That the publication in the Official Gazette and the consequent media discussion arrived in the middle of the summer is probably little more than a coincidence, but the theme is one that has held court almost daily in the last two and a half years: the strengthening of territorial and community medicine. The subject is Ministerial Decree 77, which bears the date of last May 23 and entered into force on July 7, but above all which fixes in less than a semester (at January 31, 2023to be precise) the deadline for adapting to the new legal provisions.
Within a reorganization plan involving community homes and community hospitalswith a necessarily articulated system, to have made headlines – and already raised more than a few perplexities and controversies – is the novelty that provides for the availability at any time of any day of the health personnel needed to cope with health problems both in general medicine and in many specialist areas that provide for patient management outside large hospitals.
Journalistically, this novelty has often been summarized with “Doctors and nurses always available”obviously referring not to the individual healthcare operator (who will continue to have a lot of work according to what has already been foreseen) but to territorial health structurewhich therefore inevitably will have to equip itself with a larger staff to cover a series of hitherto unforeseen shifts.
From the citizen’s point of view it would be a big step forward
Without beating around the bush, more than one journalistic commentator has defined this measure – strongly desired by the outgoing Health Minister – the most important political legacy by Roberto Speranza. In fact, the provision provides not only for the generic presence of medical personnel available at a short distance and at any time in the community houses, but also for social workers, obstetricians, pediatricians, psychologists, nurses, rehabilitation technicians and doctors in general specialized in the various disciplines who can foresee an immediate and on-site management of the health problem (acute or chronic) that occurs. And for the most serious cases, the decree provides that the structure is equipped to allow the patient to reach theHospital community closer, in order to guarantee in all respects the territorial continuity assistance.
Black on white in the provision there are also a number of other organizational measures. In addition to the aforementioned community hospital, intended as a small-scale hospital useful for absorb some of the patient traffic which would flow into the large centers, we speak of House assistance (also thanks to digital solutions), hospice, chronicity management and so on. In an attempt to ensure the fastest and most efficient adoption of the new measure, the ministry has decided to bind part of the health budget to decree 77. Those who do not adapt, in fact, will lose part of the supplementary financing through the National Health Fund, in a quantified share between 2% and 3%.
Between decreeing and doing …
Although in principle there cannot be much to object to the provision (on the other hand, it translates into law what everyone has been hoping for since before the pandemic), some perplexity remains on the front of thereal applicability than expected. Each community house, for example, in order to function according to the provisions of the law should have an estimated staff of 30-35 people only including general practitioners and pediatricians, as well as a dozen nurses and all the various specialists available. Many more than are currently expected in the staff.