4.The release of instalments in accordance with the Loan Agreement shall be conditional on available funding and a decision by the Commission, taken in accordance with Article 24 of Regulation (EU) 2021/241, that Portugal has satisfactorily fulfilled the additional milestones and targets covered by the loan and identified in relation to the implementation of the recovery and resilience plan. To be eligible for payment, the additional milestones and targets covered by the loan shall be completed no later than 31 August 2026.

3.The pre-financing shall be released subject to the entry into force and in accordance with the Loan Agreement provided for in Article 15(2) of Regulation (EU) 2021/241. Pre-financing shall be cleared by being proportionally deducted against the payment of the instalments.

2.The loan support shall be made available by the Commission to Portugal in instalments in accordance with the Annex to this Decision. An amount of EUR 350 870 000 shall be made available as a pre-financing payment, equal to 13 per cent of the loan. The pre-financing and instalments may be disbursed by the Commission in one or several tranches. The size of the tranches shall be subject to the availability of funding.

1.The Union shall make available to Portugal a loan amounting to a maximum of EUR 2 699 000 000.

4.The release of instalments in accordance with the Financing Agreement shall be conditional on available funding and a decision by the Commission, taken in accordance with Article 24 of Regulation (EU) 2021/241, that Portugal has satisfactorily fulfilled the relevant milestones and targets identified in relation to the implementation of the recovery and resilience plan. Subject to the entry into force of the legal commitments referred to in paragraph 1, to be eligible for payment, milestones and targets shall be completed no later than 31 August 2026.

3.The pre-financing shall be released subject to the entry into force and in accordance with the Financing Agreement provided for in Article 23(1) of Regulation (EU) 2021/241. Pre-financing shall be cleared by being proportionally deducted against the payment of the instalments.

2.The Union financial contribution shall be made available by the Commission to Portugal in instalments in accordance with the Annex to this Decision. An amount of EUR 1 807 948 257 shall be made available as a pre-financing payment, equal to 13 per cent of the financial contribution. The pre-financing and instalments may be disbursed by the Commission in one or several tranches. The size of the tranches shall be subject to the availability of funding.

1.The Union shall make available to Portugal a financial contribution in the form of non-repayable support amounting to EUR 13 907 294 284. An amount of EUR 9 758 504 454 shall be available to be legally committed by 31 December 2022. Subject to the update provided for in Article 11(2) of Regulation (EU) 2021/241 calculating an amount for Portugal equal to or more than this amount, a further amount of EUR 4 148 789 829 shall be available to be legally committed from 1 January 2023 until 31 December 2023.

The assessment of the recovery and resilience plan of Portugal on the basis of the criteria provided for by Article 19(3) of Regulation (EU) 2021/241 is approved. The reforms and investment projects under the recovery and resilience plan, the arrangements and timetable for monitoring and implementation of the recovery and resilience plan, including the relevant milestones and targets and the additional milestones and targets related to the payment of the loan, the relevant indicators relating to the fulfilment of the envisaged milestones and targets, and the arrangements for providing full access by the Commission to the underlying relevant data are set out in the Annex to this Decision.

Article 1 Approval of the assessment of the recovery and resilience plan

(65)This Decision should be without prejudice to the outcome of any procedures relating to the award of Union funds under any other Union programme than Regulation (EU) 2021/241 or to procedures relating to distortions of the operation of the internal market that may be undertaken, in particular under Articles 107 and 108 of the Treaty. It does not override the requirement for Member States to notify instances of potential State aid to the Commission under Article 108 of the Treaty,

(64)Portugal has requested pre-financing of 13% of the financial contribution and of 13% of the loan. That amount should be made available to Portugal subject to the entry into force and in accordance with the Financing Agreement provided for in Article 23(1) of Regulation (EU) 2021/241 and the Loan Agreement provided for in Article 15(2) of that Regulation.

(63)The support to be provided is to be financed from the borrowing by the Commission on behalf of the Union on the basis of Article 5 of Council Decision (EU, Euratom) 2020/2053. The support should be paid in instalments once Portugal has satisfactorily fulfilled the relevant milestones and targets identified in relation to the implementation of the recovery and resilience plan.

(62)Furthermore, in order to support additional reforms and investments, Portugal has requested loan support. The loan amount requested by Portugal is less than 6,8% of its 2019 Gross National Income in current prices. The amount of the estimated total costs of the recovery and resilience plan is higher than the combined financial contribution available for Portugal and the requested loan support.

(61)In accordance with Article 11(2) of Regulation (EU) 2021/241, the calculation of the maximum financial contribution for Portugal is to be updated by 30 June 2022. As such, in accordance with Article 23(1) of that Regulation, an amount for Portugal should be made available now for a legal commitment by 31 December 2022. Where necessary following the updated maximum financial contribution, the Council, on a proposal from the Commission, should amend this Decision to include the updated maximum financial contribution without undue delay.

(60)The estimated total cost of the recovery and resilience plan of Portugal is EUR 16 643 679 377. As the recovery and resilience plan satisfactorily complies with the criteria for assessment set out in Regulation (EU) 2021/241 and, furthermore, as the amount of the estimated total costs of the recovery and resilience plan is higher than the maximum financial contribution available for Portugal, the financial contribution allocated for Portugal’s recovery and resilience plan should be equal to the total amount of the financial contribution available for Portugal.

(59)Following the positive assessment of the Commission concerning the Portuguese recovery and resilience plan with the finding that the plan satisfactorily complies with the criteria for assessment set out in Regulation (EU) 2021/241, in accordance with Article 20(2) and Annex V to that Regulation, this Decision should set out the reforms and investment projects necessary for the implementation of the plan, the relevant milestones, targets and indicators, and the amount made available from the Union for the implementation of the plan in the form of non-repayable financial and loan support.

(58)For the implementation of the plan, Portugal set up a National Monitoring Commission, made up of representatives of social partners and key civil society figures, who can make recommendations for the implementation of the plan. Furthermore, the implementation of the plan will also be open to public scrutiny through the Transparency Portal. To ensure ownership by the relevant actors, it is crucial to involve all local authorities and stakeholders concerned, including social partners, throughout the implementation of the investments and reforms included in the plan.

(57)The plan has been subject to an ample debate, formal public consultations, and thematic seminars with the presence of members of the government. In parallel to this public consultation process, the government held a series of consultations with institutional stakeholders, such as the Economic and Social Council, the Territorial Coordination Council and the National Health Council. In reaction to the written contributions received during the second public consultation, the government introduced a number of changes to the plan, also including two new components: Component 4 - Culture and Component 10 - Sea.

(56)The recovery and resilience plan includes cross-border investments in the areas of justice. It accelerates and develops the interoperability of criminal record information in the European Criminal Records Information System (ECRIS) and enables the publication and search of interoperable judicial decisions through the European Case Law Identifier (ECLI). It also facilitates the exchange of information between judicial entities on the basis of E-Codex and enhances cooperation within the framework of the European Car and Driving Licence Information System (EUCARIS) and of cross-border identification resources such as eIDAS. Other cross-border initiatives are in the area of digitalisation of business with the set-up of 16 ’Digital Innovation Hubs’, one-stop shops that help companies improve business/production processes, products, or services using digital technologies. The hubs included in the plan are expected to contribute to the European Digital Innovation Hubs network. Other cross-border collaborations may also take place in the area of hydrogen. Portugal is working with other Member States on the development of a possible Important Project of Common European Interest (IPCEI) on hydrogen. The projects on hydrogen included in the plan are expected to contribute directly or indirectly to this initiative.

(55)A security self-assessment has been provided for the investments on connectivity and digital capacities, in accordance with Article 18(4), point (g) of Regulation (EU) 2021/241. The self-assessment provides for a matrix of risks and mitigating measures. A total of eighteen possible risks are identified, including vendor dependency, high risk suppliers, cybersecurity concerns, disruption of critical systems. The matrix identifies thirteen mitigating measures to be enacted to counter the possible risks, including requirement for security clearance by the providers, application of restrictions to suppliers considered to be high risk, multi-vendor strategies and backup systems for critical functions.

(54)The plan contains a series of measures that are expected to contribute to addressing the challenges in the area of gender equality and equal opportunities for all. These include reforms dedicated to combating gender pay inequality and occupational segregation, as well as measures attracting young women into STEAM studies. The part of the plan dealing with social policy responses includes a National Strategy for the Inclusion of Persons with Disabilities as well as a National Strategy to Combat Poverty.

(53)The Portuguese recovery and resilience plan reveals a strategic and consistent vision throughout the plan, displaying coherence between components and between individual measures. The reforms and investments in each component are consistent and mutually reinforcing, and synergies and complementarities exist between components. No measures proposed within a component contradict or undermine each other’s effectiveness, nor have inconsistencies or contradictions between different components been identified.

(52)In accordance with Article 19(3), point (k) and section 2.11 of Annex V to Regulation (EU) 2021/241, the plan includes to a high extent (Rating A) measures for the implementation of reforms and public investment projects that represent coherent actions.

(51)For the implementation, monitoring and control of the recovery and resilience plan Portugal will make use of IT tools. The IT functionalities are clearly described in the plan. Portugal has indicated that the General Inspectorate of Finance (IGF) will carry out a first audit on the management and control system for the recovery and resilience plan prior to the submission of the first payment request (excluding pre-financing) to the European Commission.

(50)The internal control system described in the plan is based on robust processes and structures and clearly identifies actors (bodies/entities) and their roles and responsibilities for the performance of the internal control tasks. The national management will be centralised in the ‘Recuperar Portugal’ task force. The implementation of the plan will be contracted out to public agencies or bodies or intermediaries responsible at decentralised levels. The control system and other relevant arrangements, including for the collection and making available of data on final recipients, are adequate.

(49)In accordance with Article 19(3), point (j) and section 2.10 of Annex V to Regulation (EU) 2021/241, the arrangements proposed in the recovery and resilience plan and the additional measures contained in this Decision are adequate (Rating A) to prevent, detect and correct corruption, fraud and conflicts of interests when using the funds provided under that Regulation, and the arrangements are expected to effectively avoid double funding under that Regulation and other Union programmes. This is without prejudice to the application of other instruments and tools to promote and enforce compliance with EU law, including for preventing, detecting and correcting corruption, fraud and conflicts of interests, and for protecting the Union finances in line with Regulation (EU, Euratom) 2020/2092 of the European Parliament and of the Council.

(48)Portugal has provided individual cost estimates for all investments and reforms with an associated cost included in the recovery and resilience plan. The cost breakdown is generally detailed and well-substantiated. The estimates are for the most part based on comparisons with procurement contracts for similar services, past investments of similar nature or market consultations. The assessment of the cost estimates and supporting documents show that most of the costs are reasonable and plausible. However, the fact that sometimes the methodology used is not sufficiently well explained and the link between the justification and the cost itself is not fully clear precludes an A rating for this assessment criterion. Finally, the estimated total cost of the recovery and resilience plan is in line with the principle of cost-efficiency and is commensurate to the expected national economic and social impact.

(47)In accordance with Article 19(3), point (i) and section 2.9 of Annex V to Regulation (EU) 2021/241, the justification provided in the plan on the amount of the estimated total costs of the recovery and resilience plan is to a medium extent (Rating B) reasonable and plausible, is in line with the principle of cost efficiency and is commensurate to the expected national economic and social impact.

(46)Member States should ensure that financial support under the Facility is communicated and acknowledged in line with article 34 of the Regulation (EU) 2021/241. Technical support may be requested under the Technical Support Instrument to assist Member States in the implementation of their plan.

(45)The milestones and targets of the Portuguese plan constitute an appropriate system for monitoring the plan’s implementation. They are sufficiently clear and comprehensive to ensure that their completion can be traced and verified. The verification mechanisms, data collection and responsibilities described by the Portuguese authorities appear sufficiently robust to justify in an adequate manner the disbursement requests upon completion of the milestones and targets. Milestones and targets are also relevant for measures already completed which are eligible according to Article 17(2) of the Regulation. The satisfactory fulfilment of these milestones and targets over time is required to justify a disbursement request.

(44)The administrative structure ‘Estrutura de Missão Recuperar Portugal’ (‘task force Recuperar Portugal’) should monitor and implement the plan. . Its responsibilities are clearly defined and enshrined in national legislation, which ensures sound coordination and reporting mechanism between this structure and other bodies responsible for the implementation of the investments and reforms under the various components. It has clearly assigned responsibilities and an adequate structure for the implementation of the plan, the monitoring of progress and reporting. The task-force should be in place until the end of the implementation of the plan.

(43)In accordance with Article 19(3), point (h) and section 2.8 of Annex V to Regulation (EU) 2021/241, the arrangements proposed in the recovery and resilience plan are adequate (Rating A) to ensure effective monitoring and implementation of the recovery and resilience plan, including the envisaged timetable, milestones and targets, and the related indicators.

(42)Lasting impact of the plan can also be enhanced through synergies between the plan and other programmes financed by the cohesion policy funds, notably by addressing in a substantive manner the deeply rooted territorial challenges and promoting a balanced development.

(41)In the area of investment, a lasting structural change is expected from the establishment, capitalisation and mission expansion of the National Promotional Bank, Banco Português de Fomento. The proposed increase in the bank capitalisation is expected to facilitate access to finance, particularly for SMEs affected by the crisis, and to boost competitiveness and job creation on a long-term basis. Other key policy objectives include knowledge and technology transfers to businesses, diversification of product and services, and reaching R&D investments of 3% of GDP by 2030. Finally, investments and policies to decarbonise industry aim at improving its energy efficiency and reducing the import content of the Portuguese economy, thus improving the country’s competitiveness and growth potential while helping to meet climate goals.

(40)The plan presents structural changes in the public administration, housing, business capitalisation and innovation, justice system, highly regulated professions, and digitalisation of the public administration. In many cases, measures across various components of the plan are designed to increase the level of digitalisation of relevant institutions, which is expected to have a lasting impact on the quality of services and the business environment.

(39)In accordance with Article 19(3), point (g) and section 2.7 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to have a lasting impact on Portugal to a large extent (Rating A).

(38)The digital-related reforms and investments included in the recovery and resilience plan are expected to have a lasting impact, notably on the digital transition of the country’s public administration, on the justice system, on social services, on the business fabric, on skill levels of the population and on the national and regional health services.

(37)Beyond contributing to the digital transition, these investments also address the challenges related to the skill levels of the population, in particular the digital literacy of the adult population and the need to adjust the skills to the changing needs of the labour market. The investments also contribute to address the challenges related to equal access to digital technologies as well as quality education and training.

(36)Overall fourteen components contain measures contributing to the digital objective with a broad, cross-cutting approach, with four components wholly dedicated to the digital transition. Significant reforms and investments are planned in the areas of digitalisation of enterprises and in and the provision of digital skills. Other significant reforms and investments aim at the digitalisation of the public administration, the justice system and public financial management. Other investments target the digitalisation of specific sectors such as primary and secondary education, health, culture, and forest management.

(35)In accordance with Article 19(3), point (f) and section 2.6 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan contains measures that to a large extent (Rating A) are expected to effectively contribute to the digital transition or to addressing the challenges resulting from it. The measures supporting digital objectives account for an amount which represents 22,1% of the plan’s total allocation, calculated in accordance with the methodology of Annex VII to Regulation (EU) 2021/241.

(34)Energy-efficiency interventions provide for a large part of the climate contribution. Other significant climate or environmental contributions are provided by investments in sustainable urban transport or climate change adaptation and prevention. Also research and innovation processes focusing on the low-carbon economy, resilience and adaptation to climate change as well as forest and water management measures contribute to climate and environmental objectives. Reforms aim to promote the decarbonisation of industry develop more sustainable production processes and improve transport planning.

(33)Reforms and investments are expected to make a significant contribution to advance the decarbonisation and energy transition objectives of Portugal as set out in the National Energy and Climate Plan 2030 (NECP 2030) and the Carbon Neutrality Roadmap 2050, thereby contributing to the Union’s climate target and objective respectively. Sixteen components contain measures contributing to the climate objective, and sixteen components contain measures contributing to environmental objectives, including biodiversity. Biodiversity is expected to be enhanced in particular through improvements of the forest management, addressing extensive areas of unmanaged monocultures and high risks of fires, or the promotion of a sustainable blue economy. The implementation of these proposed measures is expected to have a lasting impact, notably by contributing to the green transition, the enhancement of biodiversity, and environmental protection.

(32)In accordance with Article 19(3), point (e) and section 2.5 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan contains measures that contribute to a large extent (Rating A) to the green transition, including biodiversity, or to addressing the challenges resulting therefrom. The measures supporting climate objectives account for an amount which represents 37,9% of the plan’s total allocation, calculated in accordance with the methodology of Annex VI to Regulation (EU) 2021/241. In accordance with Article 17 Regulation (EU) 2021/241, the recovery and resilience plan is consistent with the information included in the National Energy and Climate Plan 2030.

(31)Particular attention has been paid to measures whose impact on environmental objectives warrants close scrutiny. Component 7 – Infrastructures, contains four measures that involve the construction or upgrade of road transport infrastructure (RE-C7-I2, I3, I4 and I5). To avoid significant harm to the climate change mitigation and pollution prevention and control objectives, Portugal’s recovery and resilience plan includes as a flanking measure investment RE-C7-I0 – Expansion of the Electric Vehicle Charging Network. It should decarbonise road transport through making available 15 000 publicly accessible electric vehicle charging stations by 2025. Similarly, concerning the water management measures in Component 9 – Water Management (TC-C9-I1 and I2), which include the construction of a dam, a desalination plant and irrigation and water abstraction measures, Portugal should further ensure that no significant harm to the environment is done through the implementation of any result and condition from the Environmental Impact Assessment relevant for those measures, in compliance with EU environmental law, including the Water Framework Directive (2000/60/EC). This aims in particular to avoid significant impact on the relevant water bodies that would jeopardise or delay the objective of reaching good status or potential. It also aims to ensure that protected habitats and species directly dependent on the concerned water are not negatively impacted by the measures.

(30)The recovery and resilience plan ensures for each reform and investment that no significant harm is done to any of the six environmental objectives within the meaning of Article 17 of Regulation (EU) No 2020/852, namely climate change mitigation, climate change adaptation, sustainable use and protection of water and marine resources, circular economy, pollution prevention and control, and protection and restoration of biodiversity and ecosystems. Portugal provided justifications in accordance with the ‘do no significant harm’ technical guidance of the European Commission (2021/C 58/01). Where needed, Portugal has proposed the implementation of mitigating measures to avoid significant harm, which should be ensured through relevant milestones.

(29)In accordance with Article 19(3), point (d) and section 2.4 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to ensure that no measure for the implementation of reforms and investments projects included in the recovery and resilience plan does significant harm to environmental objectives (Rating A) within the meaning of Article 17 of Regulation (EU) 2020/852 of the European Parliament and of the Council (the principle of ‘do no significant harm’).

(28)Important measures are targeted at children and youth, such as measures to raise the capacity of kindergartens and childcare services and favour the creation of permanent quality jobs for young people. The plan should also foster the enrolment in tertiary education courses, especially in STEAM disciplines, and establish a network of higher education institutions offering post-graduate courses of short duration. Measures should also support the integration of digital technologies in the primary and secondary education system with the use of digital resources in classrooms, the digitalisation of educational contents, the creation of laboratories with educational technologies like programmable robots.

(27)The plan envisages significant measures to address long-standing social challenges, which also have an important impact on the territorial dimension and the rural urban divide, thereby enhancing the economic, social and territorial cohesion and convergence within Portugal and the Union. These cover the need to strengthen the responsiveness and accessibility of health and long-term care services in view of rapid demographic ageing, and provide access to affordable and social housing. Social vulnerabilities should also be addressed through provision of a wide range of social services focusing on the elderly, people with disabilities, ethnic minorities and migrants, and through integrated programmes to support disadvantaged communities in deprived metropolitan areas. It should strengthen public transport networks in urban areas, which is particularly relevant for disadvantaged commuting workers, and reinforce labour rights, especially for atypical labour contracts linked to the digital economy. These measures will help deliver on the implementation of the European Pillar of Social Rights Action Plan endorsed at the Porto Summit of 7 May 2021 and are expected to contribute to improving the levels of the indicators of the Social Scoreboard.

(26)The main contributions to both growth and employment are expected to come from investments and reforms in innovation, education, including digital skills and vocational training, decarbonisation of the industry, digitalisation of enterprises, capitalisation of businesses and housing. Other main areas of intervention include healthcare, culture, transport infrastructure, forestry and water management, quality and capacity of the public administration, including public financial management, judicial services and digitalisation of public services.

(25)Simulation by the Commission services show that the plan has the potential to increase the GDP of Portugal by 1,5% to 2,4% by 2026. The Portuguese recovery and resilience plan includes an ambitious package of reforms and investments to address the country’s vulnerabilities to shocks and to strengthen its economic, institutional and social resilience. The reforms that remove institutional bottlenecks and foster competition, together with significant investments in active labour market policies, R&D, innovation and digitalisation target the root causes of the challenges identified and are expected to boost the country’s competitiveness and productivity.

(24)In accordance with Article 19(3), point (c) and section 2.3 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to have a high impact (Rating A) on strengthening the growth potential, job creation, and economic, social and institutional resilience of the Member State, contributing to the implementation of the European Pillar of Social Rights including through the promotion of policies for children and youth, and on mitigating the economic and social impact of the COVID-19 crisis, thereby enhancing the economic, social and territorial cohesion and convergence within the Union.

(23)By addressing the aforementioned challenges, the plan is expected to also contribute to correcting the macroeconomic imbalances related to large stocks of net external liabilities, private and public debt, in a context of high non-performing loans and low productivity growth.

(22)The plan significantly contributes to addressing the digital transition challenge in both mainland and the autonomous regions of Madeira and Azores. Significant reforms and investments are planned in the areas of digitalisation of enterprises to adopt digital technologies and processes. Investments and reforms in education and vocational education and training systems largely focus on the adaptation of curricula, teaching methods and resources for the provision of digital skills adapted to the particular needs of different groups, such as students, teachers, the workforce, businesses and civil servants. Other significant reforms and investments target the digitalisation of the public administration with actions foreseen for the general public administration, the justice system and public financial management, with the aim to make the public administration more efficient, resilient and more accessible to citizens.

(21)The plan significantly contributes to addressing the climate transition challenge. It includes investments aimed at research and innovation for decarbonising the productive sectors, as well as measures to increase the energy performance of buildings both in the private and public sector. The plan is expected to make urban transport more sustainable by strengthening public transport management authorities and investing in the extension of the metro networks as well as light rail and bus rapid transit systems in the Lisbon and Porto metropolitan areas and purchasing zero-emission vehicles for the public transport fleet. Measures also aim at promoting renewable energy investments in the mainland and the outermost regions of Madeira and Azores. Significant reforms and investments should protect forests to mitigate the impact of climate change. Landscape Planning and Management Programmes are expected to design the desirable landscape of vulnerable territories to increase their resilience to the risks associated with climate change, in particular rural fires and biodiversity loss, and to promote sustainable growth and territorial cohesion through the increase of the average size of agricultural property, the change in land use and the planning of new economic activities.

(20)Significant investments are introduced to boost research and innovation, notably via the development of innovation agendas in key sectors, including green agendas that aim at fostering business science links. Investments are also foreseen to foster research and innovation in sustainable agriculture. The plan also includes investments to recapitalise firms such as the creation of a special purpose vehicle which is to subsequently invest in viable Portuguese firms in the form of equity and quasi-equity financing.

(19)The plan includes reforms and investments that address long-lasting bottlenecks affecting the business environment. Those include the reduction of the restrictions weighing on various regulated professions to foster competition, the review of business licensing requirements and the implementation of the ‘once only’ principle in the dealings with public administration to reduce administrative costs, and the modernisation and increased efficiency of the justice system, while reaping the efficiency increase linked to the digitalisation of procedures.

(18)The plan addresses social challenges by providing a significant response to the need for improvement of the effectiveness and adequacy of the social safety nets, notably through reforms and investments in social housing and social services, with a focus on elderly, children, and vulnerable groups with disabilities. Such reforms and investments foresee the approval of the National Housing Plan and the National Strategy to Combat Poverty, and a support programme for access to housing via the construction of new buildings or the renovation of existing dwellings, the creation and renovation of places in social facilities, strengthening of home- and community based care, the setting up of social intervention teams in the municipalities of continental Portugal, integrated programmes to support disadvantaged communities in deprived metropolitan areas, and making social security services more user-friendly through digitalisation.

(17)Reforms and investments are also included to strengthen the resilience of the health system and contribute to equal access to quality health and long-term care. Such reforms and investments notably foresee the strengthening of the response capacity of the primary health care, mental health and long-term care services, combined with steps to enhance efficiency and the articulation between different elements of the National Health Service. Specific measures are targeted at strengthening the regional health system of the outermost region of Madeira and at digitalising the health systems of both Madeira and the Azores. In addition, the completion of the reform of the governance model of public hospitals addresses the root causes of persistent arrears in public hospitals. That reform is expected to combine hospitals’ greater autonomy in terms of investment and hiring decisions, with enhanced monitoring and stronger accountability, thereby contributing to prevent the accumulation of arrears in a durable manner.

(16)The plan includes an all-encompassing fiscal-structural reform that is expected to substantially improve the quality and sustainability of public finances and strengthen overall expenditure control, cost efficiency and adequate budgeting. Such a reform includes gradual steps that are expected to lead to the full and effective implementation of the 2015 Budgetary Framework Law, making spending reviews a structural feature of Portugal’s annual budgetary process and ensuring the ex-post evaluation of efficiency gains, and strengthening centralised procurement. That reform is also expected to strengthen the financial sustainability of state-owned enterprises, through the implementation of a new model for analysing and disclosing their financial situation and performance, in order to allow a more timely, transparent and comprehensive monitoring. It also provides for planning and management tools to be deployed to increase accountability, such as revamped management contracts to disseminate performance-oriented management practices. That reform is accompanied by an investment in the information systems for public financial management.

(15)The plan includes an extensive set of mutually reinforcing reforms and investments that contribute to effectively addressing all or a significant subset of the economic and social challenges outlined in the country-specific recommendations addressed to Portugal by the Council in the European Semester in 2019 and in 2020, notably in the areas of quality and sustainability of public finances, accessibility and resilience of social services and the health system, labour market, education and skills, R&D and innovation, climate and digital transition, business environment and justice system.

(14)The recommendations related to the immediate fiscal policy response to the pandemic can be considered as falling outside the scope of Portugal’s recovery and resilience plan, notwithstanding the fact that Portugal has generally responded adequately and sufficiently to the immediate need to support the economy through fiscal means in 2020 and 2021, in line with the provisions of the General Escape Clause. Moreover, the recommendation to achieve the medium-term budgetary objective in 2020, taking into account the allowance linked to unusual events for which a temporary deviation was granted, is no longer relevant, due both to the lapsing of the corresponding budgetary period and the activation in March 2020 of the General Escape Clause of the Stability and Growth Pact in the context of the pandemic crisis.

(13)In accordance with Article 19(3), point (b) and section 2.2 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to contribute to effectively addressing all or a significant subset of challenges (Rating A) identified in the relevant country-specific recommendations, including fiscal aspects thereof and recommendations made pursuant to Article 6 of Regulation (EU) No 1176/2011, addressed to Portugal concerned or challenges identified in other relevant documents officially adopted by the Commission in the context of the European Semester.

(12)Around half of all components contribute towards health, economic, social and institutional resilience, being covered by measures such as strengthening of the national networks for primary health care, continuous and palliative care, the provision of social and affordable housing and innovative integrated social services in the metropolitan areas of Lisbon and Porto. The adoption of digital technologies and interoperability solutions strengthen the institutional capacity and resilience of the public administration. Policies for the next generation are covered by a number of measures with nearly one third of all components directly related to it, with a direct impact on children and the youth, such as increasing the capacity of childcare facilities, vocational education and training courses and tertiary education, including for STEAM courses, improving youth career and income prospects, increasing the stock of student accommodation in higher education. This is accompanied by the measure on the digitisation of education and the distribution of personal IT equipment to students.

(11)The plan extensively covers the third pillar of smart, sustainable and inclusive growth, with nearly all components directly contributing. Economic cohesion, productivity and competitiveness are directly covered by nearly all components of the plan, addressing various interrelated challenges, like the promotion of sustainable growth and adapting to climate change, the universal provision of social services, the contribution to innovation, new technologies and decarbonisation, the dematerialisation of public services, and the contribution to the financing of firms and the development of capital markets. The social and territorial cohesion dimensions are closely intertwined, notably in the less developed Portuguese regions. Regional and local authorities are called upon to play a central role in the provision of various community-based services, securing a broad territorial coverage, in areas such as social housing, kindergarten and early childcare and education, health care provision, long term care services and social day care centres for elderly people and persons with disabilities in line with the UN Convention on the Rights of Persons with Disabilities.

(10)The plan envisages taking a broad range of climate related measures, with around three quarters of all components contributing to the green transition. Such measures include increasing the energy-efficiency of buildings, decarbonising industry, and adapting to climate change. The plan addresses digital related challenges in multiple areas, with around half of all components contributing, including the digitisation of public services and the adoption of digital technologies to promote entrepreneurship, and business scale-up with a view to boost the digital transition of the productive fabric. In order to address the challenges related to the lack of digital skills, the plan includes measures to modernise the education as well as vocational education and training systems, inter alia, to provide market relevant qualifications, increase the relevance of adult learning, and the number of graduates in science, technology, engineering, arts and mathematics (STEAM) courses, particularly in IT.

(9)The plan includes measures that contribute towards all of the six pillars, with a significant number of components of the plan addressing multiple pillars. Such an approach contributes to ensuring that each pillar is comprehensively addressed in a coherent manner. Furthermore, given the specific challenges of Portugal, the particular focus on smart, sustainable and inclusive growth, along with the overall weighting across pillars, is considered adequately balanced.

(8)In accordance with Article 19(3), point (a) and section 2.1 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan represents to a large extent (Rating A) a comprehensive and adequately balanced response to the economic and social situation, thereby contributing appropriately to all six pillars referred to in Article 3 of Regulation (EU) 2021/241, taking into account the specific challenges and the financial allocation of the Member State concerned and the requested loan support.

(7)The implementation of the Member States’ recovery and resilience plans will constitute a coordinated effort of investment and reforms across the Union. Through the coordinated and simultaneous implementation of these reforms and investments and the implementation of cross-border projects, these reforms and investments will mutually reinforce each other and generate positive spillovers across the whole Union. Therefore, about one third of the impact of the Facility on Member States’ growth and job creation will come from spillovers from others Member States.

(6)The recovery and resilience plans should pursue the general objectives of the Recovery and Resilience Facility established by Regulation (EU) 2021/241 and of the EU Recovery Instrument set up by Council Regulation (EU) 2020/2094 in order to support the recovery in the aftermath of the COVID-19 crisis. They should promote the Union´s economic, social and territorial cohesion by contributing to the six pillars referred to in Article 3 of Regulation (EU) 2021/241.

(5)On 22 April 2021, Portugal submitted its national recovery and resilience plan to the Commission, in accordance with Article 18(1) of Regulation (EU) 2021/241. That submission followed a consultation process, conducted in accordance with the national legal framework, of local and regional authorities, social partners, civil society organisations, youth organisations and other relevant stakeholders. The national ownership of the recovery and resilience plans is underpinning their successful implementation and lasting impact at national level and credibility at European level. Pursuant to Article 19 of that Regulation, the Commission has assessed the relevance, effectiveness, efficiency and coherence of recovery and resilience plan, in accordance with the assessment guidelines of Annex V to that Regulation.

(4)[The Council recommendation on the economic policy of the euro area recommended to euro area Member States to take action, including through their recovery and resilience plans, to, inter alia, ensure a policy stance which supports the recovery and to further improve convergence, resilience and sustainable and inclusive growth. The Council recommendation also recommended to strengthen national institutional frameworks, to ensure macro-financial stability and to complete EMU and strengthen the international role of the euro.] [If the Council recommendation is not adopted by the time of the CID adoption, please remove the recital].

(3)On 2 June 2021, the Commission published an in-depth review under Article 5 of Regulation (EU) No 1176/2011 of the European Parliament and of the Council for Portugal. The Commission’s analysis led it to conclude that Portugal is experiencing macroeconomic imbalances related to large stocks of net external liabilities, private and public debt, and non-performing loans remaining high, against a backdrop of low productivity growth.

(2)On 9 July 2019 and on 20 July 2020, the Council addressed recommendations to Portugal in the context of the European Semester. In particular, the Council recommended to take all the necessary measures to effectively address the pandemic, to improve the quality of public finances by prioritising growth-enhancing spending, to strengthen the resilience of the health system and ensure equal access to quality health and long-term care. It also recommended to improve the overall level of skills of the population (with a focus on digital skills and to increase the number of graduates in fields related to science, technology, engineering and mathematics), as well as to support quality employment and reduce segmentation in the labour market. It also recommended Portugal to improve the effectiveness and adequacy of the social safety nets and guarantee sufficient and effective social protection and income support. It recommended to focus investment on the green and digital transition, in particular on innovation, railway transport and port infrastructure, low carbon and energy transition, and extending energy interconnections, taking into account regional disparities. Further, the Council recommended to implement measures to secure access to liquidity for firms in the context of the pandemic, to frontload public investment projects and to promote private investment to foster the economic recovery. Lastly, it recommended to carry out reforms to improve the business environment, in particular to reduce regulatory and administrative barriers derived from licensing and reducing regulatory restrictions in regulated professions and to increase the efficiency of administrative and tax courts and insolvency and recovery proceedings. Having assessed progress in the implementation of these country-specific recommendations at the time of submission of the recovery and resilience plan, the Commission finds that the recommendation on taking, in line with the general escape clause, all necessary measures to effectively address the pandemic, sustain the economy and support the ensuing recovery, has been fully implemented. Substantial progress has been achieved with respect to the recommendation on implementing the temporary measures aimed at securing access to liquidity for firms, in particular small and medium-sized enterprises.

(1)The COVID-19 outbreak has had a disruptive impact on the economy of Portugal. In 2019, the gross domestic product per capita (GDP per capita) of Portugal was 67% of the EU average. According to the Commission’s Spring 2021 forecast, the real GDP of Portugal declined by 7,6% in 2020 and is expected to decline by 3,9% cumulatively in 2020 and 2021. Longer-standing aspects with an impact on medium-term economic performance include the large stocks of external, private and government debt, and low productivity growth; moreover, shortfalls in investment, make it more challenging to participate and take full advantage of the opportunities brought by the green and digital transitions.

Having regard to the proposal from the European Commission,

Having regard to Regulation (EU) 2021/241 of the European Parliament and of the Council of 12 February 2021 establishing the Recovery and Resilience Facility and in particular Article 20 thereof,

Having regard to the Treaty on the Functioning of the European Union,

on the approval of the assessment of the recovery and resilience plan for Portugal

on the approval of the assessment of the recovery and resilience plan for Portugal

EUROPEAN COMMISSION Brussels, 16.6.2021 COM(2021) 321 final ANNEX

to the Proposal for a Council Implementing Decision on the approval of the assessment of the recovery and resilience plan for Portugal {SWD(2021) 146 final}



ANNEX SECTION 1: REFORMS AND INVESTMENTS UNDER THE RECOVERY AND RESILIENCE PLAN 1. Description of Reforms and Investments A. COMPONENT 1: National Health Service This component of the Portuguese recovery and resilience plan addresses several challenges that the Portuguese health system currently faces with respect to current and evolving health care needs and associated costs. First, Portugal’s adverse demographic trends – characterised by accelerated ageing and subsequent long-term care needs – coincide with changing disease patterns, an increasing burden of chronic and degenerative diseases, as well as multi-morbidity gradually becoming more prominent. Second, there is still considerable avoidable mortality in Portugal and a relatively low number of healthy life years at age 65. Third, there is available scope to place a greater focus on health promotion and disease prevention, in combination with addressing the fragmentation of health care services and the gaps in access to health care. Fourth, out-of-pocket payments for health care are amongst the highest in the EU and the reported financial burden of medical care is relatively high. Finally, Portugal’s National Health Service has been facing a challenging financial situation for a number of years. In particular, Portugal has a track record of recurrent bailouts of public hospitals by the government, which did not succeed in avoiding a systematic cycle of hospitals’ indebtedness, with knock-on effects on supply-chain relationships. The main objective of the component is to strengthen the response capacity of Portugal’s National Health Service, with a view to responding to the demographic and epidemiological changes in the country, to therapeutic and technological innovation, and to the trend of increasing demand for health care and associated costs. To this end, the component aims to strengthen the core role of primary health care services within the overall architecture of the National Health Service, upscale long-term and mental health care services, and increase efficiency by completing the reform of the governance model of public hospitals and bringing forward the digitalisation of health care services. The component supports addressing the Country Specific Recommendation on strengthening overall expenditure control, cost efficiency and adequate budgeting, with a focus on a durable reduction of arrears in hospitals (Country Specific Recommendation 1 2019), as well as the Country Specific Recommendation on strengthening the resilience of the health system and ensuring equal access to quality health and long-term care (Country Specific Recommendation 1 2020). The component also contributes to addressing the Country Specific Recommendation to focus investment on the green and digital transition (Country Specific Recommendation 3 2020). It is expected that no measure in this component does significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852, taking into account the description of the measures and the mitigating steps set out in the plan in accordance with the DNSH Technical Guidance (2021/C58/01). A.1. Description of the reforms and investments for non-repayable financial support Reform RE-r01: Primary health care reform The over-arching objective of the reform is to reinforce the core role of primary health care services in responding to the health needs of the population within the overall architecture of the National Health Service. To that end, the reform is aimed at addressing six priorities: i) deepening the capacity for screening and early diagnosis, namely of the most frequent pathologies; ii) strengthening the response capacity of primary care through the creation of more proactive health centres with expanded service portfolio and areas of intervention, as well as more integrated with other levels of care, and by adjusting processes to the individual characteristics of each user and related life path, reducing the high variability of clinical practices (including in terms of outpatient medication prescription), improving clinical referral between different levels of health care, and seeking efficiency gains by limiting the duplication of services or the provision of ineffective, inadequate or low-value care; iii) correcting regional and local asymmetries in terms of facilities and equipment available in primary health care services; iv) supporting community-based responses and creation of support programmes for users and their families, better involving citizens and communities, including through completing the hand-over of health responsibilities from central to local governments; v) enhancing the skills of the health workforce, reinforcing multidisciplinary team work and the expansion of the number of professionals, including of specialists; and, vi) delivering on the digital transition of the National Health Service and exploiting its potential to modernise and simplify the use of health care services. In so doing, this reform shall provide enhanced framework conditions for the related investment in primary health care services. The reform shall consist of the implementation of several legislative and regulatory measures, with a view to: i) broadening the responsibilities and scope of intervention of health centre groups, as well as the typology of the functional units that compose them; ii) reviewing the legal regime for the organisation and functioning of functional units, as well as the scheme of incentives to be granted to the elements that constitute them; iii) developing a risk stratification instrument to support clinical governance in the functional units of health centre groups; and, iv) completing the transfer of responsibilities in the field of health from central to local governments. The milestone and targets related to the implementation of the reform shall be completed by 31 December 2023. Reform RE-r02: Mental health reform The over-arching objective of this reform is to improve mental health in Portugal. To that end, the reform is structured along five intervention axes: i) deinstitutionalising patients residing in psychiatric hospitals or in social sector institutions; ii) completing the national coverage of local mental health services, in the areas of inpatient, outpatient and community care; iii) expanding the national network of integrated continued care, with a focus on mental health; iv) reorganising the forensic psychiatric services; and, v) implementing the regional health plans for dementia. Concretely, the reform shall consist of the review of the current Mental Health Law – which shall establish the general principles of the mental health policy in Portugal and regulate the compulsory internment of people with psychic disorders – and of the Mental Health Decree-Law – which shall define the guiding principles for the organisation, management and evaluation of mental health services. Among others, the following changes shall be introduced in these legal provisions: i) incorporating into the legislation the principles of the United Nations Convention on the Rights of Persons with Disabilities; and, ii) increasing the autonomy and sound management of local mental health services, through the creation of Integrated Responsibility Centres. In so doing, this reform shall provide enhanced framework conditions for the related investment in mental health care services.

The milestones related to the implementation of the reform shall be completed by 31 March 2023. Reform RE-r03: Completion of the reform of the governance model of public hospitals The over-arching objective of the reform is to increase efficiency in the hospitals of the National Health Service. To that end, it is aimed at: i) reforming the organisation and internal management of public hospitals; ii) reconfiguring the hospital network according to capacity planning in terms of services demand and supply of human resources and infrastructure; iii) improving articulation with the other elements of the National Health Service, namely with primary and mental health care services, as well as with the palliative and integrated continued care networks; iv) involving health professionals and intermediate structures in the management of public hospitals; and v) focusing responses on the citizens’ real health and well-being needs. Objective metrics for assessing the performance of hospital managers shall be included in management contracts, assessing both the quality of service and the financial situation of public hospitals. This shall contribute to ensuring consistency with the government’s health policy priorities and to a more predictable management of hospital resources, with autonomy being combined with enhanced monitoring and accountability. The implementation of the revamped management contracts shall be gradual and prioritised according to the level of efficiency, dimension and geographic distribution of public hospitals. Furthermore, the monitoring role of the Ministries of Health and of Finance shall be strengthened in order to ensure an integrated and coherent approach to assessing the performance of hospitals and correcting, in good time, deviations from the approved budgets. In addition, centralised purchasing shall be strengthened with a view to achieving further efficiency savings, notably by addressing the recommendations from a recent independent evaluation. In particular, centralised purchasing is to be broadened to medical equipment and devices. Furthermore, the internal management of public hospitals is planned to be improved, notably through the creation of Integrated Responsibility Centres and implementation of performance-based remuneration regimes applicable to units associated to such Centres. Related, a full dedication regime to the National Health Service for health professionals shall enter into force. Furthermore, the measure shall include initiatives to redesign the hospital network to ensure better articulation between services. In particular, home-based hospitalisation responses shall be developed further, in order to provide hospital-level care at the patient’s home, in close articulation with primary health care services, the national network of integrated continued care services, the social sector and local communities. Moreover, the laboratory capacity of the National Health Service to diagnose infectious diseases shall be strengthened and its capacity for intensive medical care shall be increased. The implementation of the reform shall be completed by 31 December 2025. Investment RE-C01-i01: Primary health care services with more answers The objective of this investment is to expand primary health care services and reinforce the core role of primary health care services in responding to the health needs of the population within the overall architecture of the National Health Service. The investment builds on the reform of primary health care services. The investment shall include the following initiatives: -First, several sub-investments shall improve access, quality and efficiency of primary health care services, thus contributing to complete the national coverage of screening programmes and strengthen the capacity for early diagnosis. These shall include: i) extending cancer screening to all health centres, including for colorectal and cervical cancer; ii) extending the screening for diabetic retinopathy to all health centres; iii) providing all health centres with the capacity to measure C-reactive protein; iv) equipping health centre groups with spirometers for early diagnosis, monitoring and treatment of asthma, chronic obstructive pulmonary disease and smoking; v) providing health care units with Holter equipment and ambulatory blood pressure monitoring; vi) extending diabetic foot consultations to all health centre groups; vii) adopting the individual care plans for complex and multi-morbid patients; viii) defining referral protocols in the most sought-after care areas, namely ophthalmology, otorhinolaryngology, orthopaedics and urology; and, ix) completing the integrated information system that shall facilitate the referral of patients between levels of health care. -Second, other sub-investments shall target the expansion of the areas of intervention of health centre groups, thereby increasing the response capacity of this level of health care and reinforcing the offer of medical specialities by strengthening specialised and team work in health units. In detail, these shall include: i) installing dentistry offices in health centres; ii) creating integrated diagnostic centres (including, at least X-ray and clinical analyses) in health centre groups; iii) creating rehabilitation services in health centres (adequate physical spaces and rehabilitation, multidisciplinary and interdisciplinary teams); iv) providing all health centres with equipment (emergency bag, defibrillator and vital signs monitor) for qualified emergency response (basic life support); and v) boosting momentum for the programme to reduce the inadequate and/or preventable use of emergency health care services. -Third, further sub-investments shall provide for the upgrade of facilities and equipment of health centres, increasing energy efficiency, ensuring conditions of accessibility, quality, comfort and safety for patients and professionals, and adapting them to new models of health care provision. In detail, these shall include, among others: i) building 100 new health centres; ii) refurbishing or adapting 326 health facilities to increase energy efficiency, comply with contingency plans and ensure accessibility, sanitary safety and comfort; and, iii) upgrading health equipment. -Fourth, additional sub-investments shall focus on enhancing proximity responses, with a focus on home- and community-based care, intervening in the populations at greatest risk and promoting deinstitutionalisation and outpatient care. In detail, these shall include: i) providing health centres with electric vehicles to support the provision of care at home; ii) extending the number of mobile units to cover low density regions; iii) providing health centres with technical conditions to carry out teleconsultations and telemonitoring of chronic diseases, such as for heart failure; iv) reinforcing community care units and teams of integrated continued care; v) creating community teams to support palliative care at health centre groups; and, vi) creating psychosocial intervention programmes in common mental illnesses (depression and anxiety) in health centre groups. The implementation of the investment shall be completed by 30 June 2026. Investment RE-C01-i02: National Network of Integrated Continued Care and National Network of Palliative Care The objective of the investment is to upscale the national networks of palliative and integrated continued care, regarding both in- and out-patient treatment, as well as home-based care. The investment is underpinned by the reform on a National Strategy for the Inclusion of Persons with Disabilities presented in component 3 on social responses and is part of Portugal’s deinstitutionalisation strategy and overall drive to address the adverse demographic trends the country is facing. The investment shall consist of a structured and phased in programme to provide financial support to promoters from the public, social or private sectors, in order to: i) expand the national network of integrated continued care by 5 500 beds, through the construction of 275 new 20-bed modules (in either existing or new units); ii) create 20 day units to promote autonomy, with a view to monitoring 500 outpatients; iii) establish 50 home teams of integrated continued care, in order to respond to 1 000 patients at home (including equipment and electric vehicles); iv) extend integrated mental health care responses in 1 000 places, in 50 residences and socio-occupational units (support for the construction of new responses or expansion of existing responses); v) create up to 100 places in 10 home mental health support teams (support for the acquisition of the necessary material resources and electric vehicles for the teams' activity); vi) expand the National Palliative Care Network by 20 palliative care low-complexity inpatient units to respond to 400 patients; and, vii) create up to 100 places in 10 community palliative care teams (support for the acquisition of the necessary material resources and electric vehicles for the teams' activity). The implementation of the investment shall be completed by 31 December 2025. Investment RE-C01-i03: Completion of the mental health reform and implementation of the dementia strategy

The objective of the investment is to support delivery on the reform of mental health care services, thus contributing to expanding and strengthening of the response capacity of the National Health Service in the field of mental health. The investment shall consist of complementary sub-investments in facilities, structures and human resources, namely: i) creating residential services in the community that allow the deinstitutionalisation of patients residing in psychiatric hospitals or in the social sector, who do not benefit from the offer of the national network of integrated continued care, including an increase by 500 places for mental health care in the national network of integrated continued care in the field of mental health care; ii) building four inpatient units in general hospitals, eliminating acute accommodation in psychiatric hospitals; iii) creating 15 Integrated Responsibility Centres to overcome obstacles to the provision of non-hospital care, with a greater degree of autonomy and accountability; iv) renovate 20 existing facilities of local mental health services; v) forming 40 community mental health teams; vi) redesigning, expanding and refurbishing forensic psychiatry services; and, vii) developing awareness raising and training actions for ‘building the pathways of patients’ in the context of dementias. The implementation of the investment shall be completed by 31 December 2025. Investment RE-C01-i04: Equipment for new hospitals in Seixal, Sintra and East Lisbon The objective of the investment is to equip the planned new hospitals in Seixal, Sintra and East Lisbon, thereby reinforcing the hospital network and supply of hospital care in a highly populated region where the demand for health care services is considerable. This aims to ensure better access to health care for a significant part of the population and contribute to the reduction of inequalities and to social cohesion in the region. The investment shall consist of the purchase of equipment to be installed in the new hospitals in Seixal, Sintra and East Lisbon, including: i) clinical, medical and high-technology equipment; ii) general equipment, including specialised furniture; and, iii) computer equipment. The implementation of the investment shall be completed by 30 June 2026. Investment RE-C01-i05-RAM: Strengthening Madeira’s Regional Health Service The objective of this investment is to implement the Strategic Plan for the Regional Health System of the Autonomous Region of Madeira and the Regional Strategy for the Promotion of Mental Health. The investment shall consist of two sub-investments. First, it shall include a sub-investment to expand, develop and improve the regional network of integrated continued care, including by expanding the number of places in all their typologies in line with the principle of deinstitutionalisation, in cooperation with the private and social sectors, and in areas characterised by more acute demographic ageing and/or less installed capacity. Second, it also comprises a sub-investment to strengthen response capacity in the area of mental health and dementias associated with ageing, including the upgrade of infrastructure and equipment in facilities for hospital and primary care, the provision of new places for home-based hospitalisation and day hospital services, and the set-up of community mental health teams. The implementation of the investment shall be completed by 30 June 2026. Investment RE-C01-i06: Digital Health Transition This objective of the investment is to address bottlenecks hampering the digital transition in the National Health Service, including the lack of appropriate hardware and software at the disposal of health care workers, to strengthen the standardisation of the information systems in the National Health Service, and to improve user experience and access to data. The investment shall consist of four sub-investments. First, the health data network shall be enhanced, with a view to improving the quality of service and resilience of the computer systems available in the National Health Service, facilitating the use of data in decision support systems, ensuring the interoperability between different information systems and compliance with appropriate security principles. Second, the communication between citizens and health units shall be simplified, standardised and digitalised through electronic tools, such as a citizen-centred platform and telehealth tools to increase the access to healthcare. Third, upgraded and interoperable tools available to health professionals (e.g. telemonitoring and tele-rehabilitation platforms, and systems that enhance the portability of data between primary care, hospital and integrated continued care facilities) and relevant training on digital skills. Fourth, the digitalisation of clinical records shall be promoted, with a view to carrying out activities to monitor the performance of the National Health Service. The implementation of the investment shall be completed by 31 December 2024. Investment RE-C01-i07-RAM: Digitalisation of Madeira’s Regional Health Service The objective of this investment is to foster the digitalisation of Madeira’s Regional Health Service, through the deployment of digital technologies to support the quality and efficiency of health care services, and empowering health professionals and citizens. The investment shall consist of several sub-investments, including: i) implementing digital technologies to support patient monitoring, intensifying telehealth appointments and telemonitoring of citizen’s health situation; ii) reinforcing digital technologies and artificial intelligence for epidemiological surveillance; iii) increasing the digitisation of health and improving the interoperability of information systems; iv) improving citizens' access to health information and services through digital means; and, v) training citizens and stakeholders to use digital health resources in the field of health. The implementation of the investment shall be completed by 31 December 2024. Investment RE-C01-i08-RAA: Digital Hospital in the Azores

The objective of the investment is to scale up the supply of health care and ensure better access to health care in the Azores, through the digitalisation of its regional health service. The investment shall consist of creating an electronic health record for each citizen, increasing the interoperability of information systems to enable clinical information to be shared among health professionals, enhancing the accessibility of health care in the most isolated islands without a hospital by conducting telemedicine consultations, and providing for the necessary hardware, software, and information systems. The implementation of the investment shall be completed by 30 September 2025. Investment RE-C01-i09: Universal Active Life Support System The objective of the investment is to promote physical and emotional well-being in Portugal by increasing the low levels of physical activity practice in the country and contributing to better disease prevention and management of the burden of non-communicable diseases. The investment shall consist of: i) a national campaign and a technological platform to promote physical activity, increasing citizens' knowledge about the benefits of regular physical activity at all ages, prescribing exercises according to their ability, and encouraging the adoption of healthier lifestyles; ii) extending school sports to the community by promoting active mobility, from younger ages and throughout life, and sports in the family context, as a means to promote student success and healthier lifestyles; and, iii) encouraging the practice of physical activity in the workplace, promoting the implementation of measures and programmes, as well as providing spaces and equipment for the practice of physical activity. The implementation of the investment shall be completed by 30 September 2025.



A.2. Milestones, targets, indicators, and timetable for monitoring and implementation for non-repayable financial support Sequential Number Measure (Reform or Investment) Milestone/ Name Qualitative indicators (for milestones) Quantitative indicators (for targets) Indicative timeline for completion Description and clear definition of each milestone and target Target Unit of measure Baseline Goal Q Year 1.1 RE-C01-r01 M Entry into force of legal acts in the field of primary health care Entry into force of the revised legal acts Q2 2023 Revision of legal acts in the field of primary health care, namely: i) the legislation underpinning the functional units of primary health care centres (including, the Decree-Law No 73/2017 for Model B family health units, the Government Order No 1368/2007, the rules and remuneration model of Model B family health units and the associated legal act, and the legal acts underpinning the functioning of other types of primary health care units); and, ii) the legislation underpinning health centre groups (including, the legal acts underpinning health centre groups, namely the Decree-Law No 28/2008). 1.2 RE-C01-r01 T Provision of access to the risk stratification instrument to support clinical governance in the functional units of health centre groups Number 0 1 000 Q4 2023 Number of functional units of health centres getting access to the information from the risk stratification instrument covering registered users. The risk stratification instrument shall allow for proactive intervention in populations with higher clinical risk and social vulnerability, ensuring population-based screening and early diagnosis programmes across the country, as well as timely treatment and adequate follow-up of users who suffer from the most frequent diseases (cardiovascular, diabetes, cancer, respiratory, mental and osteoarticular). 1.3 RE-C01-r01 T Completion of the process of decentralisation of responsibilities in the field of health in municipalities Number 0 201 Q4 2022 Number of new municipalities where the process of decentralisation of responsibilities in the field of health has been completed, in accordance with Decree-Law No 23/2019, of 30 January, through the signing of a transfer notice by the Ministry of Health, the regional health administrations and municipalities. The transfer of responsibilities shall namely cover : i) the participation of municipalities in the planning, management and investment decisions of primary health care units and divisions of intervention in addictive behaviours and dependencies, notably in their construction, equipment and maintenance; ii) management, maintenance and conservation of other equipment related to primary health care; iii) management of health care workers in the category of operational assistant of the functional units of health centre groups and divisions of intervention in addictive behaviours and dependencies that integrate the National Health Service; iv) management of logistical support services of health centre groups; v) strategic partnership in disease prevention programmes, with a special focus on promoting healthy lifestyles and active ageing. 1.4 RE-C01-r02 M Entry into force of the new Mental Health Decree-Law, which shall set out the principles for the organisation of mental health care services Entry into force of the new Mental Health Decree-Law Q4 2021 The new Decree-Law shall reflect the proposals for amendments made by the Working Group set up by Government Order No 6324/2020, of 15 June, as amended by Government Order No 11485/2020, of 20 November, with a view to defining the principles for the organisation of mental health care services. 1.5 RE-C01-r02 M Entry into force of the new Mental Health Law, which shall lay down the principles relating to the rights of people with mental illness and regulate compulsory hospitalisation or treatment Entry into force of the new Mental Health Law Q1 2023 The new Mental Health Law shall reflect the proposals for amendments made by the Working Group set up by Government Order No 6324/2020, of 15 June, as amended by Government Order No 11485/2020, of 20 November, with a view to laying down the principles relating to the rights of people with mental illness and regulate compulsory hospitalisation or treatment. 1.6 RE-C01-r03 M Entry into force of the new management contract template Entry into force of the new management contract template Q2 2022 Entry into force, through joint approval by the Ministries of Health and Finance, of the new management contract template. The new template shall be adhered to by all future management contracts to be signed by all public managers of state-owned enterprises in the health system, in order to strengthen accountability and encourage performance-based management practices. 1.7 RE-C01-r03 M Entry into force of the new Management Accounting Plan of the National Health Service Entry into force of the new Management Accounting Plan Q1 2024 Establishment of a Management Accounting Plan for the National Health Service, in order to collect, at national level, information on the costs, incomes, and results of hospital services, thereby improving the allocation of resources in the National Health Service, benchmarking and identifying areas for improvement in the operational efficiency of the health entities. The new Management Accounting Plan shall be disseminated through a normative circular by the central administration of the health system. 1.8 RE-C01-r03 T Establishing new Integrated Responsibility Centres in the hospitals of the National Health Service Number 0 10 Q4 2022 Establishment of new Integrated Responsibility Centres in the hospitals of the National Health Service in order to: i) improve access to, as well as quality and efficiency in the provision of heath care services; ii) strengthen clinical governance, autonomy and accountability of health care services; iii) encourage health professionals to continue working at public hospitals; iv) share risks and benefits between health care services and hospitals; v) value the mission of each health care service and hospital in the regional and national context of the National Health Service. 1.9 RE-C01-r03 T Establishing new Integrated Responsibility Centres in the hospitals of the National Health Service Number 10 25 Q4 2025 Establishment of new Integrated Responsibility Centres in the hospitals of the National Health Service in order to: i) improve access to, as well as quality and efficiency in the provision of heath care services; ii) strengthen clinical governance, autonomy and accountability of health care services; iii) encourage health professionals to continue working at public hospitals; iv) share risks and benefits between health care services and hospitals; v) value the mission of each health care service and hospital in the regional and national context of the National Health Service. 1.10 RE-C01-r03 T Strengthening home hospitalisation responses in the hospitals of the National Health Service Number 0 5 000 Q4 2024 Increase response capacity in home hospitalisation by enabling the provision, at home, of health care services with hospital-level differentiation, complexity and intensity, for a limited period, in close articulation with primary health care services, the national network of integrated continued care, the social sector and the wider community, as measured by the number of new home hospitalisation episodes (defined as a set of care provided during the period in which the patient is under the responsibility of the home hospitalisation unit, running uninterruptedly from the date of admission until the date of discharge, except the day of discharge). 1.11 RE-C01-r03 M Entry into force of the action plan to strengthen centralised purchasing mechanisms for medicines Entry into force of the action plan to strengthen centralised purchasing mechanisms for medicines Q2 2024 Entry into force of the action plan to strengthen centralised purchasing mechanisms for medicines, to implement the recommendations of the independent assessment of centralised procurement of medicines in Portugal, conducted by the Austrian National Institute of Public Health under the Structural Reform Support Programme. 1.12 RE-C01-r03 M Entry into force of the new exclusivity work regime in the National Health Service Entry into force of the new exclusivity work regime Q1 2023 New exclusivity work regime for health professionals in the National Health Service, incorporating appropriate mechanisms for organising working time and remuneration tables. 1.13 RE-C01-i01 M Entry into force of the terms for referencing emergency episodes screened in white, blue or green in hospital emergency services for other types of health care services, including primary health care services Entry into force of terms for referencing emergency episodes Q1 2022 Entry into force of the procedures and administrative rules of the referral process for users with emergency episodes screened in white, blue or green in hospital emergency services for other types of health care, services, namely for primary health care services, with direct scheduling of appointments. 1.14 RE-C01-i01 T Building new health units Number 0 20 Q4 2023 Number of new health units built to replace inadequate buildings, ensuring accessibility, quality, comfort and safety for users and health professionals, and adapting them to new models of health care. The new units shall be built to replace inappropriate buildings and new buildings shall have a primary energy demand at least 20% below the requirements of nearly zero energy buildings. 1.15 RE-C01-i01 T Building new health units Number 20 100 Q2 2026 Number of new health units built to replace inadequate buildings, ensuring accessibility, quality, comfort and safety for users and health professionals, and adapting them to new models of health care. The new units shall be built to replace inappropriate buildings and new buildings shall have a primary energy demand at least 20% below the requirements of nearly zero energy buildings. 1.16 RE-C01-i01 M Complete the national coverage of screening and early diagnosis programmes in primary health care Report on the completion of the coverage of screening and early diagnosis programmes in primary health care Q1 2026 The delivery of this milestone includes: i) introduction of cervical screening in health centres; ii) introduction of colon and rectum screening in health centres; iii) introduction of screening for diabetic retinopathy in 300 health centres; iv) introduction of Holter exams and blood pressure ambulatory monitoring in functional units; v) introduction of diagnosis and treatment tools for asthma, chronic obstructive pulmonary disease and smoking (spirometers) in health centres; and, vi) introduction of C-reactive protein dosing in health centres. 1.17 RE-C01-i01 M Increase the response capacity of primary health centres and expand their areas of intervention Report on the increase of the response capacity of primary health centres and expansion of their areas of intervention Q2 2026 The delivery of this milestone includes: i) extending diabetic foot consultations to health centre groups; ii) creating dentistry offices in health centres; iii) creating integrated diagnostic centres (with low-complexity complementary means of diagnosis and therapy, X-ray and clinical analysis) in health centre groups; iv) creating movement and rehabilitation offices in health centre groups; v) providing equipment (emergency bag, defibrillator and vital signs monitor) for qualified response in emergency situations (basic life support) to health centres. 1.18 RE-C01-i01 M Refurbishment of health facilities and equipment to ensure accessibility, quality and safety conditions in primary health centres Report on the refurbishment of health facilities and equipment Q2 2026 The delivery of this milestone includes: i) building 100 health facilities, with grant support of EUR 154 841 862 to replace unsuitable buildings; these new buildings shall have a primary energy demand at least 20% below the requirements of nearly zero energy buildings; ii) renovating or adapting 326 health facilities to increase energy efficiency, comply with contingency plans and/or ensure accessibility, safety and comfort for users and health professionals, of which grant support of EUR 133 509 208 relates to energy efficiency renovation, and grant support of EUR 11 322 726 relates to energy efficiency renovation to achieve, on average, at least a medium-depth level renovation as defined in Commission Recommendation on Building Renovation (EU) 2019/786 (the requirements for improving the energy performance of buildings shall be embedded in the public procurement procedures and shall be ensured in the tender specifications); and, iii) modernising equipment (including, among others, basic clinical equipment, information and communications technology equipment, energy efficiency equipment and safety equipment). 1.19 RE-C01-i01 MT Strengthening of community-based care, home and community interventions Report on the strengthening of community-based care, home and community interventions Q2 2026 The delivery of this milestone includes: i) providing at least 770 electric vehicles to support the provision of home care by health centres; and ii) expanding the number of new mobile units by at least additional 34 to cover low-density regions. 1.20 RE-C01-i02 M Entry into force of the regulation on the allocation of financial support by the Regional Health Authorities Entry into force of the regulation on the allocation of financial support Q1 2022 Entry into force of the regulation on the allocation of financial support by the Regional Health Authorities, which shall define the governance model of the programme and the respective requirements of the applicants. 1.21 RE-C01-i02 T Strengthening the response capacity of the national networks of integrated continued care and palliative care services in inpatient and outpatient care Number 0 7 400 Q4 2025 Strengthening of the response capacity of the national networks of integrated continued care and palliative care services in inpatient and outpatient care through the creation of the following new places: i) new 5 500 inpatient beds in the national network of integrated continued care services, within the general network; ii) new 500 places in autonomy promotion day units within the national network of integrated continued care services; iii) new 1 000 places in integrated mental health continued care services; and, iv) new 400 low-complexity inpatient beds in the national network of palliative care services. It includes the use of grant support of EUR 198 337 500 to build new health infrastructure. These new buildings shall have a primary energy demand at least 20% below the requirements of nearly zero energy buildings. 1.22 RE-C01-i02 T Strengthening the response capacity of the national networks of integrated continued care and palliative care services in home care Number 0 1 200 Q4 2023 Strengthening of the response capacity of the national networks of integrated continued care and palliative care services in home care through the creation of the following new places: i) 1 000 new places in integrated continued home care teams; ii) 100 new places in mental health home support teams within the national network of integrated continued care services; and, iii) 100 new places in community palliative care support teams. 1.23 RE-C01-i03 T Refurbishment of forensic psychiatry units and equipment Number 0 3 Q4 2025 Building of a new forensic psychiatry unit (Sobral Cid) and refurbishment of two other units (Lisbon Psychiatric Hospital Centre and Hospital de Magalhães Lemos) to ensure conditions compatible with the respect for human rights, in particular privacy, comfort, and the humanisation of spaces, without neglecting the security conditions inherent to the fulfilment of judicial orders, preventing further convictions of the Portuguese Republic by international organisations (European Committee for the Prevention of Torture). 1.24 RE-C01-i03 M Development of awareness-raising and training actions for ‘building the pathways of patients’ in the context of dementias Report on the deployment of new awareness-raising and training actions and their development Q4 2022 Awareness-raising and training actions on dementias, with a view to supporting reforms in social and health care services, aimed at the staff of social and health care services or of other entities that work with the general public in the field of social and health care policies, as well as the users of social and health care services. 1.25 RE-C01-i03 M Completion of the strengthening of the mental health care network Report on the completion of all the described initiatives to strengthen the mental health care network Q4 2025 Completion of all the interventions defined to strengthen the mental health care network, including: i) setting up of four new units for hospitalisation in general hospitals; ii) creation of 15 Integrated Responsibility Centres in mental health services; iii) refurbishing 20 of the existing mental health local services; iv) creation of 500 responses to the needs of institutionalised people with chronic mental illness; v) upgrading of three forensic psychiatry facilities and equipment; vi) building three forensic residential transition units; and, vii) development of training actions for ‘building the pathways of patients’ in the context of dementias. It includes the use of grant support of EUR 58 507 675 in energy efficiency renovation to achieve, on average, at least a medium-depth level renovation as defined in Commission Recommendation on Building Renovation (EU) 2019/786. The requirements for improving the energy performance of buildings shall be embedded in the public procurement procedures and shall be ensured in the tender specifications. 1.26 RE-C01-i04 M Purchase of equipment for East Lisbon, Seixal and Sintra hospitals Purchase the equipment for Lisbon East, Seixal and Sintra Hospitals, involving a total of EUR 178 740 000 of grant support Q2 2026 Purchasing the equipment to be installed in new hospitals in Lisbon, Seixal and Sintra involving a total of EUR 178 740 000 of grant support, namely clinical/medical and high-technology equipment; general equipment, comprising furniture adapted to the tasks to be performed in different spaces and that is easy to clean and ergonomically designed; and, computer equipment. 1.27 RE-C01-i05-RAM T Increase in the number of available places in the home hospitalisation system of Madeira’s regional health service Number 0 1 500 Q2 2026 Strengthening the response capacity of Madeira’s regional health service by increasing the number of available places in the home hospitalisation system, thus enabling the provision, at home, of health care services with hospital-level differentiation, complexity and intensity, for a limited period, in close articulation with primary health care and other services. 1.28 RE-C01-i05-RAM T Setting up community mental health teams in Madeira’s regional health service Number 0 11 Q2 2026 Strengthening of the response capacity of Madeira’s regional health service in the field of mental health and dementias associated with ageing through the creation of community mental health teams. 1.29 RE-C01-i05-RAM M Deployment of the classification system, functional profile and users’ referral system for Madeira’s regional model of integrated continued care services Report on deployment of the classification system, functional profile and users’ referral system Q4 2021 Deployment of the classification system, functional profile and users’ referral system, with a view to strengthening Madeira’s regional model of integrated continued care services, as well as its coordination and technical management. 1.30 RE-C01-i05-RAM T Increase in the number of places in integrated continued care services in Madeira’s regional health service Number 0 1 080 Q4 2025 Number of places created in integrated continued care services in Madeira’s regional health service, measured in terms of new beds, in general scope (including in convalescence, medium-term and rehabilitation unit, and long-term and maintenance unit), mental health and paediatric services. It includes the use of grant support: i) of EUR 44 700 000 to build new health infrastructure; new buildings shall have a primary energy demand at least 20% below the requirements of nearly zero energy buildings; and ii) of EUR 23 300 000 in energy efficiency renovation. 1.31 RE-C01-i05-RAM T Refurbishment of primary health care services in Madeira’s regional health service Number 0 15 Q2 2026 Number of refurbished primary health care facilities in Madeira’s regional health service. 1.32 RE-C01-i06 T Upgrade of local information technology networks % 0 90 Q4 2022 Percentage of upgraded local information technology networks in the National Health Service, organised and implemented by the shared services entity of the Ministry of Health, which shall thus become able to operate in the new model of unified communications (Voice over Internet Protocol). 1.33 RE-C01-i06 T Implementation of functionalities for telehealth and telemonitoring % 0 15 Q4 2022 Percentage of users with access to new telehealth and telemonitoring functionalities, enabling the provision of remote health care services, thereby increasing levels of access to health care and citizen participation in the process of remote information collection and treatment. 1.34 RE-C01-i06 T Implementation of information technology administrative modules, basic clinical modules and emergency clinical modules % 0 15 Q4 2024 Percentage of health professionals with access to integrated information technology modules, basic clinical modules and emergency clinical modules for: i) recording and consulting clinical information within the scope of primary, hospital, and continued health care, in order to ensure the availability and integration of health information, as well as providing greater safety for users and health professionals; and, ii) emergency, nursing registry and telemonitoring health care services. 1.35 RE-C01-i07-RAM T New computer equipment for Madeira's regional health service Number 0 3 600 Q4 2024 Number of new computer equipment for Madeira’s regional health service to monitor and ensure greater proximity to the users of Madeira’s regional health service, promote a reduction in the risk of errors, as well as foster efficiency and swift access to user data. 1.36 RE-C01-i08-RAA T Increased access to the user portal of the Azores’ regional health service Number 0 25 000 Q3 2025 Number of additional annual individual users accessing the user portal of the Azores’ regional health service, thanks to the broadening of digital health services and medical information available therein. 1.37 RE-C01-i08-RAA T Introduction of telemedicine appointments in the Azores' regional health service Number 0 1 000 Q3 2024 Number of annual telemedicine appointments in primary health care services and with medical specialists at the Azores' regional health service. 1.38 RE-C01-i09 T Completion of the implementation in schools of the ‘School Sports Community’ and ‘School Sports on Wheels’ programmes Number 0 1 980 Q3 2025 Number of second cycle schools where bicycles of different sizes have been delivered with a view to teaching cycling to students, as well as of public schools where adult bicycles have been delivered in the framework of the ‘School Sports Community’ programme. 1.39 RE-C01-i09 M Launch of the national campaign for the Universal Active Life Support System and the associated technological platform New communication channels and platform in operation for the national campaign for the Universal Active Life Support System Q3 2025 Launch of a national campaign for the Universal Active Life Support System and associated technological platform, in order to increase citizens’ knowledge about the benefits of regular physical activity, at all ages and according to their ability, aiming to encourage the adoption of healthier lifestyles. B. COMPONENT 2: Housing This component of the Portuguese recovery and resilience plan addresses the challenges related to the structural shortage of permanent and temporary housing solutions for the more vulnerable groups, both in mainland Portugal and in the Autonomous Regions of Azores and Madeira, whilst also contributing indirectly to reinforcing the social protection system. Public housing only accounts for 2% of the total stock in Portugal and is deemed to be insufficient in addressing the needs of the most deprived and at risk of social exclusion. The main objectives of the component are: i) to increase the social and affordable housing supply (including addressing other related needs, such as the lack of basic infrastructure and equipment, unhealthy and insecure places of residence, precariousness or lack of contractual ties, overcrowding or inadequacy of housing for the special needs of residents with disabilities or reduced mobility); (ii) to create a national public response to urgent and temporary accommodation needs arising from unexpected or unforeseeable events such as natural disasters, fires, pandemics, migration movements, asylum applications, or situations of imminent risk such as domestic violence, trafficking in human beings, risk of evictions and others; and iii) to increase the supply of student accommodation at affordable prices. The investments in the component entail construction of new dwellings and rehabilitation of existing ones. This component contributes to addressing Country Specific Recommendations issued to Portugal in the framework of the European Semester in 2019 and 2020, notably: Improve the effectiveness and adequacy of the social safety net (Country Specific Recommendation 2 2019); Guarantee sufficient and effective social protection