Delayed Calls at SNS24 Cost €1.5m Fine, Drive AI Triage and Hiring

An unexpectedly large surge in calls to Portugal’s medical helpline has ended up costing its main contractor, Altice, a hefty penalty while forcing health officials to rethink how they keep citizens connected to primary care.

Quick glance: what’s driving the headlines

• €1.5 million fine levied on Altice for missing strict service-level targets.

• Daily call peaks above 24 000 contacts stretched the system through 2025.

• Wait times ballooned to 768 seconds during the summer before sliding back down.

• SPMS preparing a new 60-month tender to future-proof the hotline.

• Extra AI triage tools, 3 700 clinicians and better pay are already in place.

A lifeline under pressure

For many Portuguese families, the SNS 24 number has replaced the traditional drop-in at the local centro de saúde. It handles everything from paediatric fevers to vaccination appointments, and the comfort of having a nurse on the line in under half a minute was written directly into Altice’s 2024 contract. But when respiratory infections exploded and services such as “Ligue Antes, Salve Vidas” were folded into the platform, call volumes jumped by 74 % in just one year. That crowding swiftly transformed the hotline from a convenience into a source of frustration.

How the €1.5 million bill took shape

Behind closed doors, the partnership between Altice and the Serviços Partilhados do Ministério da Saúde (SPMS) includes nineteen separate key-performance indicators. Breaching them triggers automatic financial claw-backs. According to SPMS president Sandra Cavaca, Altice failed repeatedly on three core metrics:

• the average wait had to stay under 30 seconds;

• 93 % of calls should be answered inside 15 seconds;

• overall service efficacy was pegged at 95 %.

Missing those marks on nineteen occasions over twenty-one months produced the headline €1.5 million sanction. Altice board member Nuno Cadima confirmed the deductions but cited confidentiality rules when pressed for the precise ledger. The company argues that its €51 million ceiling contract never envisioned demand approaching 7 million contacts a year.

When seconds turned into minutes

Hard data from SPMS paints a roller-coaster. In January 2025, the average caller waited more than 12 minutes; by August that figure still stood at 13 minutes and weekend peaks crossed the half-hour mark. September clocked a 689-second mean delay, while November finally pulled the metric down to 153 seconds—still five times the original promise but a significant rebound. Alongside the queues came 1.6 million unanswered calls, fuelling a wave of citizen complaints that reached Parliament’s health committee.

The fix-it list: staff, software, salary

Altice and SPMS have thrown several levers to regain control:

• 265 new clinicians in September, 500 in October, 600 in November and another 600 in training now—lifting the triage pool to 3 701 professionals.

• A slimmed-down digital pre-triage for adult respiratory symptoms launched in January, already topping 5 000 automated assessments.

• A pilot for AI-assisted decision support that screens acute illnesses before a human picks up.

• A cumulative 30 % pay rise for hotline nurses and pharmacists to stem attrition.Altice insists the steps carried the service from a 65 % answer rate in August to 93 % by November—a figure that matches the contractual target albeit still shy on speed.

What worries remain

Healthcare unions warn that many hotline clinicians also hold shifts inside hospital wards, risking burnout during winter spikes. Opposition MPs question whether a private telecoms operator is the right long-term custodian of a critical public service. Meanwhile, Cavaca’s team has drafted a fresh 60-month procurement that could restructure performance clauses and widen the supplier pool.

Why this matters now

Portugal’s aging population leans heavily on remote care; keeping the helpline agile could spare emergency departments thousands of unnecessary walk-ins. The Altice fine is a wake-up call: scaling digital health requires more than bandwidth—it demands agile contracts, dynamic staffing and technology that evolves as fast as demand. Citizens will judge the next tender not by its paperwork, but by the seconds they spend listening to hold music when the next bout of flu hits their household.