Sunday, 10 August 2025

Mountain top thoughts

We are in Portugal for a long weekend. Up in the mountains, and in a tiny village called Monte Frio to be precise. Jane and I are here with my oldest friend Keith, who has moved out here permanently. It is a beautiful place. It is also festival time and very hot! Yesterday we were all sent texts to remind us that there is a high risk of a wildfire. This is our first trip abroad since Jane had her subarachnoid haemorrhage in January. So despite there being no physical reason for us to be anxious about flying again, we were a little stressed – but to be honest, that could have just been down to flying with Easy Jet.  

Now my old English teacher Miss Floyd, adopting a Shakespearian tone, once reminded us school kids, that ‘making comparisons was odious’. So ‘don’t do it’ was her advice. But, finding myself in my friend’s house tucked away in the mountains, I thought it would be interesting (and fun) to do what Miss Floyd told us not to do.

There are some predictable comparisons. Here is what the data says: Portugal is 91.550 Km2 which is considerably smaller than the UK (241,930 Km2), as is the size of the population. Portugal has 10,410,642 people, whereas the UK has 69,551,332 people. This means that in Portugal, there are 114 people per Km2 compared to the UK, which has some 287 people per Km2. No wonder it can sometimes feel crowded here in the UK.

A cursory scroll through on-line data tells me that both countries have a National Health Service (NHS). And both are universal provisions. In Portugal there are additional insurance-based schemes that folk can also have alongside NHS services. Speaking with another ex-pat, John, he pays €120 a month for his scheme, which gives him speedy access to specialist care. He told me the facilities and service were second to none. John did note however, there can still be waiting lists. The organisation of health care is like that in the UK. In Portugal, it is the Portuguese Ministry of Health that undertakes the policy guidance and strategic planning, and which also has a regulatory role as well. In 2022 a NHS Executive Directorate was established that is largely responsible for the monitoring and implementation of the Portuguese National Health Plan. Local Health Systems are responsible for commissioning, co-ordinating and managing health care providers. 

Sounds very much like rather the UK health care system, only we are currently trying to dismantle and refocus some of our versions of these organisations. In the UK we spend just over the international average GDP spend; Portugal, just under this average. However, a higher percentage of resources is spent on primary care with 53% of all doctors in Portugal being GPs (31,673). Here in the UK we are playing catch up with just 28,271 full time equivalent GPs. Indeed, there has been very little increase in GP numbers in the UK since 2015.

Tackling this shortfall in primary care is absolutely critical if we are to achieve all of the three ‘left shifts’ outlined in the recently published UK 10 Year Health Plan. Nursing shortages and skill mix is another area that will clearly need similar attention in terms of recruitment and retention. It’s clear that looking after the NHS workforce, both here and in Portugal will become increasingly crucial. The wider demographic changes and the declining populations seen Europe are already impacting on the numbers of folk available to become part of the workforce. It will only get worse over the next 10 years.

In recent weeks, both in the UK and here in Portugal, we have seen how the consequences of a dissatisfied health care workforce can result in industrial action. In the UK, we recently had a five-day strike by Resident doctors seeking higher salaries and changes to a variety of their employment terms and conditions. Last December and January, it was reported in Portugal that as many as 300 Junior doctors (equivalent to our Resident doctor) had opted not to continue their training into specialist areas of medical practice. They wanted better funded training, working conditions and higher salaries.

Urgent and emergency care doctors working at one of Lisbon’s largest acute hospitals are threatening industrial action over pay and conditions, and in a separate dispute, doctors and nurses working in a acute hospital in the Algarve went on a 24-hour strike last Thursday in a demand for better salaries and greater employment opportunities for doctors, nurses and other health care professionals.

Sounds familiar, doesn’t it? Maybe Miss Floyd was right when it comes to making comparisons, don’t go there. However, it is somehow reassuring in a non-reassuring way to know the issues we face in contemporary health care in the UK are also to be found elsewhere in the world. But, the sun is up and it is already warm. It’s time to get ready for today’s festival activities, which seem to include much beer drinking, eating, dancing and generally having a great time. 

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