With 43 votes in favour, 21 against and 6 abstentions, the Lombardy Regional Council approved the Regional Social and Health Plan (PSSR) 2024-2028. The green light was given after a long discussion and the voting of 115 amendments (20 approved, 80 rejected, 6 inadmissible, 7 withdrawn and 2 lapsed) and 100 agendas.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 provision Roberto Anelli (Lega) highlighted the innovative nature of the socio-health plan «which outlines the strategic vision of regional action with respect to health and socio-health interventions, management models, essential levels of assistance, to territorial medicine and integrated programming. A path in which long-term economic and social stability plays a fundamental role to guarantee a continuous improvement of the social and health organization for the benefit of the Lombards, in particular the most fragile, 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.”
“Prevention – continues Anelli – will be at the center of every intervention. By 2050, an increase of 662,696 citizens who will need care is expected, which will lead to an increase in health spending from 24.7 to 25.4 billion euros. The Plan, therefore, aims to address future challenges in the health sector, placing emphasis on prevention as a means of reducing costs and improving the quality of life of citizens. New strategies and policies will be implemented, with a focus on the sustainability of the health system. The approach is proactive: anticipating problems rather than treating them once they have arisen, for the creation of a more efficient health system focused on the well-being of citizens”.
The package of maxi amendments proposed by the Council and presented in the chamber by Roberto Anelli was approved. Inside are some proposals for the integration of the Pssr divided into four areas: pain therapy, rare diseases, primary care psychology service and enhancement of health professions.
For the “pain therapy” area, 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 screening for spinal muscular atrophy (SMA) and the extension to adrenoleukodystrophy linked to X.
The primary care psychology service, established by regional law no., is integrated into the PSSR. 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 involves a redefinition of the needs of healthcare and socio-health personnel of health protection agencies, territorial socio-health agencies and scientific hospitalization and treatment institutes, an increase in salaries and well-being standards organizational to make the profession more attractive, a better distribution of professionals in hospital networks and in the area, the activation of specific career paths and the strengthening of training.
Among the other most 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 healthcare and social-health personnel (Lisa Noja – Azione-Italia Viva); the promotion of actions and interventions to support family caregivers living with people with disabilities (Lisa Noja – Azione-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 structures in tourist and mountain areas during periods of greatest influx (Claudia Carzeri – Forza Italia).
The president of the Health Commission Patrizia Baffi (Fratelli d’Italia) 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, protection of the most vulnerable and the RSAs, but also a strengthening of counseling centers and the fight against drugs and addictions”.
The Health Commission involved 118 stakeholders in 11 sessions. To these sessions must be added two more dedicated to the in-depth analysis of the 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 experts in the sector.
«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 – underlined Patrizia Baffi -. The Plan 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 health and social system and continue to guarantee effective and efficient services to citizens in the coming years, especially to the most vulnerable.”
«For the first time – states Carmela Rozza (PD), councilor secretary of the Office of the President of the Health Commission – there has been dialogue and discussion between the parties, but the Plan does not address various critical issues of the health 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”.
Welfare councilor Guido Bertolaso indicated the priorities of the Lombardy social and healthcare system: «the cutting of waiting lists, the single CUP, the opening of hospitals on weekends, incentives for staff, pediatric palliative care and 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 2024-2028 Pssr moves in a scenario characterized by three trends: the progressive aging of the population (from 2020 to 2040, those aged over 85 will go from 3.6% to 8%); the sharp reduction in the birth rate (from 2015 to 2019 there was a contraction of 3.5%); the increase in the number of single-person families (from 2020 to 2040, single-person families increased by 332 thousand).
Fragility indicators are also increasing: 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 an increase of 662,696 citizens who will need treatment, from a mild clinical picture to the need for intensive care. This will lead to a forecast increase in health spending from 24.7 to 25.4 billion euros.
To respond to these numbers, the PSSR indicates primary prevention among the actions to be implemented to reduce the risk of disease onset; secondary prevention, i.e. early diagnosis to stop the progression of the disease; care, rehabilitation and assistance; the development of social and health services dedicated to the elderly, people with disabilities and those with mental disorders.
Another PSSR dossier concerns better accessibility to services, the 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 network of services for the elderly by extending daytime services and strengthening open nursing homes; greater flexibility through early and integrated management of palliative care; the strengthening and integration of the network of counseling centers 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 an evolution of the regional organizational system with the establishment of hospital companies 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 Hospitals Community and the full structuring of the Territorial Operations Centers (COT). A strategic role is attributed to digitalisation, new technologies applied to medicine, research and international partnerships.
