The crisis of the NHS, before being economic, is cultural

by Luigi Macchitella

13 APR –

Dear Director,
I have read with interest the interventions in your health forum and I would like to add these brief observations of mine. Reflecting on the NHS, on the risk that it implodes on itself due to inertia or political calculation is a difficult task because the topic is complex and the analysis of the disaster we are witnessing cannot be reduced with simplifications. The 833 was the daughter of a reforming season based on the idea that the direct participation of citizens was the salt of democracy.

But the translation of this ideal and certainly not ideological assumption was the partisan division of health care management. When the reform of the 833 came in 1994, the situation was truly unbearable and unsustainable. The problem was that while a real problem was being addressed, the issue of citizen participation was neglected and the tools for control were not identified, on the contrary these were completely excluded from the strategic choices that politics made.

I must say that if the national health service is still standing, despite struggling in such great difficulties, it is also due to the sacrifice of many general managers who have committed themselves to ensuring services to the community while budgets were constantly being cut and the staff eroded by lack of turnover and lack of contractual renewals.

But if the issue of service management was rightly and in my opinion correctly addressed, what remained outside the reform and which emptied the inspiration of the 833 was the abandonment of the culture of prevention which should have been the fulcrum of the activities of the local health authorities while the The axis shifted towards care and in particular towards hospitals with the abandonment of local services and the impoverishment of all those professional figures who would have enriched the ability to intervene in the area such as social workers, psychologists, sociologists, ecological operators, etc. with a progressive medicalization of interventions.

The culture of care and of the hospital as the main place of health protection have had a negative influence on the NHS. The epidemiological evaluation of the territory, the evaluation of the real health needs of citizens and the definition of the resources to be used to satisfy those needs have been forgotten and underestimated.

Over the years of working in the health sector, I have never seen a mayor at the head of a citizens’ demonstration demanding more prevention, while in many demonstrations citizens asked not to close dilapidated hospitals unaware that the presence of that structure could represent more of a risk which is not a guarantee of protection.

But certainly it is not those citizens who can be blamed, the responsibility is political for not having strengthened a presence in the territory of professionals capable of guaranteeing the taking charge of needs that were often social or socio-medical and not only and solely medical. The 833 did not intend to carry out the medicalization of the service, it intended to start a person’s health management process not based on waiting, but on taking charge of each person’s social and health problems.

I think that the crisis of the NHS is cultural before being economic and, either we deal with this aspect or, there will be no future for a service incapable of renewing itself in its motivations and objectives

Louis Macchitella

Health director UPMC Salvator Mundi International Hospital

April 13, 2023
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