# Portugal emergency service reforms and staffing crisis > Live situation record from CLSTR: https://clstr.news/situations/portugal-confronts-a-series-of-healthsystem-pressures-and-reform-challenges > Updated: 2026-09-11T15:41:54.000Z. Sources: 72. Developments: 29. Portugal’s health system continues to face scrutiny over emergency service reorganization and resource shortages. Under Decree-Law 143/2026, the National Institute of Medical Emergency (INEM) is being restructured into the National Authority for Medical Emergency, a move trade unions like STEPH have labeled a “dismantling” of the system due to the potential loss of specialized transport and ambulances. While the government addressed remuneration concerns by publishing Decree-Law no. 168/2026 on August 17, 2026, to include INEM doctors in overtime incentive regimes, operational concerns remain high. Labor unrest intensified as the Union of Pre-Hospital Emergency Technicians (STEPH) organized strikes for September 14 and 28, protesting the conversion of Immediate Life Support (SIV) ambulances into light vehicles and the transfer of ambulance management to Local Health Units. During the dispute, Carlos Cortes, president of the Ordem dos Médicos, warned that the strikes could jeopardize life-saving capabilities, stating that “it is not acceptable that people may die” and emphasizing that INEM must maintain full capacity regardless of industrial action. On September 11, 2026, INEM President Luís Cabral announced that an agreement had been reached between the Portuguese government, INEM, and STEPH. This understanding, achieved during meetings at the Ministry of Health, successfully bridged initially “disparate” positions and clarified the implementation of institutional changes. Consequently, the two-day strike previously scheduled for September has been canceled. The restructuring process remains informed by a report from an Independent Technical Commission, with the stated goal of improving medical emergency response and service quality. ## Claims - INEM plans to remove 100 ambulances from its operational fleet. (disputed by 11 sources) - INEM states there is no dismantling of the emergency system and no removal of 100 ambulances. (disputed by 11 sources) - 54 ambulances will be transferred to Local Health Units (ULS). (corroborated by 14 sources) - Workers say the removal will increase pressure on fire services and the Red Cross and raise risk for patients. (corroborated by 14 sources) - Workers demand Health Minister Ana Paula Martins clarify her position or replace INEM’s governing board under the new organic law. (corroborated by 14 sources) - STEPH union warned of protests if the minister does not respond by 1 August. (corroborated by 14 sources) - The plan will affect 71 municipalities, including Lisbon and Porto. (corroborated by 13 sources) ## Timeline ### 2026-09-11: INEM reaches agreement to cancel emergency technician strike Portugal's INEM and the Union of Pre-Hospital Emergency Technicians have reached an agreement to cancel a planned two-day strike and improve emergency medical services. 2 sources. https://clstr.news/cluster/inem-reaches-agreement-to-cancel-emergency-technician-strike ### 2026-09-09: Ordem dos Médicos warns of impact from INEM strikes The president of the Ordem dos Médicos warned that upcoming INEM strikes on September 14 and 28 could jeopardize life-saving emergency services in Portugal. 5 sources. https://clstr.news/cluster/ordem-dos-mdicos-warns-of-impact-from-inem-strikes ### 2026-09-08: INEM and STEPH union meet to negotiate strike avoidance The STEPH union and the Ministry of Health will meet this Friday to attempt to avert planned strikes by INEM on the 14th and 28th regarding emergency resource reorganization. 2 sources. https://clstr.news/cluster/inem-and-steph-union-meet-to-negotiate-strike-avoidance ### 2026-09-03: INEM to integrate nurses into SNS 24 call triage Portugal's INEM will integrate nurses into the triage process for calls forwarded from SNS 24 to CODU, a role previously held by pre-hospital emergency technicians. 2 sources. https://clstr.news/cluster/inem-to-integrate-nurses-into-sns-24-call-triage ### 2026-08-26: Portugal health officials meet to discuss planned INEM strikes Portuguese health officials and the STEPH union are meeting to negotiate the cancellation of planned September strikes over INEM ambulance reorganization and emergency response capacity. 7 sources. https://clstr.news/cluster/portugal-health-officials-meet-to-discuss-planned-inem-strikes ### 2026-08-24: INEM technicians call for strikes over ambulance service changes Portuguese emergency technicians have called for strikes on September 14 and 28, protesting INEM measures that they claim could reduce emergency response capacity and patient transport capabilities. 3 sources. https://clstr.news/cluster/inem-technicians-call-for-strikes-over-ambulance-service-changes ### 2026-08-23: Seia Municipality seeks clarity on medical emergency reforms Seia officials have requested details from Portugal's Ministry of Health and INEM regarding how national emergency medical reforms will affect local ambulance services and resource coordination. 2 sources. https://clstr.news/cluster/seia-municipality-seeks-clarity-on-medical-emergency-reforms ### 2026-08-20: ANTEM criticizes INEM report over ambulance inoperability ANTEM criticizes an INEM report for failing to quantify the clinical impact of a 38.82% ambulance inoperability rate and significant staffing shortages in Portugal's emergency medical services. 4 sources. https://clstr.news/cluster/antem-criticizes-inem-report-over-ambulance-inoperability ### 2026-08-17: INEM doctors included in Portuguese emergency overtime incentive regime The Portuguese government issued a new decree-law to include INEM doctors in a remuneration incentive scheme for emergency overtime, correcting a previous legislative omission. 6 sources. https://clstr.news/cluster/inem-doctors-included-in-portuguese-emergency-overtime-incentive-regime ### 2026-08-13: INEM workers announce strikes in Portugal over emergency service reorganization INEM workers in Portugal will strike on September 14 and 28 to protest the reorganization of emergency services and the transfer of ambulance management to local health units. 6 sources. https://clstr.news/cluster/inem-workers-announce-strikes-in-portugal-over-emergency-service-reorganization ### 2026-08-13: INEM reports surge in emergency calls and faces upcoming strikes Portugal's INEM reports a surge in emergency calls due to July heatwaves, while workers announce strikes and demand the president's resignation over fleet reductions and new organizational laws. 4 sources. https://clstr.news/cluster/inem-faces-strikes-and-increased-emergency-calls-in-portugal ### 2026-07-30: Portugal's INEM clarifies ambulance reforms amid health‑sector concerns Portugal's INEM says ambulance reforms will not cut emergency capacity, but health association ANTEM warns the changes could lengthen response times, especially in rural areas. 5 sources. https://clstr.news/cluster/portugals-inem-clarifies-ambulance-reforms-amid-healthsector-concerns ### 2026-07-30: Almada home birth underscores ambulance shortage in Portugal A delayed ambulance in Almada forced a 35‑year‑old woman to give birth at home, sparking union criticism of INEM's removal of 100 ambulances and prompting calls for policy reversal. 4 sources. https://clstr.news/cluster/almada-home-birth-underscores-ambulance-shortage-in-portugal ### 2026-07-28: Portugal's INEM Reorganization Threatens Hundreds of Ambulances Portugal's INEM reorganization under Decree‑Law 143/2026 may remove over 100 ambulances, affecting many municipalities, while officials claim emergency response will stay assured. 5 sources. https://clstr.news/cluster/portugals-inem-confirms-ambulance-fleet-remains-intact ### 2026-07-26: INEM rejects claim of removing 100 ambulances, cites modernization plan INEM denies any removal of 100 ambulances, saying 54 will be transferred to local health units and 46 SIV ambulances converted to light vehicles. Workers claim the plan will affect 71 municipalities, raise fire 14 sources. https://clstr.news/cluster/portugals-inem-faces-backlash-over-removal-of-100-ambulances ### 2026-07-22: Portugal obstetrics emergency units close amid staff shortages Portugal’s obstetrics emergency units in Portalegre and Lisbon close due to doctor and anesthetist shortages, sparking medical association opposition to centralisation. 6 sources. https://clstr.news/cluster/portugal-faces-ambulance-delays-and-obstetric-care-setbacks-in-hospitals ### 2026-07-20: Beja's Hospital José Joaquim Fernandes Begins €2 Million Maternity Block Renovation ULSBA's new board inspected a €2 million renovation of Hospital José Joaquim Fernandes' maternity ward in Beja, adding a cesarean suite and upgraded facilities for the region's 1,037 births in 2025. 3 sources. https://clstr.news/cluster/bejas-hospital-jos-joaquim-fernandes-begins-2-million-maternity-block-renovation ### 2026-07-18: Portugal's INEM emergency dispatch system OnCall faces criticism over failures Portugal's INEM OnCall dispatch system, launched recently, is criticised for complexity and errors that may have caused a fatal incident; officials acknowledge ongoing refinements and workers demand answers. 7 sources. https://clstr.news/cluster/portugals-inem-emergency-dispatch-system-oncall-faces-criticism-over-failures ### 2026-07-17: Hospitals in Angola and Portugal grapple with critical staffing shortages Angola's medical union says 6,000 new health‑worker posts are insufficient, while Portugal's Braga Hospital emergency department suffers severe understaffing, prompting safety concerns in both countries. 2 sources. https://clstr.news/cluster/hospitals-in-angola-and-portugal-grapple-with-critical-staffing-shortages ### 2026-07-16: Portugal INEM restructures, drops regional North, Centre and South delegations Portugal's INEM restructures, abolishing regional North, Centre and South delegations while keeping CODU centres, expanding its board, and maintaining its funding model with added sustainability measures. 2 sources. https://clstr.news/cluster/portugal-inem-restructures-drops-regional-north-centre-and-south-delegations ### 2026-07-14: Portugal's Coimbra maternity hospital project to move forward in 2026 Portugal's health minister says the new Coimbra maternity hospital will progress in 2026, though no tender date is set; the project replaces two existing wards, has budget allocated, and has faced several prior 4 sources. https://clstr.news/cluster/portugals-coimbra-maternity-hospital-project-to-move-forward-in-2026 ### 2026-07-07: Portugal President Issues New Organic Law for INEM Portugal’s President António José Seguro signed four decrees, including a new organic law giving INEM a special‑regime status and a clinical‑director governance model. 3 sources. https://clstr.news/cluster/portugal-president-issues-new-organic-law-for-inem ### 2026-06-30: Portugal's INEM faces staffing shortages and reform concerns Portugal's medical emergency unions warn that INEM staffing cuts, ambulance reductions and proposed reforms risk weaker pre‑hospital response and call for a legal framework and better funding. 2 sources. https://clstr.news/cluster/portugals-inem-faces-staffing-shortages-and-reform-concerns ### 2026-06-17: Portugal emergency services delay leaves injured patient waiting 58 minutes INEM delayed 58 minutes in responding to firefighters' call for a patient with a broken leg, prompting concerns over emergency response efficiency in Portugal. 2 sources. https://clstr.news/cluster/portugal-emergency-services-delay-leaves-injured-patient-waiting-58-minutes ### 2026-06-02: Portugal sees surge in inappropriate hospital admissions, costs exceed €350 million Portugal's APAH warns that inappropriate hospital stays have risen past 2,800 since March, costing over €350 million, and urges expanded home‑care services. 2 sources. https://clstr.news/cluster/portugal-sees-surge-in-inappropriate-hospital-admissions-costs-exceed-350-million ### 2026-05-30: Portuguese municipalities demand reopening of obstetrics emergency services Portuguese mayors protest obstetrics emergency closures at Vila Franca de Xira and Barreiro hospitals, seeking a meeting with health pact coordinator and a monitoring commission. 2 sources. https://clstr.news/cluster/portuguese-municipalities-demand-reopening-of-obstetrics-emergency-services ### 2026-05-27: Portugal's Hospital de Faro ordered to overhaul emergency care after death and denied pregnant patient Portugal’s ERS ordered Hospital de Faro to improve emergency services after a patient died waiting four hours, and the health minister demanded clarification after a pregnant woman was denied admission and sent 5 sources. https://clstr.news/cluster/portugals-faro-hospital-ordered-to-improve-emergency-care-after-patient-death-and-pregnant-woman-ref ### 2026-05-05: Portugal's pediatric inter‑hospital ambulance service faces legal uncertainty Portugal's new emergency transport decree threatens pediatric ambulance legal status; union warns, INEM says service will continue. 16 sources. https://clstr.news/cluster/portugals-pediatric-interhospital-ambulance-service-faces-legal-uncertainty ### 2026-05-04: Portugal's health system eyes €9.6 bn savings from self‑care as ICU bed capacity trails EU average Portugal could save €9.6 bn via self‑care while its ICU bed ratio remains below EU norms, prompting efficiency and capacity reforms. 3 sources. https://clstr.news/cluster/portugals-health-system-eyes-96-bn-savings-from-selfcare-as-icu-bed-capacity-trails-eu-average --- Cite as: Portugal emergency service reforms and staffing crisis. CLSTR, https://clstr.news/situations/portugal-confronts-a-series-of-healthsystem-pressures-and-reform-challenges