The National Health Service was born in 1978 with Law 833, the first signatory the Minister of Health Hon. Tina Anselmi. A law that aims to implement art. 32 of the Constitution: regionalize the management of health, establish the USL and universalize medical care, overcoming the previous health care system.
Doctors and nurses who were once protagonists
The cornerstone of the NHS from 1978 to today has obviously been the human resource that worked within it and in particular the Doctor and the Nurse. As regards the second professional figure, although there is a constant lack and incompleteness of roles, the professional path was implemented above all by the overcoming the old system of “job descriptions” and from the realization of the higher education path with a Master’s Degree and relative establishment of the Professional Order.
Instead, healthcare professionals graduated from Medicine and Surgery, in the last 30 years it has gone through a profound identity crisis, an obsolescence of university training courses, practically parallel to the establishment of the limited number and the abandonment of mass enrollment by students of the 60s and 70s of the last century “so-called medical plethora “).
Few medical specialists and low public pay
In the last decades in Italy, therefore, we have witnessed a slow and progressive impoverishment of the stocks of medical professionals (especially specialists), which in some cases have led to the uncovering of assistance in entire Italian geographical areas. Especially on the islands and in the north. This is also due to the phenomenon of the doctor’s low public remuneration and of the contemporary growth of medico-legal disputes, some branches and specialties of medicine have dried up and even some places in the Specialty Schools are left deserted by the lack of young people who want to do these more strenuous and riskier jobs (various surgeries, anesthesia, etc).
Recently, from 2018 – 2019 to date, we are also witnessing another worrying phenomenon that risks further desertifying the already scarce healthcare offer of the NHS. I’m talking about increasing abandonment of the NHS (resignations and early retirement of various kinds) of experienced and middle-aged doctors who have been employed for decades and who emigrate either to abroad or to more welcoming and better paid private clinics (pure or accredited with SSN), or towards retirement.
Hospital doctors who resign
According to a study by the ANAAO Medical Union in 2019, from the data of the Annual Account of the Ministry of Economy and Finance, 2.9% of hospital doctors decided to resign: leaving and / or retiring prematurely. According to this study over 3000 doctors they have seen a better alternative in private or in the work on the territory. Better alternative from an economic point of view, perhaps, but certainly also of quality of life with less work and psychological pressure, fewer personal attacks, less risk of aggression to one’s physical safety.
This phenomenon is completely new in Italy and if we associate it with the constant bleeding of young and very young graduates who do not even try to enter the NHS labor market deciding instead to emigrate to EU and non-EU countries (about 1000 per year), the overall result is that the NHS between 4-5 years will be desertified. Without the minimum experience and human and professional resources that are absolutely necessary to keep it alive as such throughout the vast national territory.
Without adequate human resources, will the NHS be able to survive and with it the universality of treatments we Italians are used to?
Successive governments have tried to stem the danger, intervening on the legal status of nurses, gradually giving them new competences, evidently replacing doctors. However, is this what ordinary people expect as a response from the NHS and politics?
We know that on average the NHS costs the community about 7% of GDP for a total figure of approximately 116 billion euros per year. To these must be added about another 30 billion euros per year of the so-called private health expenditure divided into various items. This private expense is the total responsibility of the families, does not provide for a tax exemption by the state except in rare cases. It does not solve the root problem. On the contrary, it steals private resources from business and investments.
The university training system, stuck in a limited number of little productive and often subtly discriminatory, has become obsolete. It is also not very capable of responding to the changed and aggressive health needs of Italian society: a society that we all remember is among the oldest in the world and therefore needs more medical care than others.
First heroes now infectors
The recent lesson of Covid with its high baggage of deaths in Italy mainly due to desertification of territorial health, further demonstrated how we got to scrape the bottom of the sanitary barrel. In addition, the Government has demonstrated little attention and sensitivity to doctors and nurses (which until a few months ago were considered heroes by the cd “mainstream mediatico” and today downgraded in a few months to infectors) by imposing on them an anachronistic, discriminatory and sanitary unjustifiable obligation to vaccinate.
On penalty of suspension and dismissal of the objectors, which further weakened their compactness and spirit of service to the country. And this with the short-sighted help of the main trade unions. of doctors and unfortunately also of the Federation of the Orders of Physicians and Surgeons.
Time, as always happens, will tell where the Via Maestra was and will give its implacable judgment.
Towards a private or mixed public-private health system
But in the writer, the suspicion remains strong that the transition to a private or mixed public-private health system is actually an objective desired, sought and strongly desired by the current Italian and European political and entrepreneurial ruling classes.
The Italians will agree with these choices and above all are informed that short with the pension hump medical care of 2024-2025 and the massive out-of-role exodus of Italian doctors from the NHS, will they remain uncovered by many assistance services, especially in certain areas of the country? And above all will they be happy with it?