In Portugal the option for a National Health Service model inspired on the European social model has consolidated the perception from the citizens of the usefulness of a public health service that, despite the high degree of dependence between citizens and state, stands as the best manner of guaranteeing the values of social access, equity and solidarity.

The organization of the health sector, founded on criteria of quality and technical and deontological competence, favours the planning, coordination and integration of care. The advantages of a system model should also contribute towards a strict pondering of investments in infrastructures and equipments, as well as towards an adequate management of human resources.

The economic, social and demographic growth of the last years leaves few doubts as to the mapping out of the needs that health systems are going to be facing over the coming decades. This tendency is clearly illustrated in the recommendation recently produced within the report by the European Parliament Development Commission when it refers to the need for substantial reinforcement in the European Union budget for teaching costs and health services, alongside financial expenditure on basic social services.

Although the aims of the health system are not restricted to gains in efficiency or in the redistribution of economic value, its good governance should incorporate the culture of efficiency as an instrument for the guaranteeing of sustainable quality. It is thus fundamental for the development of public policies to always have the quality of choices in mind.

The new paradigms of assistance make health system responses more and more demanding. In this sense, the new models of organisation and cooperation should attempt to make the priority needs of medical investigation and research compatible with the caring mission within the scope of the responsibilities of the health system. This aim should not be dissociated from the deepening of the academic dimension of clinical medicine, as well as the encouraging of biomedical and clinical research.

Institutional strategic cooperation in the health sector should be fundamentally based on under- and post-graduate training and continued medical training in medicine, biomedical sciences and health.

Reorientation of the health system necessarily implies the capacity for the rationalisation of the high cost and differentiated means available. This process should have as its critical determination the incorporation of a scientific, technical and clinical value, at the same time as a re-centring of the competences and resources in a multi-disciplinary environment that might favour the increment of biomedical and clinical research.

It is within this context that it is necessary to reflect upon the social usefulness of the creation of an Academic Medical Centre. This joint project between the FMUL, the Instituto de Medicina Molecular and the Hospital de Santa Maria (North Lisbon Hospital Centre, EPE) possesses the best conditions, on the institutional level, for pursuing a modernising path in the areas of medical education and that of the health sciences.

We are deeply convinced that we have ahead of us not only a major institutional challenge, but above all a great opportunity in the development of the academic dimension in clinical medicine and of the principles of clinical governance in the common areas for teaching.

Adalberto Campos Fernandes
President of the Board of the North Lisbon Hospital Centre, EPE