Nadef and health care: for Minister Schillaci the challenge is increasingly difficult

by Luciano Fassari

Once the spotlight on the pandemic has gone out (even if in the last week there have been over 160,000 cases and almost 500 deaths and the arrival of winter is as unknown as the new variants), healthcare seems destined inevitably to return to the bottom of the Government political agenda

07 NOV –

Nadef, as also recalled by the Prime Minister, Giorgia Meloni it is preparatory to the Budget Law and as regards health it is not legitimate to expect any new increase in addition to the 2 billion more already foreseen. The spotlight on the pandemic has gone out (even if in the last week there have been over 160,000 cases and almost 500 deaths and the arrival of the climatic winter represents an unknown factor like the new variants), health care seems destined to inevitably return to the bottom. to the Government’s political agenda.

I will be curious to see now what the Regions will say, which are largely governed by the center-right and which, however, in their first list of priorities sent to the Government had as their first point the veiled request for new funds (they were already frightened by Draghi’s Nadef, let alone that Melons).

More resources than the presidents are needed to cope with the shortage of professionals (hospitals are in trouble and the area risks being deserted in spite of the NRR’s money) and also because the expensive energy and the consequent increase in inflation (never so high in this millennium) combined with the failure to make up for the expenses incurred during the hard years of the pandemic is putting a strain on the stability of the budgets of even those Regions that have always been virtuous. It will be possible to find new tricks (not least the payback on medical devices) and some resources for expensive energy but it is clear that Nadef is designing a three-year economic stasis for the health sector.

The Minister of Health, Orazio Schillaci, in his first outings he placed among his priorities the increase of salaries for health personnel and initiatives to curb the shortage, the enhancement of family doctors and pharmacies, the recovery of outstanding services during the pandemic and the resumption of the theme of prevention starting from the screening.

Here, starting from the staff, as regards contracts, resources are needed (in this sense we must see the choices also at the level of all public bargaining). To curb the shortage of personnel, money is needed even just to file (for the territory there has been a 1 billion filing) or even (it seems impossible) to eliminate the spending ceiling on personnel. As regards the idea of ​​an indemnity for those working in an emergency, the last Government already allocated 90 million (from the Health Fund and therefore not additional) for the emergency room staff, but it is clear that it is not that money that is entice you to go to work.

The game on family doctors is wide also because it will be necessary to understand what will happen to the Community Houses (foreseen by Pnrr and Dm 77) on which the Minister has announced a reflection even if a resounding rejection from Undersecretary Gemmato. And then there’s the whole new convention to play. As for the recovery of waiting lists, Speranza put a billion on the plate but also given the latest Agenas data practically all Regions struggle to return to the levels of the number of pre-Covid services and inevitably the waiting times continue to be affected.

Of course, to obtain new resources, one could also opt for a new season of spending review (in the meantime it will have to do it to the Ministry given the new Dpcm just launched which cuts about 30 million over the next 3 years) but in addition to having seen the cleaver for over a decade health is one of the most controlled public sectors and has practically reached the bottom of the barrel in recent years even if there is always waste.

A truly arduous challenge for the Minister who, if he wants to get something concrete (given that he cannot use the weapon of political blackmail without having a party behind him), will have to build alliances first of all with the Regions and with the sector’s stakeholders. Schillaci, as he has already stated, cannot wait to look beyond the pandemic but given the Nadef it will take much more than a light than a torch to get out of this new tunnel into which public health is preparing to enter and whose exit is likely to have only one goal: the erosion of the NHS.

Luciano Fassari

07 November 2022
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