Portugal plans major shake-up of health service

Portugal’s Government is preparing a major overhaul of the country’s public health system, with plans to merge several organisations, create a new public health agency and potentially replace the current head of the National Health Service (SNS).

By Kam Heskin, in News, Health, Politics · 08 Oct 2026, 17:03 · 0 Comments

The changes could alter the way hospitals are managed, how staff are recruited and who makes some of the most important decisions affecting healthcare in Portugal.

According to reports by Público, the Government is putting the finishing touches on the reform, although several details have yet to be decided.

One of the biggest changes would bring together two organisations that currently share responsibility for running the SNS.

The SNS Executive Directorate, which oversees the coordination of public healthcare services, would be merged with the Central Administration of the Health System (ACSS), which handles much of the financial and administrative side.

Part of the Shared Services of the Ministry of Health (SPMS) could also be brought into the new organisation, leaving SPMS more focused on digital services.

The idea is to reduce the number of separate bodies involved in decisions that hospitals and health centres need to make.

At present, something as straightforward as hiring a doctor can require approval from several different organisations, sometimes including the Ministry of Finance.

For hospitals already struggling with staff shortages, that can mean additional delays.

A new public health agency

The Government is also planning to combine the Directorate-General of Health (DGS) with the National Institute of Health Dr Ricardo Jorge (INSA).

Together, they would form a new national public health agency.

The DGS is responsible for public health guidance and monitoring health risks, while the Ricardo Jorge Institute carries out scientific research, laboratory work and disease surveillance.

Bringing the two together could change how Portugal prepares for health emergencies and coordinates public health programmes.

There are, however, concerns about what the merger might mean for the scientific independence of the Ricardo Jorge Institute.

The details of how the new agency would operate, and how its research functions would be protected, have not yet been announced.

SNS leadership could also change

The restructuring could bring an early departure for Álvaro Almeida, the current executive director of the SNS.

His term is not due to end until February 2028, but Público reports that he is not among the names being considered to lead the organisation that would replace the current Executive Directorate.

The relationship between Almeida and Health Minister Ana Paula Martins has reportedly become strained following disagreements over hospital management and administrative decisions.

Two possible successors have been mentioned.

Nuno Reis, a former PSD parliamentarian who now heads the Santa Casa da Misericórdia de Barcelos, is reportedly being considered, along with Carlos Martins, president of the Santa Maria Local Health Unit and a former secretary of state for health.

Neither appointment has been confirmed.

Will patients notice a difference?

For people using Portugal’s public health service, the immediate impact may be limited.

The proposals concern the organisations managing the SNS rather than changes to patients’ existing healthcare entitlements.

But the way those organisations work can have consequences for everyday services, particularly when hospitals need to recruit staff, approve spending or make operational decisions.

The president of the Portuguese Medical Association, Carlos Cortes, has acknowledged problems with the current system, although he wants to see the final proposals before taking a position.

Xavier Barreto, president of the Portuguese Association of Hospital Administrators, has also expressed support for better coordination, while warning that simply merging organisations will achieve little unless the new bodies have clear responsibilities and genuine decision-making powers.

The reform was originally expected to be presented in July, before being pushed back to September.

Neither deadline was met.

The Government now says an announcement should come soon, but the final structure, leadership appointments and timetable for putting the changes into practice remain undecided.

For patients and healthcare workers, the important question will be whether fewer layers of administration actually make it easier for hospitals and health centres to do their jobs.