The matters at the heart of widening divisions between Madeirans and immigrants. The strain that immigration is putting on government provided services. Particularly those in the health service, education, and social security.

Before any analysis of any particular government service and the response to any strain or shortfall in services, the following should be taken into account.

1. As specific data for Madeira Island is harder to find (or even doesn’t exist), Portugal continental data will mainly be used. As the numbers and percentages of immigrants are considerably higher on the mainland, this should easily suffice.
2. Even where strain on these services exists, most of the responsibility must fall on Regional or National Government for not anticipating or reacting to immigration trends, and failing to understand the issues and providing accordingly.
3. Emigration of Portuguese people, and particularly Madeirans, has always been high. Madeira is flush with vacancies at present, particularly in hospitality and construction. Candidates for these jobs are being actively recruited from overseas, both within Europe and also outside. Meanwhile emigration continues, and of course reduces the number of active seekers for government services here in Portugal, and using instead the equivalent services of the hosting countries.
4. Entitlements for state services may differ within these recruitment initiatives to fill Madeira’s vacancies, particularly where the employment may be subject to temporary status, residence consent is not being sought, or is still being processed.
5. Illegal immigration of course brings no entitlement for state provided services.
6. Most information about government services being overloaded, either though higher demand or limited state resources, comes from social media and the political party Chega. Accordingly, they are sources of little credibility, but even so fairly numerous.

So, in no particular order, the state provided services considered here are:

A. Serviço Regional de Saúde (SRS).

While immigrants do contribute significantly to the Portuguese economy and their overall health indicators are generally more favorable, the perception exists and recent policy changes indicate that immigration is seen as a source of strain on Portuguese health service, particularly concerning the financial sustainability and resource allocation within the SRS/SNS. New rules aim to address these concerns by limiting access for non-contributing individuals (such as ‘health tourism).

Recent news reports that there are sufficient family doctors for the population of Madeira. However, complaints from Madeirans persist, saying that this is not the case for them.

Many immigrants have private health insurance, because they have the financial means, or require better services than those offered by the state. Other immigrants or short term visitors are obliged to arrange private health insurance because the new rules make it a condition of entry into Portugal.

For Portugal (everyone), the situation is of some level of private health insurance for between 30 and 35 percent of all the population.

The emergency services, the first point of entry for many immigrants and tourists, is the best managed aspect of the SRS, and although waiting time can be many hours, the system of triagem ensures that the most urgent cases are given priority. Unless locals feel that nationality should take priority over the most urgent cases, there really is no reason for complaints.

What happens after this, and also referrals by health officials outside the hospital, is, and always has been, a grave point of concern. Specialist consultants, non urgent surgery, and hospital follow up treatment have been concerns for many years. The statistics for waiting times are often disgraceful. These statistics were hidden for many years, but now it is common knowledge that these appointments can take up to 5 years, sometimes even longer. Racism unfortunately exists in the SRS, and although very hard to prove, there is sufficient anecdotal evidence that immigrant treatment slips down the waiting lists, and even the names disappear completely from the waiting lists.

The implication of this and other information suggests that any strain on the SRS/SNS is due to poor management,  underfunding and consequently under resourcing of services, with no real evidence of overloading by immigrants.

To finish, it should be noted that many medical staff complete their training, and then seek engagements in the private sector, or outside of Portugal, where wages and working conditions are considerably better

B. Segurança Social

immigrants are vital to the financial health of Portugal’s social security system, providing a net positive inflow of funds and helping to mitigate the difficulties posed by an aging population and declining workforce.

In 2022 the net positive inflow was over 1,604 million euros just from immigrants in Portugal.

Immigration contributions were sufficient to fund 17% of national pensions and retirements in 2023.

In 2024 foreign workers paid 12% of the total collected for social security in Portugal.

Of course there are outgoing funds, but the social security rules limit these to cases meeting qualifying rules. The proposal by Chega to only let immigrants use the social security system after 5 years of contributions is ridiculous and discrimatory.

C. Educação / Education

The increasing number of immigrant students does present challenges and a certain degree of strain on the Portuguese education system, but it needs to be presented as a “positive problem”, given its future benefits.

The biggest problem is the language barrier, as 25-30 percent of students do not speak Portuguese on entry into the education system. Arranging intensive Portuguese learning is a considerable challenge requiring specialist resources as a non maternal language.

Many schools do not have sufficient teachers, particularly for Portuguese, mathematics and computer science. This is an area that government should have resolved before it became a problem, and long before immigration even became a talking point.

However, declining birth rates are being addressed though immigration, reversing a downward trend that has lasted decades and has already closed many schools.

This alone is reviving Portugal’s worrying demographic situation, bringing benefits in education and for the future workforce requirements, and the added benefits for future tax contributions and the social security system.

Immigration is considered essential for Portugal’s economic functioning and social cohesion.

The Portuguese Ministry of Education acknowledges these challenges and is working on implementing mechanisms and programs to better integrate immigrant students.

Unfortunately, the barriers to integration, like racism, will considerably reduce these benefits for Portugal and Madeira, leaving many of these potential benefits at least partially unachievable.