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Climb the mountain of waiting lists with the same strength – few and exhausted by three years of pandemic – that so far those hateful queues have failed to break down, forcing millions of Italians to wait for treatment. Here is the impossible mission to which doctors and nurses are called by the new plan to cut waiting lists envisaged in the budget which allocates 280 million a year until 2026 to convince staff to work harder with the promise of better paid overtime (100 euros gross per hour for doctors and 60 for nurses).
The shortage of staff linked to the spending ceiling
The Government’s plan risks a real flop because, wherever one wants to treat the symptoms of the disease that has affected the Health Service for several years now, the cause is always the same: there is a lack of staff. The most conservative estimates say that 20 thousand doctors and at least 70 thousand nurses are needed, of which the shortage is most serious. The reason is simple and is linked to the “original sin” that this measure also does not address, like those of the last 15 years, that is, the cap on hiring introduced in the spending review era: it is a ceiling that nails spending to personnel to that of 2004, then subtracting 1.4 percent. A brake that has inexorably dried up the ranks of staff and which in recent years has dramatically worsened in the face of the flight of many from hospital wards due to exhausting shifts and too low salaries: every year there are 2 thousand doctors farewells between dismissals and early retirements .
Escape abroad, boom in retirements and crisis among residents
Many healthcare workers choose to work in the private sector or abroad, as the OECD points out, according to which 15,109 nurses and 21,397 doctors have left Italy in three years. But what makes the situation even more worrying is the expected retirement of as many as 40 thousand doctors by 2025: in fact, in these years the so-called pension hump is expected, i.e. the peak of exits due to age limits. The icing on the cake is the escape of young people, after graduating in Medicine, from many medical specializations considered unattractive (such as surgery or emergency medicine) so much so that the call for 16 thousand places which closes in recent days over one place out of three will remain empty. The risk therefore is that white coats will become unobtainable, as nurses already are.
The precedent on waiting lists and the contract in 2025
Moreover, the fact that similar measures (such as overtime) have been used in the past when the 2021 budget allocated 500 million for waiting lists and regions in two years they barely spent 70 percent of it. The Minister of Health Orazio Schillaci, in addition to the funds for the overtime of doctors and nurses on the move, has snatched 2.4 billion for the renewal of their contracts: but the forecast is that the increases in the pay slip will not be seen before mid-2025. While the spending ceiling on personnel – apart from future hiring for the local health system – has not been touched: “It is a rather odious ceiling and as soon as possible we will try to overcome it”, assured Schillaci.
Doctors and hospital managers: exceeding the hiring ceiling
“That the waiting list plan fails is not a risk, but a certainty given that we already work many hours a week of overtime due to shortages,” warns Pierino Di Silverio, secretary of Anaao Assomed, the main hospital association, according to who «if you don’t make the profession more attractive it is useless to ask to work more». The president of the Order of Doctors Filippo Anelli in recent days spoke of an extraordinary plan of 10 thousand hires to be made immediately in 2024: «We need to hold competitions, encouraging young people to stay in the NHS, for example by increasing the amount of the allowance of work exclusivity. It’s time for the spending cap on hiring to be eliminated or at least raised.” Giovanni Migliore, president of Fiaso (the managers who lead the hospitals), is of the same opinion: «To reduce waiting lists we need personnel. We need to change course, changing the rules on work organization and replacing the spending cap on personnel which has been stuck in 2004.”