that calls for help are answered in a timely manner, it is necessary to hire more professionals and create the conditions for them to remain in the Institution. O. Once again, it will be necessary to assume that it will be necessary to increase expenditure, and this can be done without burdening Portuguese taxpayers by a single cent.
Insufficient funding
INEM is not financed through the State Budget. This is a fact unknown to most Portuguese people (politicians included), but the reader is informed that the Institution’s financing is ensured through a tax applied to premiums for certain types of insurance. .
Now, the revenue is currently (and has been for several years) clearly insufficient to meet the needs. In view of the generalized increase in expenses, in view of the constant need to invest in new ambulances and medical vehicles and respective equipment, in view of the dizzying increase in the cost of the Medical Emergency Helicopter Service, in view of the increase in transfers to SIEM partners, there is no hiding it: the budget is not enough for everything!
There are only two possible paths: either taxpayers start financing the Institution through the State Budget, or the tax on the aforementioned insurance premiums will have to be increased. Whatever the choice, it will require political capacity and courage and will above all require that the “dictatorship of finance†understand that cutting costs in medical emergencies means cutting the ability to save lives. It is often said that “a life is priceless†. Not quite, but almost…
Use 1: I know the outgoing president well. The Doctor. Luís Meira is a good man and a competent professional. He did everything possible and impossible to keep INEM afloat, in particularly difficult conditions. He deserves recognition and respect.
Use 2: I know the president-designate well. The Doctor. Vítor Almeida is a professional who knows the house and the SIEM. He has unquestionable experience and competence to do a good job, so conditions are given to him by the current government. He deserves to be supported.
Use 3: INEM has the best professionals in the world. They have tasks of great responsibility and demand and unfortunately they have not received the recognition they deserve. A hug to all of them and my public thanks for their good work.
