“The right to health is in grave danger in our country. There is a lack of resources, doctors and adequate structures, but the electoral programs of the main coalitions ignore the perfect storm that is looming on the horizon”. The alarm comes from the Forum of the scientific societies of Italian hospital and university clinicians (Fossc), which denounces “the total lack of attention on these issues by the political forces that will present themselves in the next elections. The word ‘hospital’ is almost of the all absent from the electoral programs and debates “. In general, “concrete proposals and above all structured reform projects are lacking”, says oncologist Francesco Cognetti, coordinator of Fossc.
“There are about 130 thousand hospital specialists, 60 thousand fewer than Germany and 43 thousand fewer than France – reports the Forum – The bleeding of white coats also affects general practitioners: they are few, about 40,700, but every year 3 thousand go retired and it is expected that soon the exodus will be even greater. Not only that: in Italy today there are about 13 thousand pediatricians, but throughout the country there are shortages also due to the rigid distinction between territorial and hospital activities and the lack of adequate interaction and integration between them “. Cognetti stresses that “the availability of beds by number of inhabitants places Italy in 22nd place in Europe and the ability to use them is completely insufficient. Hospitals have been merged, wards and diagnostic services have been reduced and weakened. And the definition of health care in 10 years has reached 37 billion euros, with the other European countries having percentages “of resources for the sector” compared to the GDP of 3-4 points higher “.
“Healthcare spending – adds the specialist – grew by 3% in 2022 compared to 2021, but these resources have all been used to tackle the” Covid “pandemic which, among other things, has produced mortality levels in our country among the highest in Europe. The Def for the three-year period 2023-2025 scheduled for April again envisages a decrease of 0.6% per year, against an expected substantial increase in nominal GDP “. Against this background, “in the electoral programs there are references to the reorganization of local health care, to the strengthening of the staff of health workers and to the overcoming of waiting lists. However, concrete proposals are lacking – insists Cognetti – and structured reform projects that respond to a system logic “.
“The 1,350 community houses envisaged by the NRP will not be enough to solve health problems, if the central issues of the deep crisis of hospitals and resources for staff recruitment are not addressed”, warn the 30 scientific societies gathered in Fossc. “The Forum – they recall – in recent months has asked for the complete revision of the organizational parameters of hospitals sanctioned by Ministerial Decree 70 (Ministerial Decree 70 of 2 April 2015). The number of ordinary hospital beds must grow well over 350 per 100 thousand inhabitants today, up to at least the European average of 500. The number of intensive care beds must also exceed 14 beds, which have remained on paper and never reached, to reach at least 20-25 per 100 thousand inhabitants. resources needed to increase pediatric intensive care and pediatric semi-intensive care beds, which are currently below what is needed in all regions, and to upgrade equipment in many pediatric and neonatology wards in various regions “.
Investments must also concern personnel, is the appeal. “We need to hire a substantial number of doctors and nurses to strengthen hospitals – exhorts Diego Foschi, president of the Italian College of Surgeons, who is a member of the Forum – In addition, the exodus of recent graduates who go abroad to specialize must be curbed”, as well as “the early retirement of many doctors who must be guaranteed better salaries to avoid, for example, escape from the emergency room. We also asked that doctors be relieved of bureaucratic and administrative obligations, because support staff are easily found and cheaper, while There are no doctors. Every minute subtracted from treatment is a lost minute – he warns – We also asked for the clinical results achieved by the various hospitals to be made public, so that citizens can choose where to go for treatment, without taking risks and rewarding the merit “.
The Pnrr, Fossc continues in its analysis, provides for a healthcare investment based on two major items: construction and technology. “The projects, however – notes the Forum – will concern community hospitals and community homes, territorial medicine structures, and large diagnostic and treatment equipment, mainly radiological. But building walls does not mean having hospitals, which require personnel and skills that do not exist. The historical duality between hospital and territory must be overcome, in favor of a single system of interconnected, continuous and complementary services. The real hospital must also functionally extend to the territorial health realities. What is territorial must be considered pre and post-hospital, in an integrated vision of the two realities “.
“Even children – remarked Annamaria Staiano, president of the Italian Society of Pediatrics, which adheres to the Forum – must have the treatments they need to manage and prevent acute and chronic diseases in the area and in the hospital, in a system of continuity of care and in network that provides, where necessary, the possibility for pediatricians to work both in the territory and in the hospital with organizational flexibility. The number of children and adolescents with specific health needs is also increasing, which are now over 15% of the total, at least one million in the our country, and require health interventions often repeated over time, with approaches both at the local level and in the reference hospitals and universities. Technological investments and the recruitment of personnel with a system perspective are necessary, which takes into account the needs of children and of their families, also to reduce health mobility towards more advanced regions in terms of health care ia “.
The consequences of failing to upgrade hospital facilities are already evident, particularly for cancer patients, Cognetti notes. “The delays in oncological surgery have been made chronic and the rates of adherence to screening have not yet returned to pre-pandemic levels – he highlights – and we can already make predictions of an increase in cancer mortality in the coming months or years, while already more advanced cases are observed “.
“The cancer plan recently produced by the Ministry of Health appears to the” expert “to be absolutely unsatisfactory due to the lack of specific resources aimed at addressing the strategic objectives, therefore impracticable. Compared to the European Program (Europe Beating Cancer Plan), the National Cancer Plan shows an absolute absence of planning and programming, as well as the detection of the needs and resources to invest, in addition to the complete lack of identification of the timing, of the monitoring and governance indicators. to the funds of the European Plan. And that’s not all: the Oncological Networks, which constitute a model of assistance and research in the cancer sector, remain inactive in most regions “.
On the source of therapies, “the times for introducing the reimbursement by our regulatory agency of important innovative drugs remain, indeed increase, and the resources allocated to multigene tests to avoid chemotherapy for women operated on for cancer are running out. breast, given the failure to include these tests in Lea “.
“And the block, which still exists, due to the lack of regulatory compliance in our country with the new European regulation on clinical trials – continues the oncologist – will prevent many researchers and patients from accessing the new molecules compared to other European countries”.
“The result – concludes the Fossc coordinator – is the loss of significant therapeutic opportunities for patients, the lack of professional and scientific growth of the healthcare personnel involved, as well as negative economic effects due to the lack of overall economic investments by international pharmaceutical companies. and on employment, due to the lack of employment of highly specialized professional profiles “.