The SNS 24 Call Centre answered over 3.67 million calls so far this year over double that of 2019.

But how has it evolved? What is it like for those working there? What pressures are they under? How does it affect their lives?

Nine months on from the start of Covid-19 this excellent article outlines in operators own words the work that they undertake and how they deal with people’s fears and anxieties.

“We are the first line”. Beating the pandemic and tiredness with one call at a time

The covid-19 marks a before and after in the life of the SNS24 line and its health professionals, who, in addition to the struggle to overcome the pandemic, also try to overcome the fatigue of nine months of unrelenting calls.

In the ‘call-centre’ located in the centre of Lisbon, a few dozen professionals distributed throughout an ‘open space’ seek to respond to people’s concerns, while a monitor is charging the numbers of the service in real time. Calls do not stop, but you cannot hear phones ringing incessantly with the demand for an answer; everything is digital, fast and repeated by professionals to the point of seeming mechanized.

José Gouveia

At the age of 51 and since 2003 in the contact centre of the National Health Service, the nurse José Gouveia, who also works in the general surgery service of Hospital Garcia de Orta, in Almada, admits to Lusa that this was “a very complicated year” and that the first wave of the pandemic confronted the SNS24 with “total despair”.

“We are the first line in serving and meeting people’s doubts, since there were limitations for health centres and emergency rooms. We were almost the only possible help, albeit with difficulties”, he says, calmly, in contrast to the busy days due to the impossibility of responding to all problems.

And it was not just on the other end of the line that changes took place. José Gouveia responds to calls over the course of the shift with his mask on, in the image of all his colleagues, now a few meters away from security and with many in teleworking situations. When you leave, it will be time to head to the hospital to continue the fight and be replaced by another colleague, who does not sit down before disinfecting the work area.

New procedures were instituted, new guidelines were defined and everything had to be assimilated without wasting time, in a context in which information about the new coronavirus challenged even the most experienced professionals and generalized uncertainty about the future.

“It is necessary to have some experience, which counts here, but sometimes it is difficult with some tricks. It means having the experience of screening and trying to understand what it really is: if they are symptoms related to covid-19, anxiety, etc. It is the experience that gives us this ‘feeling’, this proficiency”, explains José Gouveia, guaranteeing to have “the same principles and the same dedication, but with more effort”.

Manuel Mourão

In the workspace next door, Manuel Mourão, a 52-year-old nurse with almost 30 professional experience, reviews in the days lived with this pandemic its beginning in the SNS24, in 2009, with the flu epidemic A. However, even with the accumulation of work in the emergency department of Hospital de São José, in Lisbon, refuses to let down.

“As I am in an emergency, the burden has been enormous and obviously health professionals are a little exhausted, but that is no excuse for us. As I usually say, every day I take my shower, wear my nurse’s uniform and go to the fight”, he summarizes, naming knowledge as a weapon to“ calmly clarify and give some very assertive guidelines” so that the pandemic is under control.

Unlike most days in the past few months, Manuel Mourão is in the building providing service instead of doing it from home. Although he misses living with friends created over 11 years, this nurse specialized in the field of psychiatry assumes the comfort of the option and recognizes the advantages in reducing the risks of contagion.

“The teleworking experience has been very positive. The pandemic has hurt many people, but for us it has also brought some benefits; we were already talking about it: ‘why not be at home with a computer doing this?’ There was never that opportunity, but the pandemic ended up pushing us more quickly towards that”, he says, before completing another journey and leaving his post.

Catarina Rebelo

Catarina Rebelo, a 25-year-old nurse, arrives to fill the position. After disinfecting the table, the computer and the kit, she puts his rubbers on the headphones to start answering calls. This is the routine he embraced about a month ago, after deciding to reply to an email from the Ordem dos Enfermeiros asking for applications for the SNS24.

“I felt that there was a need to want to participate in helping the front line of the pandemic and that I was unable to exercise at my workplace. So, I opted for this place, being a place where we are very in contact and we help people, despite not being directly cared for”, confesses the young woman, who still lives in her parents’ house and also works in a private clinic.

Without hiding that coming to SNS24 was a purely “personal” choice and driven by the desire for a “new adventure”, Catarina Rebelo already recognizes the tiredness in her colleagues after a “scary” November that she marked in her early days the peak of the second wave of the pandemic in the country.

“In fact, there were a lot of calls on hold when I joined and it was a completely new thing. It was quite scary”, he recalls, although later of “loving” the experience: “ It is very motivating that we are here to help people and they show even during the calls that they are satisfied with our help and our support. And this is gratifying”

Carla Miguel

A few lines ahead, Carla Miguel continues to answer calls beyond the end of the shift. In this case, a father asks on the other end of the line how to deal with the fever of the 12-month-old baby and the nurse, 56, punctuates each question with his left hand, as his right hand clicks on the mouse to enter data on the computer. “If you run your hand over her neck, you feel ganglia,” she asks, while she herself runs a hand over her neck.

Already with two children also involved in the “front line” of the fight against covid-19, Carla Miguel highlights the impact that the pandemic had on people’s feeling of security in relation to their own existence, both individually and collectively.

“The human being has become very weak in this context, all the certainties that we had … There is nothing acquired, we are all very afraid and the instability of insecurity is what concerns me the most. It is a ‘bug’ that nobody sees, a micro-organism with statistical data that leaves us completely defenceless”, she says.

Before going on to another phone call, she introduces some more information into the system, in a process that he fears to increase again from January, because of the easing of the restrictions on the Christmas season.

“We were able to control and keep a lot of people at home, but this is a time when there are people who think from the outset that with a negative test it is all safe and this will cause hospitalizations to increase in this third phase in January. I’m scared out there”, she confides, in a 2020 that was “very hard” and left her in service “from eight in the morning to ten at night” in several days.

Maria Cortes Director of SNS 24

“It is a permanent effort”, completes the director of SNS24, Maria Cortes, for whom the expectation of “light at the end of the tunnel” launched by the start of vaccination against covid-19 reinforced the determination.

“We have to consider that the effort was worth it and that we are motivated to continue until there is a time when we will live our lives again in a free and more relaxed way”, notes the official, who has been at SNS24 since 2017. Until when that moment arrives, it highlights the fact that “no outbreak occurred in the ‘call centres’” and that the system resisted the changes introduced throughout the year.

From a capacity for 200 calls simultaneously up to 2,000 in just nine months, the SNS24 has also grown in the number of professionals and in its automation of service processes, with the entry of two ‘bots’ to collect responses and which, according to Maria Cortes, allowed significant efficiency gains in call times, not only in the present, but also for the future: with or without covid-19.

“SNS24 started in 1998 with a line called ‘Dói Dói Trim Trim’, evolved to Saúde 24 and has a whole tradition of telephone screening in the most diverse areas. It has not yet emerged for the covid”, he stresses, envisioning a positive horizon for the service: “Due to the role it had in the management of the pandemic, the visibility it gained and the trust it generated in the population, the SNS24 will continue to have a determining role at the level access to health care”.

SNS24 already answered more than 3.670 million calls in 2020

The president of the Shared Services of the Ministry of Health (SPMS), Luís Goes Pinheiro, highlighted the responsiveness of the SNS24 line in a 2020 marked by the covid-19 pandemic, with a number of answered calls exceeding 3.670 million.

“More than 3,670 million calls have already been answered in the SNS24. It is, in fact, an especially significant number, considering that last year 1.5 million calls were not even answered. Therefore, more than we have already doubled the number of calls answered in the past year and, as we know, in a context that was not regular throughout the year” said Luís Goes Pinheiro in an interview with Lusa.

Stressing the year with the “greatest demand ever” of SNS24 by citizens, the president of the SPMS did not fail to admit the problems recorded in the first peak of the pandemic, in March, but emphasized the adaptability of the service, which in November surpassed all the records, with more than 816 thousand calls answered, including more than 38 thousand in a single day.

“We have more than 5,600 health professionals providing care on the SNS24 line. Some residents in the seven ‘call-centres’ that currently exist throughout the country and others at a distance, with equipment that allows them to provide this support to the line from their homes or from other locations. This is the big difference: at the beginning of the pandemic, the number of health professionals would not reach 1,000 and today there will be more than 5,600”, he noted.

“We have diversified the professions that currently provide services on the line; they continue to be mostly nurses, but we also have psychologists – namely within the scope of the psychological counselling line and about 55 thousand people have already been assisted who could benefit from this service -, dentists, pharmacists and also sixth year medical students ” , he said.

Between the recognition of covid-19 as “a fatality that caught everyone with a lot of violence” and the effect of change for the better that the pandemic had on SNS24 and that provided “a very special year”, Luís Goes Pinheiro insisted on noting the new perception of the Portuguese about the service.

“They were able throughout this year – in a context as difficult for all of us as was the context of the covid-19 pandemic – to count on this line and the support of the more than 5,600 health professionals who today provide services and who were throughout these various hard months of pandemic an ever-present voice and an open door for all those who felt that, in some way, they needed the attention of the NHS”.

Written by: João Godinho