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Last Saturday, Dr. Clara Ferreira Alves was kind enough to publish a magnificent article about the National Health Service (NHS) in which the IPO is used as an excellent example of what are unresolved needs, despite successive announcements of solutions, and the long process of political inaction that involves a reform of the NHS. Oncology, being a medical area that treats the second leading cause of death in Portugal, cancers that have an inexorable tendency to increase is the specialty that suffers most from the incompetence of the State. When I mention oncology, I am not referring only to medical oncology, but to the whole range of medical and surgical interventions, including those aimed at the physical and psychosocial spheres, used in the treatment of cancer patients, from diagnosis to cure or death.
In the case of the Lisbon IPO, the situation is even more serious in terms of how it is obtained in the express article. It’s not just about incomprehensible delays, with a history of 30 years, or crooks of all kinds, with special emphasis on political deceit. We went from wanting a new IPO, a complete hospital, to wanting a new outpatient building, and even so, nothing happens.
What is at stake is a progressive loss of capacity and, consequently, of the quality of the service provided. The Lisbon IPO, so far, in everything that involves user satisfaction surveys and levels of quantitative and qualitative production, including much of the research carried out, has managed to survive the scarcity of means, funding, State support, and to fierce competition from the private sector.
It should be noted that this same competition, still far from being able to provide better quality cancer care, supported by an occasionally shameless marketing and, it should be noted, often supported by state figures, has a very useful and indispensable role in responding to a part reduces the population that has access to insurance and subsystems. So, more than wanting to put an end to competition, the Lisbon IPO collaborates with it and would like the opposite to be more real than advertised.
The IPO is one of the safe havens where the most advanced patients, so sick that even the private ones cannot afford care, end up coming. Despite this, with the connivance of those who govern us, there are private, commercial and legitimate projects, for whom the end of the Lisbon IPO would be the best possible news. For this, they have been working using their greater capacity in hiring personnel and diverting everything they can, even beyond what they need, with the intention of emptying the public offer and gaining a monopoly in which a substantial part, most patients will remain without having someone to treat them.
The problems are real and increasingly serious. We have delays in many areas. Delays in the ability to perform imaging tests, irradiate, operate and administer intravenous chemotherapy, with special emphasis on cell therapies such as a transplant of blood progenitors, which the public calls “bone marrow”, and genetically modified cells , called CAR. These delays are already unsustainable and even more accentuated when, thanks to the global management of COVID-19, the flow of growth increases and patients emerge with more advanced pathology.
It is not fair to say that we lose patients in a general way due to inability to respond, nor that there are piles of cadavers that have to accumulate due to lack of response from the Lisbon IPO. But there is a trust that is defrauded, there are minimum quality limits that will not be consumed and there is, with great repercussion, enormous frustration in all those who, like me, have dedicated a professional life to caring for cancer patients. We are not at the stage of quantifying generalized impacts when they are punctual. But everyone’s life is 100% their own and for those who are the victim of a delay, a delay, a wait or a postponement, it doesn’t help to know that you were one of the 10% to whom the misfortune of a bad guy service was added to that of having cancer. And, as in the case of therapies involving cells, there are delays that are as impactful for those who decide priorities as for those waiting for a treatment that may never arrive.
We lack staff, already critically. There are beds and treatment stations that don’t work because we don’t have enough nurses. Imagine how, not being able to pay more, nor provide any other type of compensation, face a hard and less gratifying job, the Lisbon IPO can hire the human resources it is lacking. There are nurses, many doctors and technical personnel, specialized and non-specialized, which we lack. And it is not enough for the Ministry to say that it authorized the hiring when there is no incentive to make people choose the Lisbon IPO. And the most ridiculous thing is that the ministry, knowing that the locals today need more nurses than primary care, persists in opening competitions and vacancies in health centers, where nurses can even earn less doing it, it’s enough not to have night shifts and weekend. Every time health centers can hire nurses, they withdraw staff from the hospitals where they are treated. I do not question the need to provide the NHS, at all levels of intervention, with sufficient resources, but primary care lacks more doctors than nurses and hospitals lack regular nurses and general doctors and some specialties.
But the structural issue is at the heart of it all. The Lisbon IPO, unlike Porto where the government has always wanted to invest, is outdated. Thanks to the efforts of Dr. Passos Coelho’s first government, the former Nursing School, however, vacant, became part of the IPO’s real estate in Lisbon and there, as best as possible, several consultations that no longer had space to function were worked. was . That’s what can be done and even that hadn’t been done until we got to the government. But it hasn’t arrived.
As the new hematological precursor transplant unit has not arrived, the day hospital space for chemotherapy is not enough, the existing physiotherapy capacity does not serve, nor do we have enough beds to hospitalize patients with blood cancers and other needs that need after being hospitalized, there is a lack of equipment and personnel for imaging, there is a shortage of anesthetists, just as our capacity for outpatient care is limited by the existing human and displacement resources. The list of shortcomings would be long. But it is well known to all concerned. Let’s say that those interested who least know about this list are the patients to whom everything is done so that the absences are not noticed and do not suffer because of them. But there is a point beyond which it is no longer possible to disguise. Feeling wronged, cheated in their expectations, it is good that they complain, speak loudly and help the workers of the IPO to also be heard.
Make believe, as did the former mayor of Lisbon who sold the land at the entrance of the IPO to a private person, making any future work difficult, and ordered the construction of a bike path next to the wall that only serves to hinder access and where, strangely, if, no one passes. He pretends when he entered a budget for the construction of a new building, another plan, another turn, to which the Lisbon IPO responded by making this plan, which is successively adapted. In the 2022 budget proposal, without having spent the 2021 amount, the funding for a new building for the Lisbon IPO disappeared! He pretends when he thinks that the value of less than 60 million Euros would be enough for everything that the Lisbon IPO needs to change, remodel, grow. It is not. It is not and the more time passes, the more expensive it will be to save the Lisbon IPO.
There are those who wonder about the need for an IPO in Lisbon. The arguments that support the inevitability for the existence of a hospital specializing in cancer are many and internationally Good and publish.
But, in a simple way, the simplest reading is the one that will result from the evaluation of the many thousands of kilometers traveled by patients from all over the country profitable to the Lisbon IPO, of the dozens of ambulances that accumulate daily in “our” park – thanks to the sympathy of the entity to whom the former President of CML sold the land – and the waiting lists that patients do not abandon because they don’t want to, can’t or because they don’t have another better place to go.