by Roberto Polillo, Mara Tognetti
The criticalities of the Emergency Room are therefore one of the most visible, but also the most worrying signs of how our public NHS urgently needs to be reviewed, especially from an organizational point of view but also to guarantee everyone and in all regions, regardless from how the long process of differentiated autonomy will evolve, set in motion, albeit slowly by the Calderoli provision, the right to benefits and access to treatment but primarily prevention.
13 APR –
Among the many criticalities and distortions that our NHS is producing due to how it has come to take shape in recent decades due to both legislative provisions and defunding, there is “the overcrowding of the Emergency Departments”.
We find this situation in all Regions whether they are virtuous or not. We are therefore not in the presence of an unexpected effect but in the presence of a clear sign that the current organization of our NHS is no longer adequate for the citizens’ requests, since it is a distortion produced by the failure or rather by the incapacity of the load to function properly.
The chain of prevention, territory and urgency
The prevention, territory and emergency medicine supply chain has broken down. This distortion is one of the most visible signs that our SSN needs to be urgently realigned or reset, both to respond to the now countless requests, starting with those that QS has hosted in recent years, but not only. Both and this cannot be disregarded by the public decision-maker, to respond to the proposals that emerged from the Conference on the future of Europe, promoted by the European Parliament, the Council and the Commission, on 9 May 2022. It proposed to strengthen the European Union of health, starting from concrete suggestions such as the commitment to invest more in public health systems in order to guarantee accessibility and quality of services.
The impoverishment of local services and basic medicineThe underlying principle of the NHS based on local services (districts, basic medicine) as a filter and guider of citizens’ requests and health needs, with respect to specialist or emergency services no longer works.
It no longer works not so much because it is an inadequate model, in fact the various reform proposals of the NHS are all based, even if differently named, on this supply chain, but because everything has been created or rather everything has been done to produce a supply chain no longer aligned. This more or less explicit strategy has been pursued by pursuing the idea of the market, of the citizen’s free choice in the role of customer, but what is even more serious by definancing and emptying the local services, the districts. By impoverishing basic medicine and what is more serious in times of degenerative and chronic diseases, prevention and health promotion.
The overload of emergency rooms is also a sign of the failure of local medicine and family doctors. Or rather the fact that there are no more family doctors and more and more citizens don’t know who to turn to for the first answers to their real or presumed health needs. Just as this overload is also the result of a mere prescribing function, possibly remotely or via WhatsApp, of family doctors.
The citizen thus finds himself having to choose either the internet or the emergency room if he thinks he is ill.
The emergency room criticality is no longer limited to weekends
In fact, the criticality of the Emergency Departments no longer occurs on weekends, as the data show, when “we-sickness anxiety” can be stronger, especially among new parents, but now also on Mondays, in particular, and in other days of the week.
A clear sign therefore of a non-response or inability to respond by the system of services which should be upstream of the emergency.
Other causes and malfunctioning of the NHS are the basis of overcrowding such as the lengthening of booking times, the lack of a single generalized booking system (public and private, such as in the Lazio Region, for example). All factors that weigh on the choices of citizens who need care services.
Last but not least, the fact that more and more to speed up health checks and examinations, or to have them in decent times, it is necessary to resort to accredited private individuals or private individuals with consequent costs, thus inducing citizens to move towards the Emergency Department for some type of response . A mainly private system in emergency medicine increases access to the Emergency Department.
The lack of personnel and management of white codes
In addition to these elements, there is the fact that this structure does not have dedicated personnel due to the unfortunate hiring freeze and the excessively onerous workload that pushes professionals to resign voluntarily. The access system through the crosses is no longer sufficient. The white codes should be oriented to other structures such as the territorial ones and to the few community houses activated by implementing a telemedicine system for remote support from other professionals, primarily the cardiologist, for ECG reporting, and the pulmonologist for evaluation of the spirometry tracing.
The consequences of the pandemic and patients with low social capital
This situation then worsened further due to the COVID 19 pandemic which delayed or made scheduled accesses impossible with a consequent worsening of the pathologies themselves and an increase in the related health and social costs and the overload of specialist and emergency structures.
We also note the fact that health poverty itself, its increase, leads over a long time to an increase in access to the Emergency Department. As well as the persistence of sections of the population, those with less social capital, and new citizens, who find it difficult to extricate themselves and follow the correct path, in our intricate and difficult to read, in its functioning, health system.
The criticalities of the Emergency Room are therefore one of the most visible, but also the most worrying signs of how our public NHS urgently needs to be reviewed, especially from an organizational point of view but also to guarantee everyone and in all regions, regardless from how the long process of differentiated autonomy will evolve, set in motion, albeit slowly by the Calderoli provision, the right to benefits and access to treatment but primarily prevention.
The Bollette decree and Minister Schillaci’s proclamations
Some measures in favor of Emergency Department personnel contained in the Bill Decree have been welcomed by the scientific society SIMEU. A company that rightly does not carry out trade union activities and which therefore evaluates every act for the immediate repercussions it causes.
However, every legislative act must also be evaluated for the consequences it determines on the entire organization of the system and therefore it certainly cannot be said that there is that trend reversal that Minister Schillaci has repeatedly announced after having accused the previous governments, from to which the same had however been appointed consultant, that the killers were from the health service (see in this regard the excellent and exhaustive considerations by Maffei and Zuccatelli on QS of 6 April ca).
The need for an overall look
To get out of a crisis condition of our NHS, on which we have been dwelling for some time, those who deal with NHS need to put forward feasible and feasible proposals. The same goes for those who have government responsibilities and who should maintain an institutional courtesy towards previous administrations, especially if they have played a technical-scientific role there and let only the facts speak for themselves. Even taking into account the fact that the current Minister has nonetheless formulated interesting hypotheses for revisions, albeit sectoral.
Once again we have to look at the individual criticalities and emergencies with an overall look at the functions and tasks of the National Health Service, individual patches can do much more damage than an overall redesign. The National Health System needs to be urgently rethought starting from the forms of purposeful or compulsory financing.
Robert Polillo and Mara Tognetti
April 13, 2023
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