3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
On May 3, following the end of the State of Emergency, the Minister of Health determined that all NHS services should identify and reschedule all elective activity, which had been postponed since March 17. All health care provision should follow strict recommendations to avoid spreading the infection, including use of masks, avoiding peaks of outpatient visits, promote home visits and the use of telemedicine.
Aiming to prepare the response of the NHS during the Winter period, when it is expected that SARS-CoV-2 will circulate together with the flu and other respiratory viruses, the Ministry of Health is preparing a plan to ensure the NHS keeps its health care provision for the population, while still responding to a higher demand of health care due to the Winter season. The Plan will include the expansion of ICU beds, laboratory capacity and anticipation of flu vaccination.
On 16 March, the Ministry of Health determined that all NHS hospitals should postpone elective surgeries and treatments, discharge patients hospitalized for non-clinical reasons, and refer all non-urgent episodes from emergency services to primary health care units. Additionally, non-priority outpatient visits and exams should also be postponed. Primary health care units should reduce their face-to-face consultations as much as possible and be ready to expand schedules for assisting episodes of acute illness. Only immunization programmes and follow-up of pregnancies and patients with decompensated chronic conditions should be maintained as essential activities in primary care. The use of alternative ways of communication between health care workers and patients is strongly encouraged.
Aiming to strengthen human resources in the public sector, the Ministry of Health has also published legislation which simplifies the process of hiring health care workers. NHS institutions are allowed to hire new personnel for a period of four months (https://dre.pt/application/conteudo/130277343). The Directorate-General of Health has issued guidance to health services on management and procedures for several areas that needed to reconfigure services due to the pandemic, including pregnancy and birth, long-term care, patients with chronic kidney disease in need of dialysis, collection of health care waste, etc.