by Anna Lisa Mandorino
26 GEN – Dear manager,
on the heads of citizens. If we wanted to find a short expression to summarize the ascending phase of the PNRR, the one that led to today’s design of the entire Plan, we could use this. So much so that, as active citizenship organizations, we have created a PNRR civic observatory to ask for participation and transparency at least in the subsequent phases. And even with respect to Mission 6, net of the profusion with which the word “community” recurs, today there have been no structured opportunities for involving citizens and their communities: those opportunities that would allow their point of view and their expectations with respect to a design defined “from above”.
So it is not surprising that, not later than yesterday, the coup de theater with which the Regions rejected an agreement that, also, their Councilors for Health had defined with the Ministry, the one on the reform of medicine general, if it is true, as it is true that according to the latest Crea Report, 54.2% of the sample of citizens interviewed indicated that the possibility of having the assistance of a general practitioner was the element of greatest satisfaction with the health service national and, one can guess a little, it was especially indicated by the citizens of the lower-middle income and education classes.
So the question is: someone asked citizens – not institutions, not officials, not trade unions, not operators – what they expect from this health care reform, how much they would be willing to give up the choice of their doctor of reference, to the trust that is the premise of this choice, to the relationship established over time by many of them, especially the most fragile, especially the elderly? Someone asked the citizens, those who cannot afford to go for a private specialist visit, what does that means of immediate, direct, unfiltered access that the general practitioner represent for them? Mind you, reality is complex and there are many things that do not work: I will not list them, because the readers of these lines know them well.
But it would no longer be “cheap”, starting from facts that someone should take pains to reconstruct and interpret, investing to reinforce what is already there and that, when enhanced, would work rather than heading in the dark and groping towards something that is not there. ‘is?
Making issues such as the contractual form pass for major innovations, moreover presenting them as ambushes to the autonomy of institutions, is a pre-pandemic modality, I would say, that is, at the present stage, no longer acceptable: it escapes the consideration that the autonomy of the Regions it has no value in defining whether they matter more or less than central government, but how much better they both can do for citizens. So give yourselves – Government and Regions – common objectives, competing objectives, which means competing together towards a single goal, try to concentrate all on the same things: strengthening the training and tools available to operators, reopening the blocked healthcare system, overcoming the waiting lists, digitize access to services, focus on prevention, organize large information campaigns aimed at the population, increase the level of health literacy which is so useful in times of pandemics, raise the bar of respect the essential levels of benefits as well as that of rights.
And when you make a proposal, take it seriously. Those who do it explain, for example, what their idea of dependent work is for general practitioners, accounting for the fallout in terms of economic sustainability that the system would have to face – because, let’s face it clearly, the NRR will make the Service much more expensive national health care for our children – what will be the access hours, where we citizens will go to find our general practitioners. Perhaps in the Houses of the Community, one for every ten thousand inhabitants, in spite of territorial proximity? And while the houses are being built, what will happen? And are we sure that Campania, Tuscany, Veneto and Lazio would have the ability to interpret this new design in the same way? Because this must count, that the citizens of Campania have the same quality of services as those of the Veneto and that the demand for health – what citizens really need – is satisfied in the same way in every corner of the country. These are questions that, I fear, will remain unanswered if what matters is flexing your muscles.
And, if a muscular logic is not overcome, the further one goes forward in the implementation of this Plan, the more it could happen that this thing happens no longer only on the heads of citizens, but on the skin of citizens, and above all of those for whom the private healthcare is neither an opportunity nor a desire nor, unfortunately, a possible option.
Anna Lisa Mandorino
General Secretary of Cittadinanzattiva
January 26, 2022
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