The debate on public health in Portugal is dominated by the issue of human and financial resources. The number of doctors, the health budget, the number of people without a family doctor or the waiting time for consultations or surgeries are discussed. In this way, the debate reduces the expansion of the National Health Service (NS) to private promoters seems to be a single viable solution. Clarifying my position: I have no principled objection to the inclusion of private persons in the SNS. However, I think that the problems will not be solved if we reduce the debate on the SNS in this way.
The problem of human and financial resources is very important and will tend to increase, for known reasons: research and knowledge stop offering new solutions and do not require increasing technological investments; aging requires more health care; offer citizens’ expectations of access to more and better care and services. A different approach is therefore needed, one that places emphasis on sustainability and efficiency in the use of resources. I propose, for reflection, three pieces of information.
First, revisit the social division of work, that is, a definition of the acts reserved for different health professionals. This review is fundamental above all in terms of the responsibilities of nursing professionals, which are the data of professionals respected for their training, and can assume responsibilities similar to those of developed countries. This has been, in Portugal, a taboo topic. However, when studying the reasons for the emigration of thousands of nurses, they are always found as references to the (realized) possibilities of professional fulfillment and career opportunities in careers in opportunities.
Second, to mobilize knowledge about the forms of work organization in health institutions. In these highly reliable companies, and in stable professional quality maintenance work, stable professional quality work predominate. In many cases, combining specialization with systemic and generalist approaches to solve problems. However, they are always work solutions, they are compatible with complex organizational solutions or complications in contract modalities.
Third, responding to citizens’ expectations of participation in decisions about their health, their body, their illness. Which must be real, even when the space for the participation of authority and professional power based on scientific knowledge is preserved, as well as the perception of what will be the public interest.