The Executive Council of the SNS has invested in the Local Health Units (ULS) to reinforce the articulation of health care, thus defining a single management team. The Algarve Region is a region with unique characteristics, which make the implementation of a health management model, through ULS, both a challenge and an opportunity. In this article, I evaluate the pros and cons of implementing this management model in the Algarve Region.
What are ULS?
The ULS are organizational structures that aim to ensure the integration of health care for the population of a region.
The ULS have characteristics that guarantee integrated care management, with a single administration for all levels of care in a region, being focused on the needs of users and responsible for finding the solution to their problems.
ULS will be the maximum exponent, in terms of management and articulation, of patient-centered health care, defended by all the best quality standards at national and international level.
The ULS funding model, in turn, is focused on the resident population of an area.
In Portugal, the experience with the ULS has been very positive, currently constituting a commitment by the SNS EC, which is creating a care model with a national articulation centralized in the SNS EC, an articulation at the level of large regions between the ULS and at regional or local level through the creation of ULS.
Characteristics of the Algarve Region for the creation of ULS
Health care in the Algarve is organized into 3 ACES, which in turn have several health care units, hospital care with a university hospital center for the entire region, continuous and palliative care. We are in a region that has all levels of care currently available.
The Algarve region is a region that has a Regional Coordinating Committee for itself, has had a Regional Health Administration (which will soon be extinct), has a unique Intermunicipal Community, an Association of Algarve Municipalities, a University, a Clinical Academic and a District Social Security Center (also essential for articulation with health care). These characteristics are important because they reinforce the regional character of the decision, being a very well defined region.
Advantages, disadvantages and risks of ULS for the region
The advantages of creating ULS can be well identified, namely:
• User-centred healthcare;
• Articulation of all levels of health care in a region;
• Single administration team, with decisions made to be implemented by all levels of care;
• Ease of strengthening differentiated care with greater proximity to users;
• Availability of resources according to the needs of users and not of current institutions;
• Greater strategic integration in investment, focusing on regional particularities;
• Resource sharing with optimization of efficiency in its use.
ULS may have disadvantages or risks, namely:
• Difficulties in implementation in regions with a large population fluctuation, as is the case of the Algarve region;
• Risk of being understood as a disqualification of hospital care, given that they were only created in regions without teaching hospitals;
One or Two ULS for the Algarve
Lately, the possibility of creating 2 ULS for the Algarve Region has been raised, however this situation would be an authentic aberration and goes against the articulation model defined by the SNS EC, which aims at articulation and collaboration and not disarticulating something that is already articulated in hospital terms. Furthermore, the region already has its remaining structures united in terms of management, namely the CCDR, AMAL, Social Security, University and Academic Centre.
The possibility of two ULS was hardly raised in a serious and considered way, being certainly rumors circulated to create confusion, realizing in advance that the only objective could be the creation of administration “pans”, without utility or benefit to the population.
A unique ULS for the Algarve will best articulate health care, allowing for a better response and the possibility of adapting care and its providers to the needs of users. On the other hand, a ULS continues to serve a population with sufficient numbers and impact to take the lead in national terms.
The creation of 2 ULS would create a first division ULS in the east and central region of the Algarve and a second division in the Barlavento, and it is not fair or appropriate to disqualify the inhabitants of the western Algarve in this way.
Are the difficulties surmountable in the Algarve?
The issue of funding will be surmountable, if the funding to be allocated to the ULS is defined with the sum of the inhabiting population, plus the flows resulting from tourism in the region and which are regularly accounted for by the Algarve Tourism Board. I do not foresee any difficulty for the SNS EC and the Ministry of Health to approve this form of financing for the Algarve region.
The question of the disqualification of hospital health care is more delicate, however it can be overcome if it is presented correctly and taking advantage of the fact that the construction of the Central Hospital of the Algarve is being launched (Finally!!).
I cannot fail to point out that the disqualification carried out in hospital care in the last 3 years occurred even without the creation of a ULS. The Centro Hospitalar Universitário do Algarve, unfortunately for all Algarve residents, was disqualified in its university character, which only kept it in the name. The creation of a ULS, at a time when the replacement of those who made those decisions has already been announced, could be an opportunity for the region.
I would also point out that the SNS EC has already hinted that the whole country, including Lisbon and Porto, will have its ULS, with administrative articulation between the various levels of care, including university hospitals.
Shall we move towards a ULS in the Algarve?
After this reflection, it is clear that the advantages of creating the ULS of the Algarve Region will be desirable, and it is essential to ensure that:
• The articulation of care is total, with the ULS consisting of:
the Hospital Universitário do Algarve with all its centers
the 3 ACES
o Continuing Care
o Palliative Care
• The construction and integration into the ULS of the Hospital Central do Algarve is guaranteed, with all the features necessary for tertiary level health care (which will replace the Hospital de Faro);
• Adequate financing is guaranteed with a mixed model, based on the resident population plus the floating population;
• The first Regional ULS with a University character is created, taking advantage of the fact that it integrates a University Hospital and the first primary university health care units (namely with the agreed and defined attribution of the University character to the University Health Center of Loulé, whose building is in progress);
• Bet on the certified quality of the entire ULS and all its levels of care.
I also emphasize that the creation of the ULS of the Algarve Region should work in a very articulated way with all the other ULS in the south of the
Tejo, allowing an articulation of care and sharing of resources, strengthening the SNS network.
These guarantees, I have no doubt, will be given by the CE of the SNS, and in this way the ULS of the Algarve Region can be created.
We are going to innovate in the Algarve and bet on a new model that will certainly serve our users better! Algarvians deserve the best quality health care!!
It's the right time for the ULS of the Algarve Region!
Author Nuno Marques is a cardiologist and Associate Professor at the Faculty of Medicine and Biomedical Sciences at the University of Algarve
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