The appeal of the Forum of the 75 Scientific Societies of Italian Hospital and University Clinicians. Between 2019 and 2022, 11,000 clinicians chose to leave public facilities and the exodus continues inexorably. Hospitals are also decreasing: in a decade, 95 have been closed, 9%. And the resources are fewer and fewer. Francesco Cognetti, FoSSC Coordinator: “The essential levels of assistance are not respected in 12 out of 21 Regions. The strengthening of hospitals is essential”.
18 APR –
Our health service must continue to be defined as universalistic. Waiting lists, lack of doctors, hospitals and beds, deserted competitions, specializations without members, progressive defunding put at risk compliance with article 32 of the Constitution and the founding principles of our care model. In just two years, during the Covid emergency, the number of beds actually decreased, and 32,508 were cut: in 2020 there were 257,977, reduced to 225,469 in 2022.
It is estimated that, in Italian hospitals, there is a lack of at least 100 thousand ordinary inpatient beds and 12 thousand intensive care beds. The average age of doctors is increasingly higher, with as many as 56% being over 55 compared to 14% in Great Britain and even lower percentages in other countries. By 2025, 29,000 white coats and 21 thousand nurses will retire, without sufficient inclusion of new professionals. Around 11,000 hospital clinicians (not of retirement age) have already chosen to leave public facilities between 2019 and 2022. And more and more young people, trained at state expense (around 150 thousand euros each) go abroad, where they receive salaries even three times higher than in Italy and with significantly better working conditions.
The number of hospitals is also decreasing: in 10 years 95 have been closed, 9%. In 2012 they were 1,091, in 2022 they dropped to 996, with a more significant reduction for public ones (67 less, from 578 to 511). Not only. In 2024, National Health Fund funding increased in absolute terms compared to 2021, but decreased relative to GDP and eroded very substantially by higher inflation. Furthermore, these resources have largely been used for negligible contractual increases in staff, which are unable to contain the exodus of doctors.
Today at a press conference in Rome, in the headquarters of the representation in Italy of the Parliament and the European Commission (Esperienza Europa – David Sassoli), 75 Scientific Societies gathered in FoSSC (Forum of the Scientific Societies of Italian Hospital and University Clinicians) ask the Government for a structural reform, with urgent measures to save the health service and maintain its universalistic character.
“Twelve out of 21 Regions do not guarantee not the totality, but not even the minimum sufficiency of the Essential Levels of Assistance (Lea), i.e. the treatments considered fundamental. In fact, the majority has values below the threshold in at least one of the three macro areas examined: prevention, local assistance and hospital – he explains Francesco Cognetti, Coordinator of the Forum -. And these are the LEAs currently in force which date back to the Prime Ministerial Decree of 29 November 2001, or rather to the Ministerial Decrees of 1996 and 1999, updated with the Prime Ministerial Decree of 12 January 2017, but never implemented”.
“Furthermore – say the 75 Scientific Societies united in FoSSC -, the introduction of the new parameters, although published in August 2023, has been postponed to 2025 due to lack of resources. And the Regions should also shoulder the considerable burden of new services, most of which have now become an integral part of correct clinical practice. The weakest and poorest, in particular those subject to a recovery plan, certainly cannot do so. The Scientific Societies ask how it is possible to even think about passing the law on Differentiated Autonomy in these conditions. Dramatic phenomena, such as the waiting lists for necessary diagnostic services and the heterogeneity for therapies that would have a positive effect on the course of serious illnesses, as well as the interminable waits, even for days, in the emergency room before admission to the inpatient departments, are due to very serious structural and organic deficiencies.
It is urgent to resolve these problems with a structural and system reform of hospitals, with the allocation of truly adequate resources to respond to the main parameters in force in other European countries and with the true creation of territorial networks for pathologies”. “It should also be noted that all European countries, during the pandemic, produced increases in public healthcare funding that were significantly higher than ours – continues Cognetti -. From 2012 to 2021 the increase for Italy was only 6.4%, compared to 33% in Germany, 24.7% in France and 21.2% in Spain”.
Over the last 10-12 years, the governments that preceded the current one have made irresponsible cuts. But now, even in 2024, the financing of the National Health Fund stands at only 6.4% of GDP, as indicated in the Economy and Finance Document of the Ministry of Economy itself, with the forecast of a further decrease to 6 .3% in 2025 and 2026, up to 6.2% in 2027. Net of inflation, this year there is even a decrease in public resources allocated to healthcare by 6.2% compared to 2021. A worrying trend, given that the OECD foresees a desirable investment of at least 1.4% more than the 2021 GDP for countries that invest few resources in healthcare, such as Italy, which is equivalent to an annual increase of 25 billion EUR.
Consequently, the contribution to healthcare spending by private citizens is continuously and exponentially growing and, in 2022, reached the figure of 41 billion and 500 million euros, a significant increase compared to the 8-12 billion of previous years , with a value double that of France and Germany, which is equivalent to 24% of the total expenditure (171 billion and 867 million).
“As highlighted by the Court of Auditors – say the Scientific Societies – the serious crisis of sustainability of the national health service no longer guarantees the population effective equality of access to healthcare services, with intuitable consequences on people’s health and a heavy increase in private spending . The health service, after having sustained the impact of the pandemic, is suffering from a systemic crisis, accentuated by the flight of staff, who are not adequately remunerated, which should be responded to, at national and regional level, with decisions and investments that can no longer be postponed, in the fields of organisation, structures, training and salaries”.
To stop the bleeding of doctors it is necessary to intervene with immediate measures. Over the next 7 years, based on the forecast of the Commission established by the Minister of University and Research, Anna Maria Bernini, there will be 30 thousand more doctors, but the times are too long, given the significant current shortage and other initiatives are needed. “The objective must be the transition from a limited number to a limited number – underline the Scientific Societies -. Substantial salary increases are also necessary, especially for ‘neglected’ medical specialties (for example Emergency-Urgency, Anesthesiology and Resuscitation, Radiotherapy and some surgeries), whose calls for specialization courses have remained largely deserted in recent years. The minimal salary increases in the latest contract are of no use compared to the much higher salaries that our young doctors find in other European countries, even bordering ours. And the introduction into roles of professional figures such as research nurses, data managers and biostatisticians must be considered, especially in Irccs and University Hospitals, as well as expert figures in topics such as Artificial Intelligence and Data Mining, to be trained through courses innovative”.
The inclusion of new professionals has been prevented for many years by spending caps on personnel and hiring freezes, in a bleak picture of total lack of planning on the part of all the governments that have followed one another in the last 10-12 years . And today we are forced to include specialists in the services, even from the very first years of the course, without this measure having been the subject of the necessary discussion and planning.
“Today the press conference takes place in an institutional venue, such as the Italian Parliament and the European Commission, signifying the absolute necessity that the health service of Italy, the founding country of the European Union, is brought back and adapted to current standards in the other States that are part of the Union – continue the Scientific Societies -. We need a major system reform, which takes into account the diversity of health needs, the progress of technologies and the organization of hospitals. Italy occupies 22nd place in the European ranking of the number of beds. The Italian average is 314 ordinary hospital beds per 100 thousand inhabitants compared to the European average of 550 and 8-10 intensive care beds per 100 thousand inhabitants compared to 30 in Germany and more than 20 in France. But the Pnrr plans to reserve only 8.3% of the funds provided for healthcare, the majority of which for the strengthening of local assistance and for the launch of structures such as community homes and hospitals, which will be very difficult to achieve due to the shortage of medical personnel and nurses.
Resources are allocated to hospitals, but only for technological updating and scientific research, but nothing for structural and organic strengthening or for the acquisition of new personnel. The consequences are insufficient hospital-territory interaction and an irrational compartmentalization of the system. In order to address and begin to resolve all these problems, in June 2023 a Technical Roundtable on the reform of Ministerial Decrees 70 and 77 was launched at the Ministry of Health, to which our Forum offered an immediate and active contribution with the presentation of documents, analyzes and proposals which, unfortunately, have not yet received acceptance. In any case, we maintain our total availability to collaborate with the Government and political forces.”
More investments are also needed in prevention. “It is scientifically proven that 40% of high-incidence pathologies, such as tumors and cardiovascular and cerebrovascular diseases, can be avoided thanks to healthy lifestyles – conclude the Scientific Societies -. Secondary prevention is also key. But the percentages of citizens who take part in oncological screening are around 40% for mammography and Pap tests or HPV tests and less than 30% for colorectal screening. The European Union calls on all member countries to reach the 90% level of membership for all three programs by 2025.
This is a very ambitious objective, but it is important to solicit action from the Regions in this sector, possibly providing rewarding or penalizing systems in terms of economic resources to be allocated at local level. Furthermore, the National Oncology Plan 2023-2027, which at present is only a valuable treatise on oncology, must be transformed into a real operational plan and adapted to the European Commission’s ‘Europe’s Beating Cancer Plan’, a streamlined, incisive and concise document , with the provision of precise initiatives and objectives and a timetable as well as the possibility of accessing financing for its implementation. Similarly, the National Strategy for Brain Health 2024-2031, which establishes the Italian Government’s ratification of the World Health Organization’s Global Plan on Brain Health, must be implemented in all Regions, to reduce the impact of diseases neurological and mental disorders in all age groups”.
April 18, 2024
© All rights reserved
Other articles in Work and Professions
Tags: appeal scientific societies beds cut doctors run Treatments risk major structural reform save NHS
