Case Q-2326/15 Entity addressed: Health System Central Administration Date: 2016.08.01 and 2016.10.11 Subject: Access restriction to the National Network of Integrated Continued Care, concerning patients using oxygen therapy; discrimination of public healthcare subsystems users Status: The modification of the first criticized normative solution has been accepted; the second aspect remains under discussion Upon a concrete situation, of an elderly patient suffering from Amyotrophic Lateral Sclerosis, with scarce economic resources and no family support besides the one provided by his also aged wife, the Ombudsman evidenced to the competent authorities two normative aspects which could lead to the lack of protection and discrimination of patients, regardless of the actual verification of the conditions of dependency that justify their access to continued long-term health care. The first one concerned the regulatory exclusion of access to long-term units by patients who were in need of permanent or near-permanent respiratory support measures, as expressly provided for in article 19, paragraph 4, b), of Ordinance No. 174/2014 of September 10. The aforementioned norm was considered inadequate as it excludes from the longterm care specifically a group of chronic patients who should benefit from this type of clinical and social attention, including those suffering from Obstructive lung disease or Neurodegenerative diseases. Following an intervention with the Regional Health Administration of Alentejo, the complainant was provided with a place in a long-term care unit. Furthermore, a normative modification was suggested to the Health Systems Central Administration aiming the repeal of the rule stipulating the condemned exclusion criterion. In response, the addressed entity communicated that the government had in the meantime adopted a legislative procedure in compliance with the critical remark assumed. The second controversial issue concerns the conditions for access to the National Network of Integrated Continued Care by the beneficiaries of public health subsystems, whereby the right of entry is conditioned to the existence of a vacancy in a unit accepted by the subsystem concerned. Since the agreements between long term and medium term care facilities and the subsystems are often scarce in certain regions, this has resulted in much longer waiting times when compared to the ones experienced by other National Health System (NHS) users (which do not belong to any subsystem). Following previous interventions on the same subject, the Ombudsman issued a recommendation to the Secretary of State of Health, aiming the rejection of a practice that allows the discrimination of NHS users, based on the fact that they cumulatively benefit from a public health subsystem. The question extends to other areas of healthcare such as home-based respiratory care or non-urgent patient transportation, and must be regarded | 157