of Slow Medicine ETS Association
The serious structural critical issues that have emerged for some time in our healthcare are progressively compromising the main strategic support of every public and solidarity-based NHS: citizens’ trust in its concrete and homogeneous reliability. For this we need a truly new founding Social Pact, similar to the one which in the 70s of the last century led the country to adopt the Law of 23 December 1978, n. 833, which established the SSn
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In the three years of the pandemic, the responsible behavior of most Italians, the commitment of scientists and the dedication of most professionals of the National Health Service (SSN) have contained the spread of the virus and limited the number of possible victims. Despite some vocal dissonant minorities, most of the national community has adopted appropriate behavior and has accepted to receive the new antiviral vaccines. In other words, Italians have largely benefited from the public health measures suggested or ordered by the health authorities and, in the most serious situations, have asked for and obtained the diagnostic and therapeutic support of their NHS.
In a country characterized by persistent – and not recent – economic, social and cultural inhomogeneities, the preventive, diagnostic and therapeutic response activities to the pandemic have understandably recorded different levels of quality, effectiveness and timeliness, with a single common characteristic all territories and all regions: the serious slowdown in healthcare activities dedicated to the management of acute and chronic pathologies unrelated to viral infection, and the consequent lengthening of citizens’ waiting times to obtain answers to their needs for health.
The chronicles of the last months of 2022 and the increasingly pressing appeals of citizens’ associations, professional orders, medical-scientific societies and the health institutions themselves testify to a growing concern about the real possibilities of a return to normality within a reasonable time framealso due to the coexistence of a large number of other negative phenomena:
- the chronic lack of public economic resources earmarked for financing the NHS, insufficient to support the growing costs of drugs and innovative technologies, which forces an increasing number of patients every year to use their own economic resources or to give up treatment,
- the inadequate planning of the turnover of professionals, particularly serious in the emergency-urgency sector,
- wage levels – for professionals and all other operators – lower than in all other European countries,
- the serious organizational, managerial and leadership shortcomings, which affect the correct performance of healthcare activities, almost always tending to subordinate the quality and appropriateness of the care relationship to performance efficiency and unjustified delegation to the private agreement,
- the serious deficiencies in the planning and programming of primary and specialist training and continuous updating of professionals and all other operators,
- the waste of resources and care practices that are often ineffective, inappropriate or harmful,
- the significant environmental impact of health care activities and institutions,
- documented conflicts of interest,
- the non-homogeneities and inequalities in the provision of assistance, with conspicuous qualitative differences between the various Italian regions.
Slow Medicine ETSan association of health professionals and citizens, which has always been a promoter of sober, respectful and fair professional and welfare practices, on the tenth anniversary of its convinced adhesion to the international campaign Choosing Wiselybelieves that these serious structural problems are progressively compromising the main strategic support of each public and solidarity-based NHS: the trust of citizens in its concrete and homogeneous reliability.
Without documentable reliability, and without the trust and active participation of citizens, a universal system of prevention, treatment and rehabilitation loses its raison d’être, and leaves room for less effective, more expensive and more unfair alternatives, such as US private insurance.
To prevent further aggravations of the dangerous trust crisis and to effectively counter the objective criticalities of the system, Slow Medicine ETS believes that it is essential to propose – to political representatives and healthcare administrators, NHS professionals and their organized representatives, citizens and their institutional representatives – an authentic large strategic investment, a collective assumption of social responsibility aimed at the systemic and systematic valorisation of a significant part of the national heritage.
In fact, we need a real new founding social pact, similar to what in the 70s of the last century led the country to adopt the Law of 23 December 1978, n. 833, which established the National Health Service, still in force today. An in-depth reflection on all the critical issues listed above must be rapidly initiated, in all the appropriate forums, which obviously takes into account the opportunities present, such as the funds of the PNRR and those of the ESM, and the risks and threats that loom over the near future of the our national community as an integral part of the wider community of European citizens and of the even wider community of citizens of countries of the world with systems of government based on freedom and democracy.
In the definition of a new National Health Pact in fact, we cannot fail to take into account the global geopolitical context in which we live, with its problems and threats, of which we are increasingly aware in recent decades. The damage to the ecosystem and the consequent climate changes, the economic and social inequalities, the global food crisis, the wars for the grabbing of strategic territories and resources, the fragility of the supranational institutions born after the Second World War, are so many epochal challenges, which make the new Pact even more necessary and urgent.
They are needed urgent concrete actions to rebuild and consolidate confidence of professionals and citizens in the NHS, tackling the root causes of the critical issues listed above with determination and courage:
- allocate a greater share of national economic resources to the protection of salute also, if necessary, reducing the resources hitherto allocated to other expenditure items (Italy’s per capita health expenditure continues to be lower than the average of European countries both in absolute terms and in relation to GDP);
- valorise the people involved in the various organizational articulations of public health institutions through a substantial increase in current salariesto counter the flight into private healthcare and that of other countries;
- improve working conditions for professionalsparticularly in the urgent and emergency sectors, and relieve them of improper bureaucratic burdens;
- revisit and modernize i training courses of health professionals, who will have to take into account the foreseen personnel needs, be adapted to European models and also provide for the systematic acquisition of relational, IT and bioethical skills.
It is then necessary to start from the knowledge of the health needs of the population and no longer only from the often inflated demand for services: at least 30% of the tests, drugs and other treatments carried out are not necessary and can even cause direct damage to patients and indirect. The application of Choosing Wisely Italy recommendations through the assumption of responsibility by professionals, their dialogue with patients and the commitment of company management, it will be able to reduce waste of money and time, the risks for patients and help address the serious issue of long waiting lists.
In this regard, where the long institutional waiting lists coexist with freelance activities within or outside the walls in which the wait is short or none, it is necessary to always and scrupulously comply with the authorization prerequisite that has never been repealed and too often disregarded: that of guaranteeing that the choice of citizens to resort to freelance services at their own expense is authentic free rather than conditioned by unacceptably long institutional times and using, if necessary, specific funds to reduce waiting times for institutional services.
It is necessary at all organizational levels involve local communities in the promotion of healthy lifestyles and in activities aimed at protecting health, especially in the workplace and in the most disadvantaged family communities, and concretely promoting social and health integration, proximity care and the reform of primary care. It is necessary to introduce regulatory and financial instruments aimed at overcoming the current qualitative differences between different territories and regions.
According to Slow Medicine ETS, it is necessary that all the parties involved are aware that a sober, respectful and fair NHS is the only way to keep the NHS, e it is not the dream of a few visionaries but a concretely achievable goal. You just really want it.
Among those who want it, we think we can also include the Minister of Health Horace Schillaciwhich in the interviews and parliamentary hearings of the last few days has declared its intention to address and resolve some of the critical issues examined in this document.
Slow Medicine Association ETS
December 13, 2022
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