There are ‘gaps’ in the text on differentiated autonomy, “significant criticalities on the equity of access to services and civil and social rights which must be guaranteed throughout the national territory with direct effects on the unity of the country”. Thus Tonino Aceti, president of Salutequità, commenting on the bill for the implementation of the differentiated autonomy of the Regions, approved in recent days by the Council of Ministers and which “from December to today has seen at least 4 different versions”. Aceti lists the “most macroscopic flaws” found in an initial technical analysis of the text, “to make it available to Parliament, called to express its opinion on the bill, other institutions and stakeholders”.
Preliminarily – writes the president of Slautequità – it is evident how the words “fairness, equality, inequalities, control, verification, involvement, participation, concertation” are never mentioned in the text of the bill. Instead, we find the word “unity” only once, the word “monitoring” twice, and the word “solidarity” three times. As specified in art. 1 and 4, “the differentiated autonomy – continues Aceti – is allowed only after the determination and financing of the essential levels of services (Lep) and is not subordinated, as it should be, for example to the identification of criteria for allocating the financing of the Lep that look at equity and the specific characteristics of the Regions; the definition and approval of a guarantee system of the Lep at the height, which allows to verify concretely, promptly and punctually their effective and equitable disbursement in the regions; positive verification of the guarantee of the Lep; the definition, financing, approval and verification of the national personnel, technological, organizational and infrastructural standards that will have to concretely support the Lep. If you do not want to leave the Lep on paper – he specifies – the related standards are unavoidable.In healthcare, where the Lea (essential levels of assistance) were already introduced d to 2001, it was decided to start working (and there is still a lot to do) on the definition of further ‘limits’ only recently and, despite this, inequalities are galloping”.
On the determination of the Lep, in the explanatory report of the Ddl “there is no trace instead of a survey on the essential and unsatisfied needs of citizens to be guaranteed through the Lep. In this way, in fact – observes Aceti – the Lep risk being reduced only to a more orderly list of what is already being provided and preferably compatible with current resources”.
Another flaw found concerns the “heavy and rigid mechanism for approving and reviewing the Lep. Article 3 of the Ddl – notes Aceti – provides for at least 8 steps to arrive at the determination of the Lep (without considering publication in the Official Gazette) A long and demanding mechanism, which does not provide for the involvement of stakeholders (social partners, citizens’ and patients’ associations, etc.) and which does not identify (certain and peremptory) times for revision.Health care leads the way in this case as well. to the new Lea of 2017, these are still in fact unimplemented after more than 5 years due to the non-adoption of the tariff decree”.
But there is more, continues the president of Salutequità: “The verification of the guarantee is not an ‘optional’ as instead provided for by Article 7 which states that ‘the Ministry of the Economy or the Region can (and must not ) arrange checks on specific profiles or sectors of activity”. According to Aceti it is “as if to say: I authorize the Region to drive a fast car without having previously verified whether it is capable of driving it and, if it crashes, there will not necessarily be proportionate sanctions and no one will ever revoke her driving licence. It is precisely the role of guarantee of the central level that is missing”.
Another critical issue is the strengthening of the Regions and not of the State. “There is no provision for any kind of strengthening of the role of the central level of coordination, monitoring, evaluation and guaranteeing compliance with the Lep”, recalls Aceti who also draws attention to the “residual” role of Parliament which “has 60 days to express itself with an act of address on the preliminary agreement scheme of differentiated autonomy, but it is not clear if and how binding it is”. Finally, he concludes, in the Ddl “there is no trace of any concrete commitment for an extraordinary infrastructural leveling program of the Regions capable of putting all the Regions on the same level in all sectors of public policies”.