Public health has been underfunded for decades. This year is no better and the emergency rooms are already collapsing from North to South. Operators and trade unions in the streets. let’s get out of balance! proposes to bring spending to 7% of GDP.
There is a new topic, from Polesine to Abruzzo, and is “emergency aid for collapse”. The combination of the tail end of the Covid-19 pandemic and the new flu emergency has saturated the emergency and emergency departments in hospitals even before the peak of the Australian coronavirus infection expected in January after holiday contacts.
According to some trade union sources there are 300 deaths a day in the emergency rooms of Italian hospitals in these pre-Christmas weeks and that waiting in the corridors can even be as long as a week. But the previous situation could not have been much better if an increase from 15 to 50 percent compared to the average accesses in recent weeks was enough to cause these “war” situations in the bystanders, so much so that in some cases, such as in Turin, they intervened , the carabinieri and the prosecutor’s office.
The blame goes not only to a particularly virulent flu and this year’s poor flu vaccination coverage but above all to the decades of cuts, the still unmetabolized congestion of health facilities during Covid and the structural weakness of territorial medicine services. Sbi
Large hospitals with thousands of beds such as the Policlinico Umberto I and the San Camillo in Rome or the Cardarelli in Naples already in October-November the emergency rooms were in haywire with patients on stretchers in the corridor for days waiting for sorting in overcrowded wards and understaffed. One wonders what could happen if a new contagious and deadly pandemic like that of Covid occurred. It is true that there is a national prevention plan for 2020-2025 and a pandemic influenza plan for 2021-2023, but beyond the many pages, there are references to the essential levels of assistance (the LEAs, which despite being updated in 2017 are still on the paper), references to high-sounding English words, once again everything was entrusted only to vaccines, in this case anti-flu.
Healthcare in the budget maneuver continues to be de-financed: the 2 billion and 150 million euros more allocated to the National Health Fund, in fact, are a substantial cut if we consider that it is an increase of only 128 million , equal to 2% against an increasing demand and considering that almost the entire amount of difference – 1 billion and 400 million – will only serve to cover high bills.
And for the staff? The Minister of Health Orazio Schillaci has promised 200 million a year to remunerate emergency room operators with a specific indemnity but only starting from 2024. In the meantime, as the CGIL and UIL trade unions denounced with the December 15 demonstration in the square Santi Apostoli in Rome entitled “Let’s save public health“, the system risks complete collapse and operators do not see clear stabilization rules or effective contract renewals on the horizon.
According to the report of the Parliamentary Budget Office, in 2025 the expenditure to finance the National Health Fund will be lower than the pre-pandemic one and in any case 6.1 per cent of GDP, while according to WHO assessments below 6.5 per cent percent of GDP rushes into the collapse zone (and in fact Italy has been at 6.4 since 2019, and will be in 2023, and even worse, at 6.1 in 2025).
The campaign Let’s balance ourselves! he asks that spending on the NHS reach 7 percent of GDP already from this year’s maneuver, a measure that would cost at least 10 billion but would serve to restore oxygen to a vital system in comatose conditions.
Of the 17 amendments to the 2023 budget law of the Meloni government selected by the right-wing majority for the health chapter, some are on topics such as screening for celiac disease and zooprophylaxis institutes, all are aimed in any case at increasing spending limits for cover agreements with private and affiliated structures. A couple extend the deadline for accruing stabilization requirements for personnel who served during the two years of Covid. But both of these amendments, both that of the Brothers of Italy and that of the Forza Italia group, simultaneously admit a “flexible” stabilization, both for doctors and for nurses. It means that they will be able to go from “token holders” – called to commercials to cover the gaps in the workforce in the shifts – to collaborators, that is cococo, still precarious even if slightly more protected. To give an example, in Trento, in the emergency room of the main city hospital, out of 27 doctors, 10 are “token holders”, on call.
According to the accounts of the CGIL Public Function, there are 5,000 “token holders” doctors in general medicine wards and another 5,000 would be needed in the emergency rooms, plus at least 12,000 nurses, but this is a minimum quota for hospitals to function: recent data from the Agenas report say that Italy has the lowest ratio in advanced Europe between the number of nurses and the resident population.
Italy has 33 per thousand inhabitants, negatively exceeded only by Greece, Poland, Slovakia and Latvia but very far from the Scandinavian standards of 80-90 per thousand inhabitants and also by France, the United Kingdom, not to mention Germany. The average of the most advanced OECD countries is 49. The doctor-patient ratio is less dramatic, substantially in line with the European average, but the expectation that another 48,000 doctors – 46 per cent of the total – will retire by 2030.
And then one wonders again why scholarships for emergency medicine are refused by young undergraduates. And why from 2019 to 2021, i.e. in the pandemic period, according to the Anaao-Assomed hospital white coats union, there were over 8,000 voluntary resignations of doctors, fleeing the NHS due to harsh working conditions. Among other things, not even the contract that has already expired, for the years 2019-2021, has been fully honored due to a lack of boiling by the Ministry of Economy and Finance and this does not bode well for the next negotiation.
The Regions have not obtained from the government in office the authorization to splatter to cover the deficits of staff hired, on a temporary basis, during the Covid and so now the more virtuous ones that have strengthened public and territorial services the most risk a health default and a compulsory administration . The current discussion around the possible use and necessary reform of the Mes could allow the recovery of important European funds to avoid the risk of collapse of the national health system. And perhaps also allow the implementation of the reforms wanted by the former minister Roberto Speranza on community houses for territorial health (ministerial decree 77/22) which also concerns the new standards and the reorganization of the hospital system. For now, in the Meloni maneuver there are only 500 million for the reduction of waiting lists, which in cities like Rome or Milan have impossible booking times in public clinics.
It must be considered that in approximately twenty years 300 hospitals have been closed (111 since 2010) and thus over 80,000 beds have disappeared. And this means that from 1997 to 2020 the emergency rooms went from 61 to just 26 only in a region like Piedmont.
The professional union of nurses NursingUp, satisfied with having won 100 euros of shift allowance for those who work in the ward, an allowance which, however, is not known since when it will start if from 2023 or even from 2024, estimates a shortage of 80 thousand nurses in Italy. But we must also consider the wear and tear of a profession conducted in often emergency conditions for a staff who has the highest average age in Europe, 55 years.
In these conditions, the ancient “jewel” of the Italian public and universal health service seems a memory but it could go even worse if the projects of the right-wing majority to implement an already strong differentiated regional autonomy were implemented (here an in-depth analysis and a proposal). Against this sale to private individuals and the impoverishment of public good number 1, both the unions and the centre-left parties promise to do battle in recent months.