An important provision in the health sector has entered into force, which obliges all Italian Regions to have an adequate and appropriate “territorial” health organization by January 2023. Those who do not respect this legislation will lose 2-3% of the supplementary funding of the National health fund. Specifically, the provision provides Community Houses (Cdc) open 7 days a week for 24 hours with 30-35 general practitioners and pediatricians on duty (on a rotating basis) and between 7 and 11 nurses. In addition to these professional figures, there is also the availability of psychologists, obstetricians, social workers, rehabilitation technicians and any specialists who may be useful to a citizen who is ill, without the need to go to large hospitals.
The intent is to strengthen “community” medicine, and for this he turns to community houses and community hospitals. The former are multipurpose structures, distributed in a rather widespread manner throughout the territory, which guarantee primary health care functions (and prevention activities) with the aim of ease the burden of emergency rooms and provide faster diagnoses. The latter, on the other hand, are real health facilities for short-term hospitalization, “for patients who need health interventions with low clinical intensity”. In practice, places where it is possible (theoretically) to have any type of health care (for small pathologies) without having to hinder emergency aid.
But do these structures already exist? The plan provides that our territory it hosts about 1300 – that is, one every 50,000 inhabitants more or less – by 2026, making use of the funds provided for by the National Shooting and Resilience Plan. In order to truly reach an efficiency such that the citizen receives 24/7 health care of all kinds, one thing is necessary: that the staff is there. The structures must necessarily have a larger staff, to prevent an overlap of shifts and schedules from generating yet another situation that is humanly and laboriously unsustainable.
As we told you in our recent study, Italian healthcare is on the verge of collapse. The Simeu (Italian Society of Emergency Medicine Urgency) stated that only in the emergency room about 4,200 white coats are missing (the data dates back to last November). Figures that could rise further (in 2022, 600 have already resigned). More and more exhausting shifts weigh on the situation, more and more patients to manage for each individual doctor and increasingly intense work, in exchange for inadequate remuneration.
And if the health institutions that continue to ask to be able to hire new staff (as in fact must be done following the provision), will continue to be “cannot be done”, the measure on doctors always available is destined to quickly become a dead letter . In fact, there is an “expenditure ceiling” for the staff of the health service, introduced for the first time by the Finance Law of 2010 (191/2009). Until action is taken on this mechanism, nothing can be done to increase the staff.
In any case, regardless of the money (which is not there) the time available is very little: even if 2023 seems so far away, in reality the six months that remain of 2022 are very few to revolutionize a system, the health one, that has been imploding for several years now.[di Gloria Ferrari]