by Walter De Caro
22 APR –
Dear Director,
I thank you for having deservedly made available the “Manifesto of Italian doctors: here are all 20 requests to change health and the profession” and the report of the conference on the “medical question” of 21 April. Although with various aspects that can be shared, starting with the fight against inequalities and the protection of carers, there is a clear desire to reaffirm medical centralism and the interposition with respect to any change in the system of relations between the health professions.
From an initial reading, I want to underline – going a little over the top – some of the many points of the manifesto:
Write “To ensure the psychophysical well-being of all doctors by guaranteeing an adequate number of health and administrative personnel, for example for general medicine, by providing for an increase in the company fund of production factors referred to in Article 47 letter d) ACN”, As well as posed, raises some interpretative doubts.
The justification is not, as one would expect, the quality of care, patient safety, and the desire to work in multidisciplinary teams to ensure a holistic approach to health.
No! It is “ensuring the psychophysical well-being of all doctors” through more health care and more administrative.
In addition, from the overall reading, the maintenance of an “ancillary” vision of the other health professions, in addition to the lack of “trust” with respect to digitization, as regards administrators, is highlighted.
No less usual is the umpteenth request to set up “Tables” and “Observers”. Won’t there be too many already? And then more and more often with the same representatives and many times with the same offices / figures.
The need for this new “table” is indicated for:
✓ enhance the social role of the doctor also through regulatory provisions;
✓ ensure greater incisiveness to the medical profession in the governance of the NHS;
✓ safeguard professional autonomy;
✓ protect the medical act in Telemedicine processes.
Enhance? Medical act in telemedicine? Professional autonomy? Greater incisiveness in Governance?
If the data do not lie, in addition to the bureaucratic burden required, in Italy the doctors “govern” too much: the doctors are all “Executives” and everything is too “medicalized”: in the strategic and clinical management areas, in Parliament, in the Regions, in the Universities where they “govern” [impropriamente] other professions too.
At the same time, objectively, difficulties in delineated areas due to the general economic contraction and programming errors, for some medical specializations, are evident.
However, nurses are far worse off in terms of organic and strategic weight. In Italy too, the nursing shortage is dramatic: we are at the limits of system sustainability.
More than 100,000 nurses are missing according to optimistic comparative estimates.
Minister Speranza, present at the disclosure of the Manifesto on the shortage of doctors, declared that “For the medical staff we will have difficulties for the next 2-3 years but then, thanks to the investments made and the financed medical specialization grants that have reached over 17 thousand, the situation will change. The problem is how to manage the next 2-3 years and we are working on it, to find immediate solutions: on this, I am also thinking of an extraordinary use of trainees, which we have started to do but which must be strengthened “.
While thanking the Minister, at the same time, together with the extraordinary use of postgraduates, could you envision an extraordinary plan to have even more places for students in universities and nursing teachers? to take action to make nursing more attractive? To let nurses operate at their full potential? To enhance the specialized and advanced skills, with prescription, in line with what happens in over 70 countries in the world? To avoid the forward flight of the Regions that devalue the nursing function?
Another area of the manifesto is linked to the very role of the Professional Orders as revealed.
All the various professional orders seem – in continuity – to overflow, towards typical “representative” functions of free associations / scientific societies and trade unions. This manifesto is yet another demonstration of this, on headed paper of the Federation of Orders and with the joint signature of the trade unions.
For example, such as “Non-economic public bodies that act as “subsidiary bodies of the State”, in order to protect the “public interests”, guaranteed by the legal system, connected to professional practice ” (mainly registration / deontology and related disciplinary actions), the Orders have provided, according to the law, for the suspension of thousands of health workers, on the vaccination obligation or on other disciplinary aspects of competence or in the future, as a hypothesis, they will act with respect to the ECM obligations. The link with the state is evident and written in the rules.
At the same time, the same Orders therefore appear to be “governing” for some aspects and “fighting” and “on the barricades” to defend “the rights” of the reference profession, as in this case.
We are really sure that this is the role of the Orders as Public bodies and subsidiary bodies of the state?
In conclusion, with reforms and courageous choices, it appears necessary to get out of the “medical question” and medical centralism / dominance, and work to truly guarantee health to citizens and to our increasingly long-lived and chronic society, in the broad and chronic integrated socio-health vision that should have always characterized our NHS.
Our country could finally demonstrate that it is possible to go beyond equilibrium and “powers”, in complete safety, without trivializing the different knowledge, and adhere to what is indicated by the WHO in the “Report on the state of nursing in the world“, in the strategies for the development of global and European nursing and in the ICN and EFN documents, translated into Italian by CNAI.
With particular regard to the primary health careall countries are urged to enhance the nursing function up to the completion of the care process with advanced and autonomous nursing practice with prescription, for the benefit of health and with full satisfaction and safety, as amply demonstrated in the literature.
It is not a question of replacing, but of removing certain “artificial barriers”, which prevent us from offering better care, assistance, accessibility and sustainable costs for the system and citizens.
Walter De Caro
National President of CNAI-National Association of Nurse Associations / i
April 22, 2022
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