by Claudio Maria Maffei
It seems that the 26 Scientific Societies of hospital and university clinicians gathered in the Forum presented to the press on 2 February last. From them some positions have emerged that appear somewhat obsolete and which evidently have not taken into account the evolution that has now involved the very concept and role of hospital networks in the world.
04 FEB – Two days ago QS reported the proposals of the newborn Forum of the Scientific Societies of Italian Hospital and University Clinics (FoSSC). This Forum, it says, was set up at the specific request of the Minister of Health to initiate an interview with the professionals who assist millions of citizens.
A total of 26 Scientific Societies belong to it. Substantially the same ones who signed the document of Permanent Forum on the National Health System in post-Covid presented on 15 September 2021, the reading of which I think can provide some more details on the analyzes and proposals of the new Forum of hospital and university clinicians presented on 2 February last.
That document is written in an almost exclusively medical and hospital key and in the general proposals it takes this position:
“Basically, we are absolutely opposed to the concept of a minimum” proximity “hospital (defined in the PNRR as a” community hospital “, to be built every 160,000 inhabitants approximately, for a total of 381 structures), and even less to their management delegated to nurses ; an obsolete concept, excessively simplifying but above all inadequate to cope with the many and different complexities posed by the health questions of modern medicine. The hospital, as a service, is no longer willing to be considered at the “minimum” of its possibilities but must be re-evaluated and reorganized but also rethought and structured as functionally operational to correspond to all needs, which if satisfied guarantee the achievement of the best health results allowed by the development and application of scientific knowledge “.
The Document in these passages contains important errors of reading / interpretation of the PNRR and of the DM 70:
• there are neither documents nor acts at national level that speak of a minimum proximity hospital: the DM 70, the specter that wanders like a stone guest in the document, does exactly the opposite by providing integrated networks of hospitals with increasing levels of complexity without never use the word “proximity” and clearly defining the community hospital as one of the intermediate structures that can be a direct interface between local and hospital assistance;
• the PNRR does not transform the non-existent “minimal hospital” into a community hospital, but limits itself to further enhancing its role in the network of services, a role that has in Italy a long history of analysis, regulation and experience in the field such as very well reconstructed recently here on QS by a group of Asiquas experts;
• it is not true that there is a community hospital for every 160,000 inhabitants because the 381 new hospitals should be added to the 163 already available (an analysis by Franco Pesares makes this point very clear).
I believe that, to reassure the clinicians who signed that Document and who in their majority have now constituted the new Forum, they lay down the wealth of analyzes and experiences that underlie the so-called intermediate care and community hospitals.
I limit myself to referring to the website of the Community Hospitals Association of the United Kingdom to get a quick idea of the history of over fifty years and the value of these structures considered in the document of the Forum almost a sort of organizational subversion of the last hour.
The final comment that the new Forum makes to its proposals also deserves a comment: “The widely shared need to deeply reform the Ministerial Decree 70 and abandon all de-hospitalization policies that unfortunately have affected the sector in the last 40 years”, a position also confirmed in the press statements of the new Forum on 2 February.
On this condemnation of the document’s de-hospitalization policies, the reading of an intervention entitled “Do hospitals still make sense? The reasons for a decentralization of health care “and subtitle” The future is here: moving care from the hospital to home and into the community “. This intervention does not come from some enthusiastic supporter of PNRR, but from the New England of Journal of Medicine Catalyst Innovations in Care Delivery in which a contribution entitled “Do Hospitals Still Make Sense? The Case for Decentralization of Health Care “.
I translate an excerpt from the first sentences of the intervention: “From its humble beginnings as almshouses for the poor and destitute who could not receive assistance at home, hospitals have evolved to become large, profitable institutions (translator’s note: we are still in the United States), expensive, highly technological and at the heart of the healthcare universe. Almost every community has at least one large centralized general hospital, and many have more than one. But healthcare is changing. The exponential growth of digital and virtual healthcare, the deeper penetration of advanced technologies into the community, and the shift of increasingly complex acute care activities to the outpatient setting create the opportunity for a shift from centralized healthcare in large facilities to healthcare made by smaller, faster and more efficient facilities where healthcare is more accessible, more affordable, more personal and closer to home. “
I believe that the new Forum can make its contribution better if, in addition to defending and promoting by relaunching the role of the hospital in Italy, it updates its position in the light of what has for years been the common heritage of those involved in public health in the world. Denying value to what the PNRR has rightly valued is not good for anyone, not even those who work in hospitals.
Claudio Maria Maffei
04 February 2022
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