hospitals lack 30,000 doctors and 70,000 nurses. We need funds and system reforms

In recent weeks, WHO leaders have repeatedly reiterated that the pandemic will end soon and already in Italy the suspension of the obligation to wear a mask in various environments, including hospitals, has been announced.

It’s about a good news, because Covid-19 no longer represents that tragic emergency that has upset all our lives in recent years. All health systems on the planet have had to deal with an epic challenge. And in our country we recorded, in the most acute phases of the pandemic, the highest mortality in all of Europe, despite the fact that the level of contagion of the population was not among the highest. In countries like Germany and France, where Public Medicine was stronger, things went better. It went badly for us like the British and we still mourn ours 190,000 dead. In the spring of 2020 the virus highlighted the major weaknesses of a systemwhich we mistakenly believed to be efficient.

Now, however, the time has come to act. The first point on which we must intervene is the increase in financial resources dedicated to the health sector. The forecast of health expenditure in relation to GDP for the period 2023-2026 will already record a return to values ​​of 6.3% in 2024 compared to an average of 8.8% in 37 OECD countries and around 10% in France and Germany. We will then return to levels of health expenditure on GDP lower than in the pre-pandemic era. The restoration of the linear cuts to healthcare of the Monti and subsequent governments, the same ones who reduced Healthcare to the extreme, letting it crash against the catastrophe of the pandemic.

In a decade (between 2010 and 2019) there has been a progression weakening of hospital care of our country. Healthcare institutions decreased from 1,165 to 1,054, with a cut of about 25 thousand beds of ordinary hospitalization (from 215 thousand to 190 thousand). They are missing in our country 30.000 medici, especially hospitals, 70,000 nurses and about 100,000 beds. In these conditions it will be impossible to implement what is foreseen by the Pnrr on territorial medicine, as Minister Fitto has also recently pointed out.

In a situation where well 12 Regions out of 20, over the past decade, they have not recorded cumulative fulfillment of at least 80% of the Essential Levels of Assistance and 14 out of 20 register a negative balance in the health mobility of their citizens and for 9 of them it is also very heavy. Weak and deficient then there are the interventions of the public health institutions on primary prevention programs for the most important pathologies and, as regards secondary prevention and in particular cancer screeningsas many as 13 Regions out of 20 have membership levels below 50% of the target population, while Europe asks all Member States to reach the percentage of 90% by 2025.

Not to mention the programs of care for cancer patients with the presentation of a ministerial document which represents a valuable cultural exercise, but it certainly is without specific goals, a time schedule and sufficient resources. It is not an operational plan, as instead was produced by the European Commission in the «Europe’s Beating Cancer Plan».

This situation has been strongly represented by the Forum of Scientific Societies of Italian Hospital and University Clinicians (FoSSC) and by the 30 related Scientific Societies. We had repeated encounters with the Minister of Health Tell usin which we asked to abandon all dehospitalization policies. We have also outlined possible and practicable solutions, imagining one new, more modern and more advanced idea of ​​hospitaltherefore a path to be shared between representatives of science and institutions, a project also capable of offering and seeking a sustainability agreement also to eliminate diseconomies and reduce waste.

In addition to more funding, there is no doubt that our healthcare badly needs one system reform and not of buffer and parcel measures, undertaken on the basis of specific emergencies. There is an overall emergency of our Health System that needs to be addressed. The now antiquated duality between Hospital and Territory. A single system of interconnected, continuous and complementary services is needed, in which the idea of ​​a hospital extended to the territory and adapted to the needs of the population prevails. Only in this way will it really be possible to remedy two long-standing problems of our hospitals: the long waiting lists and the overcrowding of the emergency rooms.

The OECD, very concerned about possible new health crises in countries that invest fewer resources in health, for Italy it foresees an investment of at least 1.4% per year, which is equivalent to around 25 billion euros, taking the 2021 GDP as a reference.

Where there are no other sources of funding, the possibility of draw on the 36 billion of the Mes, matter dismissed too hastily on Health. More than 45 years have passed since the approval of Law 833/78, the one which established the National Health Service. Never before has it been necessary to adopt all the measures so that the principles which inspired that fundamental reform are applied.

But perhaps the most delicate issue is that we feel the duty to express our great concern on the serious degree of compromise of the system of constitutional guarantees to which citizens are entitled. The situation of the hospitals is really heavyno longer tolerable and requires adequate and timely interventions. The crisis of the hospital systemdue to the deliberately anti-hospital policies of the past even before the pandemic, e paradoxically ignored by the Pnrr is undeniable and has reached such critical levels as to create for the first time in all of us a enormous ethical and moral problem.

Us today we are no longer willing to indulgeto the detriment of our moral duties, the wrong political choices which for years, despite ourselves, we have been suffering as doctors, with extremely harmful consequences for our patients. We have always been on the side of the sick and on no account do we intend to fail in our duties to them.

*Oncologist and Coordinator of the Forum of Scientific Societies of Italian Hospital and University Clinics – (FoSSC)