«We also had a confrontation with the EU 2 days ago. The framework we are building is clear: by the end of December we will present the new decree Ministerial Decree 71 to the State-Regions Conference which will indicate how the community houses, the IT platforms managed by the operational centers, home assistance will work ». There is still a lot of uncertainty in the regions about the plan that the Draghi government is implementing for the various sectors with funds from the NRP, the restart plan financed with billions of Europe. But at least on the health front this is not the case: the revolution that we will experience in the coming years for care in the area is increasingly taking shape. The Government entrusted it to the Agenas agency, directed by the Vicenza manager Domenico Mantoan, assigning it to the interventions for the homes of the community and the taking charge of the person: home as the first place of care (Adi); implementation of the Cot Territorial Operations Centers; telemedicine for better support for chronic patients; intermediate health care with community hospitals. And with the decree passed at the end of September, it put about 11 billion on the table for the structures to be built.
The money for the staff «I can only speak for health, but I assure you that for the application of the PNRR the work progresses like a big puzzle that gradually puts every single piece in place. All the central apparatus is working to make the PNRR operational. And the Regions, including the Veneto, are identifying the 1,350 homes of the “hub” community, as well as the Cot Centers and community hospitals. But perhaps the most important aspect is that, from what has been known, the Budget proposed by the Government puts in place another fundamental piece: the NRP gives us the resources for “the walls”, but now it is indicated that the State will put in place three years in the National Health Fund +2 billion, then +4 and +6. Within those 12 billion – observes Mantoan – there is an increase in current spending to meet the cost of new staff, including hiring and stabilization, to really start the houses. The goal is for them to be operational by June 2026, but there are Regions like Lombardy that have already written in their rules that the first houses of the community will be activated as early as 2023, and I believe that Veneto can also be on the same line “. Meanwhile, as mentioned, “the Regions must identify where to build the houses of the community, especially by recovering publicly owned buildings from the real estate assets of Ulss, municipalities and bodies that make them available for free, with maintenance to be paid by the Ulss. The IT platform for telemedicine and home care is also starting up: it has its own guidelines and we will define who will call the tenders, probably Consip ».
Change everything It is strange, of course, to think of a revolution at a time when there are some thousands of Venetians who have lost even their family doctor – retired and not replaced – and they only have the nearest emergency room as a reference. But the change will be epochal: “The” Community House “will be open 24 hours a day, seven days a week – assures Mantoan – and citizens will find three key figures there: a general practitioner, a pediatrician of free choice, a nurse family who will also provide home care for people ». But the priority now is to the so-called “hub” community houses (as for hospitals): they are those structures in which in addition to these three figures there will also be outpatient specialists able to make specific visits even with instrumentation (ultrasound, spirometry, various). There will be 1350 “hub” houses, one for every 40 thousand inhabitants – for the Vicenza area, as is known, there will be 18 – and they must all be active with European funds by June 2026. Instead, the “spoke” community houses, with the three doctors – pediatrician-nurses, will be programmed by the individual Regions. And how do general practitioners reorganize themselves? «It is still a question – replies the dg Mantoan – on which we are discussing: one of the crucial points to be resolved is that the National Collective Acn Agreement must be modified. There are three hypotheses: that doctors become employees of the Ulss (there are Regions that ask for it), or that they are accredited, or that they remain in agreement as now. But even in the latter case it will be envisaged that the general practitioner, in addition to providing his / her activity in his clinic, will have to accept the organizational model of the Community House and therefore make working hours available in that structure “(in addition, obviously, to the colleagues of the “Continuity of care”, former medical guards). “It is one of the aspects to be regulated: the House must always be open”.
Cot And then there is telemedicine: «We will activate a national IT platform (or maybe 2 or 3, but this does not change for the citizen). It will allow the patient in Adi home care to measure blood pressure, or blood sugar or other values: the platform will ensure that the data is transmitted to the Cot operations center, and from there, based on the evaluation of the possible seriousness of the data, it will be transmitted to the doctor general practitioner or hospital. It will be an information highway that runs data and directs it to the competent care center. The node is the Cot. We have foreseen 600, one for every 100 thousand inhabitants, and given that it means having to assist about 25 thousand people over 65 who in 10% of cases are chronically ill, it means that each Cot will have to evaluate about 2500 cases continuously ». By the end of December – assures Mantoan – the rules will all be defined. And the money is there: the construction site of the new health care starts.