Human capital for territorial assistance

at Mauro Marine

15 NOV – Dear Director,

PNRR investments for Mission 6 Health absorb 51.4% of additional resources in information systems and digital technologies (ICT) and 30.4% in local health facilities in order to guarantee the necessary sharing of data and places for the integration of multidisciplinary assistance. But the quality of territorial assistance depends above all on human capital and on art. 88 and following of the budget law 2022, an increase in the health fund for personnel is envisaged.

The standards of local health personnel are awaiting a homogeneous definition at national level in accordance with the provisions of article 92, paragraph 2 of the 2022 budget law. Up to now they have been defined variously by the Regions. The DGR n.1704 / 2017 of the FVG Region has provided for a ratio of nurses for home care / residents equal to 1 / 2500-3000 residents in the urban and lowland area and 1 / 2000-2500 in the piedmont area with sparse population.

In addition to this standard, law n.77 / 2020 converting Legislative Decree 34/2020 established the community nurses and provided that healthcare companies can recruit no more than 1 every 50,000 residents, as per the guidelines of the Conference of the Regions of 10 September 2020 which include in the tasks assistance in protected residences and intermediate structures that by name have their own staff, the promotion of socio-health integration, health education and rehabilitation in the local territorial network of professionals with specific qualifications such as social workers, health educators, health assistants, physiotherapists, general practitioners (1/1500 residents), continuity care doctors (1/5000 residents), specialists and district medical managers for which the DGR 1704/2017 provides a standard of 2 / 100,000 residents in addition to the district director.

The Agenas draft document on Territorial Care takes up the standard of 1 community nurse for every 2000-2500 residents without yet stratifying the population by need and considering the coexistence of the standard of integrated home care (ADI) nurses, both also operating at home .

But according to the FNOPI model, ADI nurses perform prevalent performance functions different from those of the community nurse distinguished by epidemiological skills, knowledge for the activation of the local network of services and relational skills acquired with training that will be defined later. Law 219/2017 has established for all healthcare professionals that the time for communication is the time for treatment. The acquisition of relational skills, in addition to the technical ones, is therefore already a duty of all operators, regardless of their roles, towards the assisted and other operators involved in the ADI.

The DGR of the FVG n.1704 / 2017 “standard of personnel for the health area” has fixed at the territorial level a ratio of 4-6 physiotherapists for every 10,000 residents over 65 years, stratifying the population by age of greatest need and a ratio of 1 psychologist for every 20,000-30,000 residents, all-inclusive for family counseling, child and adolescent neuropsychiatrist services and disabilities. Article 100 of the 2022 budget law extends the funding for additional additional psychological assistance assignments until 31 December 2022

In order to reduce the long waiting lists for access to specialist medical examinations, Article 94 of the Financial Law opens to the purchase of services from accredited private structures, but the constraint imposed by Article 1, paragraph 177, of the law remains. 311/2004, which froze the number of company hours of specialists agreed in 2004, different for each company, creating an inequality of access to territorial specialized care between provinces of the same Region.

There is still a lack of a standard of social workers in health care companies, although the request for services by the Courts to family consultants and neuropsychiatrists requires it. Article 43 of the 2022 budget establishes the essential levels of social benefits for non self-sufficient people called LEPS which complement the LEAs provided for by the Prime Minister’s Decree of 12 January 2017 in order to define all the rights payable for taking charge of fragile people through the Single Access Points present in the health districts.

In initiative medicine, the anticipated trust, consent and adherence to the proactive engagement of the client is not taken for granted if he is not involved and motivated with his family in health choices by operators capable of working together and coordinated as a team in the health district with knowledge and mutual respect for roles.

Mauro Marin
ASFO Pordenone Health District Director

November 15, 2021
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