Home Health From family doctors to nurses, here are all the personnel shortages that risk holding back the Pnrr and causing the NHS to collapse. OECD numbers

From family doctors to nurses, here are all the personnel shortages that risk holding back the Pnrr and causing the NHS to collapse. OECD numbers

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From family doctors to nurses, here are all the personnel shortages that risk holding back the Pnrr and causing the NHS to collapse.  OECD numbers

The personnel problem is the first piece of the puzzle to be put together to see the PNRR implemented and it is the alarm raised by the Regions: in addition to the economic resources to guarantee services, there is a lack of doctors, nurses and, in general, there is a shortage of everything the social and health personnel who should deal with the revitalization of the territory, but also with the rebalancing of hospital services, starting from the emergency rooms.

The analysis of the Italian situation with respect to the European panorama (not only in the EU countries and in any case also in comparison – for the professions of doctor and nurse for which data is available in the OECD’s Health at a Glance 2022 report – with the partners of the G7 as more industrialized countries and, therefore, with greater possibilities for development, also from a technological point of view, as the PNRR itself indicates in many of its “missions”) emerges from the focus that Eurostat, the statistical office of the European Union, has recently conducted, also in light of the latest data provided by the 2022 edition of the OECD’s Health at a Glance.

Beyond the general data and those referring to the economic differences regarding doctors and nurses, already illustrated at the time, Eurostat compares the situation of the workforce of the various European systems for professions and assistance activities and allows have a general framework for what it considers the main professions to keep “under observation”, both from the point of view of distribution with respect to the population and on the basis of the functions performed: doctors, nurses, but also midwives and, for the first time, the assistance support personnel (considering in this chapter both operators similar to Italian social and health workers, and home caregivers, even those not adequately trained in healthcare, but who in any case support the most fragile categories in carrying out daily activities) .

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Eurostat’s focus is not limited to the workforce situation, but also analyzes possible future developments based on the training of the professional figures considered, believing that training is one of the keystones to gradually fill the gaps and, in any case, to rebalance the care functions based on the development of skills and specializations.

As far as Italy is concerned, the overall picture that emerges is the one repeatedly underlined, of a country where there is no shortage of doctors, but some figures and specializations are lacking. But if today they seem not to be lacking on paper, we know well that public health is instead suffering from a strong shortage. And another alarming figure, Italian doctors are the oldest in Europe. On the other hand, very critical numbers as regards the number of nursing staff whose numbers are “in reserve” both in terms of consistency and, more seriously for future prospects, for training and possible adaptation to the rest of Europe (but also of many OECD countries) of responsibilities and competences.

Obviously, the numbers of shortages cannot be deduced from comparisons between countries, because the structure of the various health systems is different and therefore the needs are different, as Eurostat also points out. No one can say that, for example, there are “too many” doctors in Italy because their ratio per thousand inhabitants is higher than the international averages, also because, as Eurostat points out, there are sectors in which this type of comparison highlights major weaknesses compared to other countries.

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For example, that of general medicine, where Italy is not entirely lacking, but has lost about 5,000 doctors in ten years, those who theoretically should be recovered to bring the number of Italian GPs per 100,000 inhabitants to the European average. And the current ones often fail to manage their role as a filter on the territory due to a lack of multi-professional organization of assistance.

Or even, as Eurostat points out, the balance of some specializations (the Eurostat analysis takes into consideration those present on average in the largest number of countries in a similar way) with respect to emerging pathologies or treatment needs.

Just as it cannot be declared that there is a shortage similar to that which would arise, for example, for nurses, if their ratio per 100,000 inhabitants were to be raised to the values ​​of the OECD averages: around 150,000 more than at present would be needed and not the 65 thousand also indicated by the Court of Auditors in its recent brief on the NADEF (October 2022) and by the Italian National Federation of Nurses which in this sense, aware of the impossibility of finding such a workforce in any case in a short time, has proposed a different organization of assistance, focusing on greater responsibility of its professionals towards the social and health care chain (with respect to the training and management of support operators in the structures and also to the training of home caregivers, analyzed by Eurostat in the chapter on “support staff ”), with a development of roles and responsibilities that Eurostat also indicates in the description of the prof nursing mission in the countries analysed.

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And for midwives, a further example: Eurostat data show a shortage in Italy of about 8,300 units, but also in this case the structure of the services, the demographic trend (with sharply declining births), the epidemiological trend (with some perinatal pathologies on the increase which may need support and continuous monitoring) and the multi-professional organization of care.

But the consistency on the basis of the relationship with the population is in any case an indication of the response capacity of the services and of the possibility that these can develop, as the PNRR indicates, above all towards assistance to the person at home.

Julius Nisi

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