“No voices have risen yet, from no side, to say what you want to do to intervene in a structural way to change this state of affairs”. This was stated, a few days before the elections of the new administration of the Lombardy Region, by Dr Stefano Ongaro medico di Medicina Generale than in an articulated letter analyzed the state of health of the health system. A precarious situation that had already emerged before the pandemic. A predictable crisis exacerbated by the health emergency. And after all these years, in which the health sector has always sounded alarm signals, now there is an attempt to “put a patch to close a leak which is, in reality, an abyss”. But no one has yet put on the table useful solutions to change course.
Dear Director,
we are approaching with rapid steps towards an electoral confrontation that sees opposing sides in the field but which have a single programmatic point between them main thing in common: Health.
In recent days I have had the opportunity to participate in the Legnano area in some meetings promoted by the three main political competitors. In all the events, the predominant theme was the management of Lombardy healthcare. There is no doubt that the Covid pandemic has caused upheaval with regard to the ability of our Health System to absorb the demand for health, putting territorial medicine as well as hospital medicine in crisis. At this point however, with a pandemic peak now at an all-time low for some time now, the difficulties in accessing treatment have not shown, except in a few cases and with an almost intangible decline, how the system crisis is not contingent on the Covid period but rather, unfortunately, structural.
In short, the pandemic has only blown the cork in an already critical situation of his own that today shows the crisis of the system in a clear way for everyone. In our regional context, in particular, we have witnessed in recent years a progressive dismantling of local medicine and the public hospital sector, often in favor of private healthcare.
Some examples? In our hospital in Legnano, in the past years there were active departments that represented the flagship of the Legnanese and Lombard health care, departments that everyone envied us. They were reference structures that attracted patients from all over Lombardy and sometimes even from outside the Region by virtue of their high quality standards in terms of care and assistance to the sick. When territorially neighboring private healthcare organizations were born, we have witnessed a progressive weakening due to constant underfunding in terms of material and human resources; this has produced a gradual reduction of treatments in quantitative and qualitative terms, a situation which has led to the fact that patients have progressively had to change their orientation of presumed, only presumed “free choice” towards the private sector, a sector which has benefited, moreover, the possibility of being able to choose the services that can be provided, moving towards those with less professional commitment, of lower quality but extremely more remunerative. Another theme is that of the shortage of medical personnel which everyone today regrets and throws lai to the sky; I remember how for more than five decades medical associations, primarily trade unions, have reported that the statistical projections based on the personal data of the doctors then active predicted with mathematical precision the fact that, up to our times, approximately half of the health workers active between the end of the 1990s and the beginning of the 2000s would have gone into professional retirement in recent years almost en bloc (the so-called Hump Pension), with the results that we can see today.
According to reliable estimates, in the period between 2020-2024, a pension exodus of about 35,000 doctors belonging to the NHS (Source FIASO) is expected. Translated into practice, it means a depopulation of hospital wards and an ever-increasing number of citizens who will be left without their family doctor.
Well, dear director, do you think that someone, among those responsible for planning and managing the health sector, in all these years, despite the constant requests and cries of alarm, have you thought of a solution to remedy this drift? To date, the solutions identified have been there for all to see: clinics managed by the continuity of care (former Guardia Medica) from 20.00 to 24.00 for patients left without a family doctor, patients forced to migrate tens of kilometers away to a doctor, extension of the choice ceiling from 1500 to 2000 patients for general practitioners still active, planes from Cuba loaded with doctors willing to work in Italy, probable extension from 70 to 72 years of age for retired doctors who want to continue working, and other amenities of this kind. In other words, an attempt is made to patch up a leak which is, in reality, a chasm. No voice has yet been raisedfrom no side, to say what you want to do to intervene in a structural way to change this state of affairs.
I point out that a doctor is trained with a course of study of at least 10 years; this means that a trend reversal could be seen in any case in the medium-long term and certainly not immediately, even with timely intervention which, as far as I know, is not in sight. Finally, in recent years we have, as category representatives, underlined these critical issues to our institutional interlocutors and put forward our proposals for a change of course in order to improve the ability to respond to the needs of our patients. We have been listened to in assemblies and technical tables, often even applauded, but not listened to in practice. Obviously, I could go on with the examples but for love of country and not to abuse the patience of your readers, I’ll stop here.
At this point, however, I would like to close with a question: are we really convinced that whoever steered the ship towards the rocks did so due to incapacity, carelessness, incompetence? There is nothing more? Can it not be that, I wonder, the ultimate goal is to achieve a gradual, progressive but at the same time inexorable dismantling of our NHS? After all, knocking down a wall with a pickaxe makes a lot of noise, taking it apart brick by brick, in silence and in general indifference, takes longer but certainly generates less sensation. After all, the important thing is to pursue the goal.
With this, dear Director, I thank you for the space granted and, with a pinch of bitterness, I offer you my most sincere greetings.
Stephen Ongaro
Doctor of general medicine