No serious reform of the NHS will ever be possible, bringing it back to what was the original spirit of the 1978 reform, if the current form of government is not revolutionized, removing the management of health and hospital companies from local politics. The intervention of Cesare Greco, former associate professor of Cardiology at “La Sapienza” University, Rome
A new Covid alarm arrives from China, with the forecast of 65 million infections per week. A nightmare that returns. WHO calls on governments to be ready. Difficult for our country, which has not yet begun to reorganize a health system that from 2019 to 2022 showed all its limits.
Everyone is saying that the Italian health system works badly and does not ensure what was hoped for with the establishment of the national health system (NHS) exactly forty-five years ago. Those who have continued to describe it as the best health system in the world also say so, obstinately not seeing, or perhaps pretending not to see, the many signs that unequivocally showed its progressive decline. The reason for pessimism, albeit of a few, derived from the fact that an all-Italian variant of the English system was introduced from the very beginning, which inspired law 833 of 1978. In fact, healthcare management became political and inevitably began, immediately and with increasing frequency, the complaints of waste of money that should have been used exclusively for welfare purposes. The pervasiveness of politics in decisions concerning the governance of the healthcare system was supported and defended by the political representatives themselves, with the need to ensure “democratic control” by the citizens through their representatives, without ever being able to understand what meant this expression.
Between the end of the last century and the beginning of this one, in the two-year period 1999 – 2001, the “military” occupation of the NHS by the political class was completed and it was fragmented into 21 different systems, entrusting the responsibilities to regions. What began as a universal system that was the same for everyone has turned into a sum of different systems, which has made the use of health care different according to the place of residence and the adequacy of the representatives of the various regional governments.
What is really serious is the fact that the different possibility of accessing effective treatments has ended up affecting the very survival of patients, as in the case of oncological pathologies, depending on the region of residence.
The inadequacy of the health system, which each region has organized in its own way, has sensationally come to light with the Covid pandemic. The absence of a primary care network in the area, the lack of structures ready to intervene avoiding the mixing between the infected and other patients, especially frail and elderly patients, the lack of equipment suitable for the necessary intensive care, the lack of health personnel , whose number has gradually dwindled due to the various turn over blocks, and last but equally important, the unleashing of the jackals of suffering who immediately took advantage of the emergency, have silenced forever the supporters of the best healthcare system in the world . The upheaval caused by Covid ended up causing thousands of victims, not only among patients affected by the virus, but also among those suffering from serious oncological, heart and other pathologies who were denied treatment or gave up going to the hospitals. hospitals, often transformed into centers for the amplification and acceleration of the infection.
Now everyone, from the majority to the opposition, claims daily that they want to place the health problem at the forefront of things to be reformed to improve the country’s fortunes, especially now that a robust injection of resources is looming with the PNRR.
The solutions proposed by the majority, and more strongly requested by the opposition, concern the strengthening of territorial medicine (but it would be more correct to speak of creation from scratch) and, also in order to stop the diaspora of healthcare personnel towards other European and non-European countries , new hires and higher salaries, above all in the emergency-urgency departments, emptied by the inevitable and foreseeable aging of the staff resulting from the block on turnover implemented by many regions to meet the recovery plans.
But this is not the solution, or at least not only this.
If the possibility of wasting public money is not blocked, which not even the tragedy of Covid has managed to do, if a clear separation is not established between those who buy health services, those who deliver them and those who check their adequacy, roles today performed by the same subject, if the medical role and its dignity within the system are not reconsidered, we will only waste mountains of money to finance an intrinsically inadequate system.
After the implementation of the Bindi law, which made the General Managers of political appointment absolute and unpunished lords of the health structures, after the reform of Title V, which handed over the power of government to the individual regions, the bureaucratization of the system, already underway , has undergone a very strong acceleration, which has marginalized more and more doctors and other figures in charge of assistance from strategic decisions on the organization of assistance, transforming them into mere officials, executors of the will of a bureaucracy often incapable and incompetent of the matter they demanded to govern with the arrogance of the worst political underground.
The solutions proposed, therefore, precisely because they also avoid mentioning a change in the government system and a recovery of the dignity of the medical role, lead to the suspicion that in the end no one, of any alignment, wants to give up the conspicuous political, economic and above all clientelists of the current structure of the system.
We need to fundamentally reform the NHS if we don’t want everything to be progressively absorbed by a private individual, on the contrary, increasingly efficient and aggressive in subtracting benefits from a weak public system interested only in defending the privileges of a few. It is necessary to restore dignity to the medical role, freeing operators from the snares and snares that have progressively and increasingly entangled them and enslaved them to the power of bureaucrats, if we want the public to return to attracting good young doctors, increasingly penalized even by a of hiring and careers strictly controlled by bureaucrats and their politicians of reference. Therefore, one should not be surprised by the fact that operators are increasingly attracted by the better organization of foreign structures or, in Italy, by private healthcare, not only by the much more substantial earnings. Outside of the public service, what they find above all is recognition of their professionalism and social status, the possibility of carrying out their work unburdened by a useless and vexatious bureaucratic load.
It is necessary to reconstitute the alliance between doctors and citizens, an alliance that for a short time the Covid drama had brought about, putting an end to the discharge of responsibility on the shoulders of operators by those who have not taken steps to create better working conditions, better for the sanitary and safer for patients. Very often, among other things, this little game practiced by politicians and bureaucrats has found an ally in a press eager to sensationalize and arouse emotions, amplifying alleged medical errors in the vast majority of cases not confirmed by the scrutiny of the magistrates. The logical result is the emergence of defensive medicine, with a monstrous increase in costs, and the abandonment of the specialties most at risk. Those who work in surgical departments and emergency rooms, often with exhausting shifts and exposed to disputes and even physical aggressions, even from an economic point of view, must be recognized as having the peculiarity of their work.
No serious reform of the NHS will ever be possible, bringing it back to what was the original spirit of the 1978 reform, if the current form of government is not revolutionized, removing the management of health and hospital companies from local politics. Unfortunately, this argument remains absent from any discussion and, however many investments one thinks of planning, the substance of the problem is destined to remain unchanged. Disparities in treatment between regions will continue to exist, many citizens will be forced to seek treatment at their own expense, perhaps far from home, or to give up treatment, just as the disaffection of operators for public medicine will continue. The system will not stop its decline, the indigent, the fragile will be treated less and less and worse, pace of article 32 of the most beautiful constitution in the world. On paper.