What If There Were a National Think Tank on Hospital Emergency Services?

By Paul Nunesdea, editor of Architecting Collaboration and curator of Think Tank Saúde Sustentável

Over the Easter weekend of 2025, ten hospital emergency departments were closed in Portugal — seven of them in obstetrics and gynaecology. Once again, the epicentre of the crisis was the Lisbon and Tagus Valley region, where the shortage of medical specialists is most severe. The news hit the headlines, but the danger is that we are growing used to it. It risks becoming the new normal.

But what's truly missing isn't just doctors. What's missing is a way of solving problems that involves everyone affected, including patients, in a structured and meaningful way.

That's precisely why we created the SNS de Contas Certas Think Tank process in recent years: a collaborative, independent, and structured space to reflect on the big challenges facing our health system, with time, method, and all voices at the table.

Our methodology draws inspiration from the Think Tank Factory approach, where collective intelligence and diverse perspectives are brought together to co-create actionable recommendations with political, institutional, and social impact.

The successful gathering of the IV Plenary of the SNS de Contas Certas Think Tank on April 3–4 showed just how valuable these structured spaces for listening can be. Decision-makers and local leaders worked side-by-side to produce constructive, grounded recommendations. The recordings of the event's key moments will be made available in early May, so that what was co-created can ripple even further.

There is no lack of willingness from the authorities or hospital managers to address the crisis. Since the current government took office in 2024, a comprehensive effort has been launched — the Emergency and Health Transformation Plan, which includes 54 structural measures across five strategic pillars. This plan has already brought visible results, such as reduced oncology waiting lists, new support lines, and incentives to bolster maternity care within the National Health Service.

And yet, despite these advances, what is still missing is a safe and collaborative process where that willingness and those measures can be translated into responses that are fine-tuned to local realities, grounded in representation, evidence, and the engagement of all stakeholders, including patients.

So, what if we applied that same approach to the hospital emergency services crisis?

Imagine a series of three collaborative plenary sessions, bringing together the SNS Executive Board, hospital administrators, professional orders, unions, municipalities, universities, private institutions, and — critically — women and mothers who experience the impact of closed emergency units firsthand. What kinds of solutions could emerge? What new paths of public commitment might open?

The answer may be simple: this kind of approach hasn't been missing because we lack diagnoses — it's been missing because we lack safe spaces for dialogue. Spaces to listen to discomfort, to sit with disagreement, and to work in the "in-between" of opposing views.

The Think Tank methodology we use doesn't start with a solution. It starts with a conversation. And a well-designed conversation can open roads where there were only walls.

What types of solutions could emerge from a national Think Tank on emergency care?

• Hybrid regional coverage models with shared incentives between hospitals and regional health authorities

• Collaborative obstetrics and paediatrics networks with shared referral protocols

• Direct user involvement in re-evaluating the emergency care experience

• Legislative proposals to allow more flexible working arrangements during extended holidays

• New contract program models that prioritise not only presence but also continuity and prevention

• Talent retention and attraction plans based on quality of life and contractual stability

• Participatory simulations to redesign the care network based on mobility, birth rates, and local morbidity data

This isn't a critique — it's an invitation. An invitation to try something constructive: the creation of a National Think Tank on Emergency Services in the SNS.

Urgency demands courage — the courage to try new approaches, based on dialogue and collaboration.

If political will, technical capacity, and structural measures are already in motion… why not complement that effort with a structured process of listening and co-creation? A national Think Tank could help bring decisions even closer to local realities and the lived experience of those who care, who serve, and who depend on the NHS.

We began with SNS de Contas Certas — but we could go further.

About the Author

Paul Nunesdea is the pen name of Paulo Nunes de Abreu, a Collaboration Architect, IAF Certified™ Facilitator, and author of the Architecting Collaboration book series.

He curates the Architecting Collaboration platform, sharing insights on facilitation, dialogue, and systems thinking. As co-founder of Debate Exímio Lda, Paul has designed and hosted transformative events across sectors.

He also leads the Health Data Forum, a UK-registered charity advancing the Data First, AI Later movement and curating a global network of independent experts in health data and AI.

About Debate Exímio 

Based in Oporto, Debate Exímio is a spin-off dedicated to collaboration and innovation. We design and facilitate bespoke events — from high-impact think tanks to engaging LinkedIn Live sessions — tailored to spark dialogue and deliver meaningful outcomes.

With a seasoned team and global experience, we offer:

• Tailored event design aligned with your strategic goals

• Innovative tech to boost participation and track impact

• A trusted network of venues, suppliers, and thought leaders

Whether co-creating solutions in health systems or showcasing digital leadership, we help your organization make a lasting impact.