INEM Shake-Up in Portugal: What 112 Callers Need to Know

Portugal’s emergency health system is again under the spotlight after the Government moved to replace the interim leader of the National Institute for Medical Emergency, INEM. In theory, the hand-over closes a 15-month period of provisional leadership, yet the man tipped to take the chair — Luís Cabral — is already facing a wall of opposition from unions and frontline doctors.

Why the change matters now

The emergency ambulances and helicopters that dispatch every eight minutes across the country depend on a clear command chain. Since July 2024, when Luís Meira resigned, that chain has been held together by stop-gap appointments. President Marcelo Rebelo de Sousa warned this week that the constant turnover “creates uncertainty at the very moment Portugal is rewriting its emergency statutes”. The governing coalition wants to transform INEM into the Autoridade Nacional de Emergência Médica (ANEM), a legal upgrade similar to the creation of the National Civil Protection Authority in 2019. A permanent president is therefore crucial before the new blueprint reaches Parliament.

How the selection unfolded

Behind the scenes, the Commission for Recruitment and Selection for Public Administration (CReSAP) ran a competitive process. Out of dozens of applications, three names were shortlisted. The commission scores candidates on proven integrity, management track record, technical expertise and commitment to the public interest, then interviews them in closed session. President Marcelo underlined that the shortlist “follows the law to the letter” — an indirect rebuttal to critics who claim the Ministry of Health had already chosen its favourite. Sérgio Janeiro, the army doctor who has been steering INEM on an interim basis since last year, did not re-apply.

Who is Luís Cabral?

Cabral built his reputation in the Azores, where he helped set up an island-based dispatch model that relies on multi-purpose ambulances rather than physician-nurse teams. Supporters say the approach trims response times in scattered territories; detractors insist it costs six times more than the mainland system and delivers poorer outcomes. A 2024 Court of Auditors report described the Azorean network as “fragile and inefficient”. Cabral, 52, is a seasoned anaesthesiologist, trained in Porto, and once chaired the regional medical emergency service on São Miguel island. He has not yet commented publicly on the Lisbon uproar.

Criticism from inside the ambulances

The Pre-Hospital Emergency Technicians’ Union (STEPH) urged Prime Minister Luís Montenegro to freeze the appointment, arguing Cabral’s record “contradicts the strongest scientific evidence”. The National Association of Medical Emergency Technicians (ANTEM) echoed that view, warning that importing the Azores model could “turn the clock back on two decades of Portuguese know-how”. Forty-two VMER medical-rescue teams and the Madeira rapid-response unit sent a joint letter to the Health Ministry claiming that any move away from doctor-nurse crews would be “a grave error paid in lives”. Conversely, the Independent Doctors’ Union (SIM) focused on the bigger picture: it lamented yet another leadership shuffle but promised “tough, permanent scrutiny” rather than outright rejection.

Political and institutional reactions

Health Minister Ana Paula Martins defended the process, stressing that recourse to CReSAP eliminates political favouritism and “brings merit back to the civil service”. The opposition Socialists countered that the timing — just weeks before the ANEM bill lands in committee — “smells of pre-packing the board”. In Belém, Marcelo Rebelo de Sousa sided with the rules: “A definitive solution is preferable to provisional improvisation.” His office reminded reporters that Portugal’s constitution bars the President from vetoing senior civil-service hires unless they breach transparency laws, which CReSAP says they do not.

What happens next for INEM — soon ANEM

If the Council of Ministers rubber-stamps Cabral in the coming days, he will inherit a service scrambling to modernise its computer-aided dispatch, helicopter coverage and data analytics. The draft ANEM statute also transfers disaster-medicine training to the authority, expands powers over private ambulance firms and links funding to a new outcomes dashboard. Critics fear these reforms may be diluted if the leadership war drags on. For everyday residents, however, the litmus test is simple: when a 112 call goes out, will the right help arrive in time?