The “wedge in the old health gears” preparatory to a radical change in the public system left by the outgoing health minister Roberto Speranza as the culmination of the season that saw him protagonist of the management passed silently, without headlines and talk shows. of health policy at the national level. On this the minister has often clashed with the inadequacy of regional health systems, including that of the Fvg, which has now slipped to the bottom of the rankings. Speranza’s vision of quality health, with the evident approval of Mario Draghi without whose endorsement the provision would not have been possible, is the real reason for the attacks carried out against the minister by the right, both of the government (Lega and FI) that of opposition Fdi. The decree published in number 144 of the Official Gazette, DM 77, and which came into force on 7 July, is one that promises to change the lives of Italians. “With the publication in the Official Gazette of the territorial assistance reform decree – commented Health Minister Roberto Speranza – all the objectives of the PNRR Salute, expiring on 30 June, have been achieved. Now we can invest unprecedented resources to strengthen our National Health Service ”. In essence, the decree asks all regions to equip themselves with an adequate “territorial” organization by January 2023: those who do not do so will lose 2-3% of the supplementary funding of the National Health Fund and obviously millions of euros. The SSN’s financing system is based on the regional fiscal capacity, even if corrected by adequate equalization measures, establishing that IRAP, the regional surcharge on IRPEF and the participation in VAT contribute to the financing of the SSN. This decree is undoubtedly the most important legacy left by the outgoing minister Roberto Speranza. The text defines in detail the new organization that the health services for citizens will have to have. It foresees that there must be Community Houses (Cdc) open 7 days a week for 24 hours with general practitioners and pediatricians (30-35 in rotation) and nurses (7-11) in service, but also psychologists, obstetricians, social workers , rehabilitation technicians. In short, all the health professionals who can reach diagnosis and treatment without forcing the citizen to the wheel of fortune of individual bookings for specialist visits. Obviously, if the situation is not manageable by this first impact structure, the hospital option will remain but the community option. A small hospital that can manage acute pathologies but also aggravations of chronic diseases. All that can be done without going to a large hospital to clog it up with small pathologies that can be solved differently. A real revolution also because the DM77 then introduces other institutions necessary to treat us, which organize home care, hospices and so on. The news are many and the fact of having foreseen a penalty for those who do not adapt should, but the conditional is a must, force the regions to act, because the possible political revolution following the early elections could see a new minister dismantle the system public in favor of the private sector, a difficult operation because the plan is included in the NRP and therefore dismantling it could have consequences on the disbursement of European funds. Also for this reason, times are very tight, probably deliberately, because a new government will not have time to dismantle the Speranza rule before January 31, 2023. We are waiting for September 25 and then January 31 2023, but however things go we are sure that the Fvg will not be ready to adapt the structures to the new course.
Ministerial Decree 77/2022, published in the Official Gazette 144
What has so far been defined as “Ministerial Decree 71” for continuity with Ministerial Decree 70 regarding the hospital now has a name: it is Ministerial Decree 77/2022, published in the Official Gazette no.144 of June 22, 2022, after the resolution of 21 April 2022 (published in May) of the Council of Ministers with which, overcoming the lack of agreement on the provision in the State Regions, the new model of territorial organization was launched.
Here are the main innovations of the Reform which redesigns above all the functions and standards of the District as described by the Ministry of Health.
Community house – Open up to 24 hours a day and 7 days a week, over 1350 Community Houses financed with PNRR resources, spread throughout the country, are the physical and easily identifiable place to which citizens can access for assistance needs health and social health. They represent the organizational model of proximity assistance for the population.
Operations center 116 117 – The Operational Center 116117 (Harmonized European Number – NEA for non-urgent medical care) is the free telephone service available to the entire population, 24 hours a day every day, to be contacted for any low-intensity health care and socio-sanitary need
Territorial Operations Center – The Territorial Operational Center (COT) carries out a coordination function in taking charge of the person and connecting services and professionals involved in the various care settings: territorial, health and social and health care, hospital activities and communicates with the emergency-urgency network.
Family and Community Nurse – He is the professional figure of reference who ensures nursing assistance, at different levels of complexity, in collaboration with all the professionals present in the community in which he operates. Not only does it deal with patient care, but it interacts with all the actors and resources present in the community to respond to new current or potential needs.
Continuity care unit -. It is a district mobile team for the management and support of the care of individuals, or communities, who are in particularly complex clinical-care conditions and which involve a proven operational difficulty.
House assistance – The home as the first place of care. Home care is a service of the District for the delivery of interventions at home characterized by a varying level of care intensity and complexity within specific care paths and a personalized care plan. Medical, nursing, rehabilitation, diagnostic treatments, etc., are provided by qualified health and social health personnel for the care and assistance of non self-sufficient people and in fragile conditions, to stabilize the clinical picture, limit functional decline and improve quality of daily life.
Community hospital -. It is a hospitalization facility of the Territorial Assistance, with 20 beds, which performs an intermediate function between home and hospitalization, to avoid improper hospital admissions or to favor protected discharges in places more suitable for the prevalence of social and health needs, clinical stabilization, functional recovery and autonomy and closer to home.
Palliative Care Network – It is made up of services and structures capable of guaranteeing the overall care of the assisted person and his / her family nucleus, in the hospital setting, with consultancy activities in the OU, outpatient, home and hospice. Palliative care is aimed at patients of any age and is not the prerogative of the terminal phase of the disease. In fact, they can complement active treatments from the early stages of chronic-degenerative disease, control symptoms during the different trajectories of the disease, preventing or mitigating the effects of functional decline.
Health services for minors, women, couples and families – The Family Consultancy and the activity aimed at minors, couples and families guarantee services, including home-based, specialist medical, diagnostic, therapeutic, obstetrical, psychological, psychotherapeutic, nursing, rehabilitation and preventive services, in the context of assistance territorial, women, minors, couples and families. The consultancy activity can take place within the Houses of the Community, favoring solutions that protect its confidentiality.
telemedicine – It is used by the healthcare professional to provide healthcare services to clients or counseling and support services to other healthcare professionals. Included in a network of coordinated care, Telemedicine allows the provision of remote healthcare services and services through the use of digital devices, internet, software and telecommunication networks.