The Draghi government wanted to reorganize local medicine – increasingly in crisis – with a solution already seen at work in Chavez’s Venezuela: the Community Houses. But the project has already failed and despite the money from the PNRR it is destined to rise in costs.
One of the most difficult problems of Public Health is the Medicine of the territory. During the two-year pandemic, among the various mistakes with which the governments of Conte and Draghi managed the emergency state, it emerged with dramatic clarity that the situation relating to basic health care in Italy is at a critical level. In a nutshell: there are fewer and fewer general practitioners. The shortage of family doctors has various reasons: lack of planning, doctors with exorbitant numbers of patients and “desertification” in disadvantaged areas which end up making it impossible to find a general practitioner in the vicinity of the home, with consequent inconvenience and risks for health“. The most critical situations due to the shortage of these professionals are found in the large northern regions: Lombardy, Veneto, Emilia Romagna, Piedmont, and as far as the south is concerned, Campania.
The Draghi government wanted to start a reorganization of Territorial Medicine, thinking of radical changes in a strategic sector for the treatments and for the professionals involved, leading to a review of the role of the general practitioner. The hypothesis of a transition to a dependency relationship made its way. Basically, general practitioners and paediatricians would no longer be – as they are now – freelance professionals affiliated with the National and Regional Health System, but civil servants, just like hospital doctors are. The CGIL welcomed this project with enthusiasm, which envisaged a reorganization of the territorial network based on the so-called “Complex primary care units” (Uccp): structures that would house more general practitioners, nurses and secretarial staff capable of keeping clinics and diagnostic services open basis with greater continuity. However, this would sacrifice the professional autonomy of the doctor, or what is left of it, because between protocols and guidelines and other compulsory bureaucratic tracks, this autonomy has long been eroded, and the pandemic has revealed it in a sensational way.
These organizational units would have taken the somewhat vintage name of “Community Houses”, with the transformation of what was once called a “family doctor” from a freelancer to an employee of a state organization. The model of inspiration for these new basic healthcare facilities was none other than Chavez’s Venezuela, where they were introduced some time ago and where they have already failed spectacularly, leading to an increasingly poor supply of personal services.
And the situation that the current Minister of Health Schillaci found to have inherited reveals to us a clamorous flop of this project, which was also embraced with great enthusiasm by Letizia Moratti when she found herself to be Councilor for Welfare of Lombardy. To date, in fact, less than 10% of the community houses announced with great pomp in the previous legislature have been built, and they are present in only five regions. Given the huge delay in the project, perhaps it would be worth asking whether it is worth pursuing. The Minister of Health himself said he was perplexed: “I am confident that all the Community Houses envisaged by the Pnrr can be built but we could have problems with funds given that compared to when they were disbursed – explains the minister – the costs have risen significantly . Furthermore, no availability for personnel and equipment was foreseen in the allocation”.
And not only. If the CGIL had embraced the draghian-chavista project, other unions are now showing all their skepticism, such as the Italian Doctors Union (Smi), with the general secretary Pina Onotri, who is convinced that the Community Houses are not the solution to the crisis of family doctors. «You are very concerned about the reform that provides for the establishment of Community Houses. We are afraid that we want to address the shortage of family doctors by moving them from one part of the territory to another: we ask for a complete rethinking of Ministerial Decree 77 which reorganizes territorial medicine”.
Other doubts come from the Undersecretary of Health Marcello Gemmato who declared: «Who do we put in the 1,350 community houses envisaged by the Pnnr, which personnel do we use to make them actually work? The health facilities envisaged by the National Recovery and Resilience Plan are currently without professional resources to guarantee their activity”. Once there was talk of “cathedrals in the desert”, and this definition fits perfectly with the case of community houses. The bitterness of seeing how for years the organization of public health has really navigated on sight remains, until it ends up on the rocks. And meanwhile, year after year, the number of doctors is decreasing, all to the detriment of the need for care of an increasingly elderly, frail population in need of assistance. Getting the ship out of the shallows and back on the water won’t be easy, but it’s absolutely essential.
