When nurses across the United Kingdom went on strike on December 15 and 20, 2022, their actions resonated well beyond the UK, and nurses from different countries expressed their support. Among them were 125 nurses from Portugal who published an open letter in solidarity with their British comrades, reminding readers and patients that their own public health system faces many of the problems troubling the UK’s National Health Service.
Mário André Macedo, a specialist nurse and one of the first signatories of the letter, told People’s Health Dispatch that their initiative was inspired by both solidarity and a pressing need to point out the shortcomings that could bring the Portuguese public health service to its knees. In fact, the health system in Portugal shares a lot of similarities with the NHS, being itself inspired by the Beveridge model introduced in the UK.
While still drawing upon its positive association with public funding and universal access, things have been going downhill for the Portuguese public health system for years. If we look at the position of nurses in the system, their problems are as pressing as those of the health workers in the UK. The professionals who signed the letter estimate that over the past decade or so, nurses in Portugal have faced a 20% wage loss – double of what nurses’ trade unions in the UK have reported.
During the same period, thousands of nurses have emigrated from Portugal to other countries, with the UK being one of the preferred destinations. Many of those migrant nurses are now also on strike, points out Macedo, because they are aware of their responsibility towards fighting for good quality health services that are accessible to everyone. The nurses who emigrated from Portugal to the UK are all too familiar with the background processes that have undermined public health systems, putting people’s right to health in danger.
Divide and profit
The health system in Portugal, just like the NHS, has been an object of interest for the private sector for a very long time. In both cases, the goal of the private providers is to break down the systems, privatize the profitable parts, and leave what remains to a shrunken public budget. The main losers in this scenario are, of course, the poor and the working class, who have no alternative but to seek care in the public sector, no matter its state.
But it would be wrong to think that health workers are not harmed in the same process. Because of the dedication to austerity and public budget cuts that accompany attempts to commodify health systems, health workers’ rights have plummeted, leaving most of them overworked and burned out. In Portugal, the failure of the government to adequately address nurses’ grievances over salaries and career progression led to the first country-wide strike in this profession since the beginning of the COVID-19 pandemic.
“Trade unions did not push for industrial action at the height of the pandemic, but the government’s first proposals for the regulation of our salaries and professional progression led to a landslide of support for this kind of action: at least 75% of the nurses supported going on strike,” says Macedo.
More improvements needed as cost of living continues to increase
Rating career progression might seem as an abstract reason to go on strike for. In practice, the lack of a proper system has serious consequences. “Let’s say you’re a nurse who is retiring tomorrow. In case there is no change in the current system, your pension will be around 600 euros higher than the pension of a nurse who is now entering the workforce and who will accumulate the same experience and working hours as you have now,” explains Macedo.
He concedes that following the strike, the government has agreed to introduce certain provisions to value career progression. But they have decided to implement these provisions starting January 2023, without making any retroactive payments – which for some means a loss of thousands of euros.
The topic of increasing nurses’ salaries according to career progression became more difficult to ignore because of the growing inflation and increase of costs of living. Because there is no increase in salary in line with accumulated experience, around 80% of hospital and primary health care nurses earn a gross salary of around 1,500 euros. After taxes, their income rounds up to some 1,000 euros.
At the same time, rent prices for one-bedroom units in Lisbon and tourist regions like Algarve start at around 700-800 euros. It’s not a surprise, then, that those are the areas facing a serious shortage of nurses. It is literally impossible to make ends meet on a nurse’s wage in a single household.
Some of the trade unions remain cautiously content with the promises made by the government, hoping that they will be enough to catch up with what was lost in past years. Others – most notably the Portuguese Nurses’ Union (SEP), which spearheaded the strike in November – have already announced that they will continue to fight for a fairer deal.
As they do so, they will also be fighting for a better healthcare system. According to Macedo, “As health workers, we should protect the universal character of our health system. And since nurses are the most numerous group inside this system, we have the opportunity to make a particular impact.”
The nurses’ intention is to push for change at the local level, but also to build stronger relations with their counterparts in other countries. “We can only win if we stand in solidarity and learn from each other. In some cases, the nurses’ position is better because the country channels more money towards the health system. But in most places, it is the workers’ struggles which actually make the difference, and we can only become stronger by connecting them,” concludes Macedo.