With 43 votes in favour, 21 against and 6 abstentions Regional Social and Health Plan 2024-2028 (PSSR) was approved by the Lombard Regional Council, after a long discussion and the vote of 115 amendments (20 approved, 80 rejected, 6 inadmissible, 7 withdrawn and 2 lapsed) and 100 agendas.
The vice president of the Health Commission and rapporteur of the measure Roberto Anelli (League) highlighted the innovative character of the socio-health plan “That outlines the strategic vision of regional action with respect to health and social health interventions, management models, essential levels of assistance, territorial medicine and integrated planning. A path in which long-term economic and social stability plays a fundamental role in ensuring continuous improvement of the social health organization for the benefit of Lombardy, especially the most vulnerable, with a paradigm shift: prevention as the main asset of Lombard welfare, capable of combining the health and well-being of citizens with the sustainability of the system”.
Package approved big amendments proposed by the Council and presented in the Chamber by the vice president of the Health Commission Roberto Anelli which contain some proposals for integration of the Regional Social and Health Plan 2024-2028 divided into four areas: pain therapy, rare diseases, primary care psychology service And valorisation of healthcare professions.
For the area “pain therapy” the maxi amendment provides for the development of the Pain Therapy Network by identifying four second level specialist centers (hub centres) and twenty-five first level centers (spoke centres). Furthermore, the development of the Palliative Care Network is envisaged through early and integrated management of non-self-sufficient patients suffering from chronic pathologies at home, in hospital facilities, outpatient clinics or residential services.
The maxi amendment on rare diseases provides for the development of neonatal screening to identify severe congenital immunodeficiencies, lysosomal storage diseases and leukodystrophies, support for Spinal Muscular Atrophy (SMA) screening and the extension to X-linked adrenoleukodystrophy.
The PSSR integrates the primary care psychology service, established by regional law n. 1/2024. The “primary care psychologist” is therefore a figure who will operate within the Community Houses in close coordination with the specialist services. He will provide his service both at the request of the general practitioner and at the spontaneous request of the patients, and his task will be to activate timely management through first level psychological assistance. When necessary, it will be your task to proceed with a referral for further consultation, of a psychological or psychiatric nature (referral to secondary and tertiary care).
The scope of valorisation of healthcare professions provides for a redefinition of the needs of the health and socio-health personnel of the ATS, ASST and IRCCS, an increase in salaries and standards of organizational well-being to make the profession more attractive, a better distribution of professionals in hospital networks and in the territory, the activation of specific career paths and enhanced training.
Among others more significant amendments approved: the extension to the entire regional territory of the DAMA (Disabled Advanced Medical Assistance) project for people with severe disabilities and specific training courses for health and social care personnel (Lisa Noja – Action-Italia Viva); the promotion of actions and interventions to support family caregivers living with people with disabilities (Lisa Noja – Action-Italia Viva); support for mountain healthcare through greater investments in healthcare facilities and the provision of adequate economic incentives for healthcare workers in mountain areas (Carlo Borghetti – PD); the inclusion of consent to organ donation in patients’ medical records (Claudia Carzeri – Forza Italia); the provision of social housing policies for healthcare personnel in tourist and mountain area facilities during periods of greatest influx (Claudia Carzeri – Forza Italia).
The president of the Health Commission Patrizia Baffi (Brothers of Italy) underlined that “the approval of the PSSR comes after a long and in-depth process of hearings in the Health Commission with numerous public and third sector entities on key issues such as disability, the protection of the most vulnerable and the RSA, but also a strengthening of the clinics and the fight to drugs and addictions”.
The Health Commission involved 118 stakeholders in 11 sessions. More must be added to these sessions 2 others dedicated to the in-depth study of Annual Epidemiological Report of Lombardy (REAL) and the role of prevention for the sustainability of the regional health service, which saw the presence and intervention of sector experts.
“In a scenario characterized by the aging of the population, early diagnoses, chronicity, increased costs, with the PSSR we reorganize and innovate the system to continue to guarantee a free public health service to future generations – he underlined Patrizia Baffi -. Plan It is based on the concept of prevention on which the economic sustainability of the system also depends and on the courage to make choices that serve to ‘secure’ the Lombardy social and health system and continue to guarantee effective and efficient services to citizens in the coming years, especially the most fragile.”.
“For the first time – he claims Carmela Rozza (PD), secretary councilor of the President’s Office of the Health Commission – there has been dialogue and discussion between the parties, but the Plan does not address various critical issues of the healthcare system and does not respond to the real care needs of Lombardy. For decades in Lombardy the shortage of nurses has been very serious and is now becoming an emergency. We need to enhance the profession through economic and career incentives: the recognition of professional autonomy without adequate compensation and the possibility of a career path is not enough. Furthermore, the Plan does not present a defined model of local medicine and does not enhance the figure of the basic psychologist”.
The Welfare Councilor Guido Bertolaso indicated the priorities of the Lombardy healthcare system: “the cutting of waiting lists, the single CUP, the opening of hospitals on weekends, incentives for staff, pediatric palliative care and the prevention of youth distress. We must also complete the network of community homes and hospitals and implement tools to support the quality of life of elderly people, especially those who are not self-sufficient.”.
The PSSR 2024-2028 moves in a scenario characterized by three trends: progressive aging of the population (from 2020 to 2040, those aged over 85 will go from 3.6% to 8%); the strong one reduction in birth rate (from 2015 to 2019 there was a contraction of 3.5%);increase in the number of single-person families (from 2020 to 2040, the number of single-person households increased by 332 thousand).
The indicators are also increasing fragility: 3,127,000 citizens have at least one chronic condition, 672,000 Lombards have limited self-sufficiency and from 4% to 38% of citizens live in a disadvantaged social environment.
The evolution of the clinical complexity of the Lombardy population predicts that by 2050 there will be a increase of 662,696 citizens who will need treatment, from a clinical picture of mild intensity to the need for intensive care. This will result in a prediction of increase in health spending from 24.7 to 25.4 billion euros.
To respond to these numbers, the PSSR indicates among the actions to be implemented: primary prevention to reduce the risk of disease onset; there secondary prevention, i.e. early diagnosis to stop the progression of the disease; there treatment, rehabilitation And assistance; the development of social and health services dedicated to the elderly, to people with disabilities it’s at those with mental disorders.
Another dossier of the PSSR concerns better accessibility to services, there reduction of waiting lists and the improvement of the intake process.
The objective is to combine the maintenance of high performance quality standards with the sustainability of the system. This means remodulating the supply network for customers elderly people extending daytime services and strengthening open RSA; greater flexibility through early and integrated management regarding palliative care; the strengthening and integration of the network of consultants to address the birth crisis and support the family; an increasingly strong integration between hospital and territory to respond to the emergency of mental distress.
The tool to achieve these objectives is one evolution of the regional organizational system with the establishment of hospitals equipped with all highly specialized disciplines, the strengthening of the role of the ATS, the consolidation of the health districts, the completion of the offer of the community homes and the full structuring of the Territorial Operations Centers (COT). A strategic role is attributed to digitalisationat new technologies applied to medicine, research and international partnerships.
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