For the past two years, hospitals have been the center of attention – for better or for worse – but parties seem to have quickly forgotten what it was. The proof is that the word “hospital” is almost completely absent from the electoral programs of the main coalitions. Yet for health care and hospitals the worst is not behind us, on the contrary. There are about 130,000 hospital specialists, 60,000 fewer than Germany and 43,000 fewer than France. The bleeding of white coats also affects general practitioners: they are few, about 40,700, but every year 3,000 retire and it is expected that, in the short term, the exodus will be even greater. Not only. In Italy today there are about 13,000 pediatricians, but throughout the country there are shortages also due to the rigid distinction between territorial and hospital activities and the lack of adequate interaction and integration between them. The risk is that after two years of pandemic a storm could still be unleashed, as reported by the “Forum of the Scientific Societies of Italian Hospital and University Clinics” (FoSSC).
“The availability of beds by number of inhabitants places Italy in twenty-second place in Europe and the ability to use them is completely insufficient – reports Francesco Cognetti, Coordinator of the Forum -. Hospitals have been merged, wards and diagnostic services have been reduced and weakened. And the definition of health care, in ten years, has reached 37 billion euros. With the other European countries that present percentages with respect to the GDP of 3-4 points higher. Healthcare spending grew by 3% in 2022 compared to 2021. But these resources have all been used to tackle the pandemic which, among other things, has produced in our country some of the highest mortality levels in Europe. The DEF for the three-year period 2023-2025 scheduled for April again envisages a decrease of 0.6% per year, against an expected substantial increase in nominal GDP. In the electoral programs there are references to the reorganization of the territorial health care, to the strengthening of the staff of health workers and to the overcoming of waiting lists. However, there are no concrete proposals and, above all, structured reform projects that respond to a ‘system’ logic ”.
More beds
In recent months, the Forum has asked for a complete revision of the organizational parameters of hospitals sanctioned by Ministerial Decree 70 (Ministerial Decree 70 of 2 April 2015). “The number of ordinary hospital beds must grow well over 350 per 100,000 inhabitants today to reach at least the European average of 500 – explain the 30 Scientific Societies gathered in the Forum -. The number of intensive care beds must also exceed 14 beds, which remained on paper and never reached, to reach at least 20-25 per 100,000 inhabitants. In addition, resources are needed to increase the number of pediatric intensive care and pediatric semi-intensive care beds, which are currently below what is needed in all Regions, and to upgrade equipment in many pediatric and neonatal wards in various Regions “.
Invest in personnel
Investments must also concern personnel. “We need to hire a large number of doctors and nurses to strengthen the hospitals – says Diego Foschi, President of the Italian College of Surgeons, a scientific society that adheres to the Forum -. In addition, the exodus of new graduates, who go abroad to specialize, and the early retirement of many doctors, who must be guaranteed better salaries to avoid, for example, escaping from the emergency room must be curbed. We also asked that doctors be relieved of bureaucratic and administrative obligations, because support staff are easily found and cheaper, while doctors are not there. Every minute taken away from treatment is a lost minute. We also asked for the clinical results achieved by the various hospitals to be made public so that citizens can choose where to go for treatment, without taking risks and rewarding merit ”.
Not just walls
The PNRR provides for a health investment based on two major items: construction and technology. “However, the projects will concern the Community Hospitals and Community Homes, structures of territorial medicine, and large diagnostic and treatment equipment, mainly radiological. Building walls, however, does not mean having hospitals, which require personnel and skills that are not there – the scientific societies underline -. The historic duality between hospital and territory must be overcome, in favor of a single interconnected, continuous and complementary system of services. The real hospital must also functionally extend to the territorial health realities. What is territorial must be considered pre and post-hospital, in an integrated vision of the two realities “.
Attention to the little ones
“Even children – highlights Annamaria Staiano, President of the Italian Society of Pediatrics, a scientific society that adheres to the Forum – must have the treatments they need to manage and prevent acute and chronic diseases, in the territory and in the hospital in a system of continuity of care and online, which provides, where necessary, the possibility for pediatricians to work both in the territory and in the hospital with organizational flexibility. Furthermore, the number of children and adolescents with specific health needs is increasing, which are now over 15% of the total, at least one million in our country, and require health interventions often repeated over time, with approaches both at the local level and in hospital centers. and university of reference. Technological investments and the recruitment of personnel with a system perspective are necessary, which takes into account the needs of children and their families, also to reduce healthcare mobility towards more advanced regions in terms of healthcare ”.
There is no planning on tumors
“The Oncology Plan, recently produced by the Ministry of Health, appears absolutely unsatisfactory due to the lack of specific resources aimed at addressing the strategic objectives, therefore impracticable. Compared to the European Program (Europe Beating Cancer Plan), the Oncology Plan shows an absolute absence of planning and programming as well as the detection of the needs and resources to invest, in addition to the complete lack of identification of the timing, monitoring and governance indicators. . Moreover, due to these serious shortcomings, we will not be able to draw on the funds of the European Plan ”, affirms Cognetti. Not only. The Oncological Networks, which constitute a model of care and research in the cancer sector, remain inactive in most regions. The times for introducing reimbursement by our regulatory agency of important innovative drugs remain, indeed increasing, and the resources allocated to multigene tests to avoid chemotherapy for women operated on for breast cancer are running out given the failure to include these tests in LEA. “And the block, which still exists, due to the lack of regulatory compliance in our country with the new European regulation on clinical trials will prevent many researchers and patients from accessing the new molecules compared to other European countries” concludes Cognetti.