This could involve “a possible de facto emptying of the agreed territorial emergency”, in addition to the “possibility of accessing the roles of the medical management in derogation of the possession of the specialization qualification” and additional charges to be borne by the state budget. In any case, it should be remembered that at the moment there are three bills being examined by the Senate which provide for a reorganization of emergency medicine. Thus the undersecretary responding to an interpellation by Villani (M5S).
25 MAR – “A possible legislative initiative, aimed at placing the doctors under permanent contracts in the health role of the medical management, would also present some critical issues”. These include the possible “de facto emptying of the agreed territorial emergency”, in addition to the “possibility of accessing the roles of the medical management notwithstanding the possession of the specialization qualification” and additional charges to be borne by the state budget.
In any case, a general reorganization of emergency medicine is possible through legislation since the Senate is working on three bills concerning precisely this issue. The Undersecretary of Health recalled this, Andrea Costareplying this morning to the Chamber to the question presented by Virginia Villani (M5S).
Below is the full reply from Undersecretary Costa:
“Thank you, President. Thank you to the honorable respondents for having certainly drawn attention to an issue that presents some critical issues, to which we must certainly try to give answers.
In the current system, the territorial health emergency falls within the scope of agreed medicine and is governed by the national collective agreement for general medicine, referred to in article 8, paragraph 1, of legislative decree no. 502. Therefore, the legal and economic status of the aforementioned personnel is quite distinct from that of the medical management of the National Health Service. The relative agreement, for open-ended positions, is accessed with the certificate of specific training in general medicine, together with a specific certificate of suitability for the exercise of the territorial health emergency activity, issued by the companies of the National Health Service.
Furthermore, due to the provisions of article 1, paragraph 272, of law no. 234, in order to ensure continuity in the provision of essential levels of assistance, the medical staff in service at the structures of the territorial emergency-urgency system 118, who at the date of entry into force of this law have matured a seniority of at least 36 months, can access the procedures for the assignment of conventional open-ended positions, intended for the emergency-urgency service 118, even without the possession of a diploma certifying specific training in general medicine. The working length requirement, referred to in the previous period, is determined by periods of activity, even if not continuous, carried out in the last ten years in the emergency-urgency services 118 with a fixed-term contract. However, the emergency-urgency services are regulated by the regions in completely different ways. In many regions there is a mixed model of territorial emergency, for which both doctors in agreement and medical managers employed by the National Health Service contribute to the relative services.
A possible legislative initiative, aimed at placing the doctors under permanent contracts in the health role of the medical management, would also present some critical issues. In fact, the possibility for all contracted doctors to transition from the conventional relationship to the employment relationship could lead to a possible emptying, in fact, of the territorial emergency under agreement, with a consequent impact on the organization of services by the regions themselves. Furthermore, such a provision would entail the possibility of accessing the roles of the medical management in derogation of the possession of the specialization qualification, prescribed as a requirement for access to the management of the health role of the National Health Service and would entail additional charges to be borne by the State budget. .
I also remember that three bills are currently being examined by the Senate (S. 1715, S. 2153 and S. 2231), which provide for a general reorganization of emergency medicine and also address the issue of the transition to dependence on a voluntary basis. , by the 118 doctors in a conventional relationship and in possession of certain requisites.
I also point out that the Conference of Regions and Autonomous Provinces, as part of the “Programmatic document on the needs of health personnel”, approved in the session of 2 March 2022 – therefore it is recent – has expressly requested regulatory intervention, aimed at identifying the areas of activity of territorial emergency and service medicine, which require the establishment of an employment relationship.
In particular, the document hopes that in these areas of activity the doctors on duty – in charge of territorial emergency and service medicine activities and, as of 31 December 2021, resulting in permanent positions for at least five years or in any case upon completion of the fifth year of permanent assignment – are placed, on request, in the health role of the medical management, assigning the doctors of the territorial health emergency to the services of the emergency-urgency network, including first aid, and medical doctors of services to the respective sectors of dependence, for at least five years, in derogation of the spending limit provided for by article 2, paragraph 71, of law no. 191 of 2009, without prejudice to financial compatibility, on the basis of regional guidelines in line with the three-year plans for personnel needs, subject to an assessment of suitability according to the procedures in force.
In this regard, the regions and autonomous provinces ask that the classification in the health role entails the simultaneous acceptance of the stay in the services of the emergency-urgency network, including first aid, for at least five years, and to provide that, pending the transition to dependency, the regions and autonomous provinces can identify adequate forms of integration of the contracted doctors in charge of the territorial health emergency with the activity of the services of the emergency-urgency system, according to criteria of operational flexibility, including forms of inter-company mobility.
On the possibility of allowing doctors with agreements in the territorial emergency to be admitted in excess to the School of specialization in emergency-urgency medicine, I would like to point out that Article 35 of Legislative Decree 17 August 1999, n. 368, allows supernumerary access to specialization schools exclusively to permanent employees.
It should also be specified, however, that a provision aimed at allowing surplus access to the specialization school in emergency-urgency medicine for affiliated doctors would require a preliminary and careful evaluation, as participation in the school’s activities could actually determine also difficulties in the management of services.
I conclude by reassuring the Honorable Member of the utmost attention that the Ministry is placing on this issue and obviously I renew my complete and total availability, beyond the response to the interpellation, to continue a discussion and a dialogue, in the awareness that the questions posed from the interpellation are questions on which we must try to find points of sharing and try to give answers “.
During the reply Villani (M5S) said she was partially satisfied. “More needs to be done on the situation of 118 doctors with agreements. We must be grateful to them for their self-sacrificing and self-sacrificing work in the most difficult months of the pandemic. Now, after having called them ‘heroes’, the time has come to listen to them and to recognize that professional respect for too many years denied both in legal and economic terms “, he commented.
“We are talking about a sector, that of the Emergency Urgency, which is crucial and strategic for Italian healthcare – continues Villani -. Without rights and protections, doctors will continue to leave this service, further impoverishing the professional fabric of the emergency 118. The entire system is emptying of professionalism and competence and we cannot afford this ”.
“We of the 5 Star Movement – he adds – have tenaciously asked for a reorganization of the matter to recognize the seniority of service gained in the field by the territorial emergency doctor and the placement of the doctors with permanent contracts in the health role of the medical management, in in order to align the legal structure to the actual situation in which they operate “.
“These professionals have guaranteed the right to health of citizens with great difficulty and with an enormous spirit of self-denial. They have the right to stabilization and a professional legal framework. Our commitment to institutions will continue alongside these professionals ”she concludes.
25 March 2022
© All rights reserved
Other articles in Government and Parliament
