In a future Italy of autonomy differentiated, will the State really be able to verify that citizens are guaranteed essential rights, without differences between the various territories? It is an absolutely central question, which is being asked forcefully as the government moves forward with its contested reform project. Just ai Lep (essential levels of services) and their financing, which however is not currently defined, is referred to by the executive when trying to give guarantees on the balance of the whole process. However, the premises are far from encouraging.
Autonomy, key roles for Zaia’s loyalists to distribute the funds: the commission for the Lep has been appointed
AND BALANCE SHEETS
The point is that in health care, which is currently the main competence of the Regions and the largest item in their budgets, the Lep already exist and are called Lea (essential levels of assistance). And the Ministry of Health is already called upon to verify compliance with users’ rights through a mechanism called “New guarantee system”. However, as highlighted in an article on lavoce.info (authored by economists Massimo Bordignon and Gilberto Turati), the results of the monitoring for 2020 – disclosed in recent days – are quite surprising. This is essentially a block promotion for most of the Regions, in a year characterized by very evident critical issues: both those linked directly to the pandemic and those which derive more indirectly from Covid, i.e. the delay of a series of services with consequent lengthening of waiting times.
It is true that the Ministry of Health takes this specific situation into account by providing that for the year in question the evaluation exercise has only an informative value, and therefore is not used for the distribution of bonus funds. The fact remains that Piedmont, Lombardy, the autonomous province of Trento, Veneto, Friuli Venezia Giulia, Emilia Romagna, Tuscany, Umbria, Marche, Lazio and Puglia have passed the test in all three macro-areas considered, which concern, in summary, prevention, basic and specialist medicine and the hospital system. As regards district assistance in particular, or rather the second of the macro-areas, almost all Regions improve their performance compared to the previous year. And even this judgment alone seems to clash with the reality with which the Italians have had to deal. Previously only Calabria and Molise had failed to comply.
To understand how the issue of verification is decisive, it suffices to recall what article 117 of the Constitution provides, which among other things assigns the State exclusive legislation on the subject of “determination of the essential levels of services concerning civil and social rights which must be guaranteed throughout the national territory. Therefore the criteria for the respect of rights and equality among citizens are set at a central level, but the Regions then have ample organizational autonomy when it comes to concretely recognizing the services: hence the centrality of state evaluation. If a wider range of skills were to be handed over to the Regions, the checks would have to concern many more services, such as school services.
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Meanwhile, a new important step is expected shortly in the process of the bill on differentiated autonomy, which on 2 February was approved by the Council of Ministers only on a preliminary basis. The text will in fact be brought to the attention of the Unified Conference (in which the State and local authorities participate) tomorrow afternoon, and in the morning of the same day there will be discussions within the Regions on the point. Any perplexities and requests for changes from the governors could emerge here: in particular from those of the southern regions, not excluding those who were elected with the centre-right. The government should take these findings into account in the second passage of the measures in the Council of Ministers: this will be an important test bench. The parliamentary process will then begin.
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