Hospitals: 30,000 doctors and 100,000 beds are missing
Not just general practitioners. In Italy there are also 30,000 hospital doctors, 70,000 nurses and about 100,000 beds. Deficiencies that endanger the health of citizens who, in times of need, could find themselves without the necessary assistance. The Forum of the Scientific Societies of Italian Hospital and University Clinics (FoSSC) has been rattling off the data and launching an appeal, asking the Prime Minister, Giorgia Meloni, for urgent measures to save hospitals by revising the organizational parameters of hospitals enshrined in the Decree Ministerial 70 (DM 70 of 2 April 2015).
Stop the weakening of healthcare
What worries scientific societies is the progressive weakening of health care. In 10 years (2011-2021), in Italy, 125 hospitals have been closed, a good 12%. In 2011 (between public and private) there were 1,120, to decrease to 995 in 2021, with a more marked cut for public structures (84 fewer). In just one year, almost 21,500 beds were eliminated, increased only to face the toughest months of the pandemic: in 2020 they were 257,977, to then drop to 236,481 in 2021. "We want to make our voices heard - he says Francesco Cognetti, Coordinator of the Forum. “We represent the professionals who assist citizens in the wards. The right to health is in grave danger in our country. The situation of the hospitals is really heavy, no longer tolerable and requires adequate and timely interventions. The crisis of the hospital system, due to the deliberately anti-hospital policies of the previous Governments, paradoxically ignored by the PNRR, is undeniable and has reached such critical levels as to create for the first time in all of us an enormous ethical problem.
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The shortage of staff
At least 30,000 hospital specialist doctors are missing: there are around 130,000, 60,000 fewer than in Germany and 43,000 fewer than in France. There is also a substantial exodus of new graduate and specialist doctors, more than 1,000 a year, because salaries and working conditions are much better abroad. In particular, in the Emergency Departments, the shortage of staff can be quantified at 4,200 white coats (in six months, from January to July 2022, 600 resigned, about 100 per month). There are also some 70,000 nurses missing. The forecast of health expenditure as a percentage of GDP for the period 2023-2026 will already record a return to value of 6.3% in 2024 compared to an average of 8.8% for the 37 OECD countries and about 10% for France and Germany. “The Minister of Health Schillaci - continues Cognetti - is doing his part and is finally in the process of setting up a Technical Discussion Table on the critical issues of DM 70 and DM 77, which will involve, among others, the authoritative clinicians proposed by the Forum. But there is a resource problem. We are no longer willing to indulge, to the detriment of our moral duties, the wrong political choices that we have been suffering for years, despite ourselves, as doctors, with extremely harmful consequences for our 15 million patients".
Hospitals: the consultation table between the Ministry of Health and FoSSC is underway
The fields of application of the Pnrr
The thirty Scientific Societies gathered in FoSSC have learned with interest the intentions of the President of the Council to want to change the direction and fields of application of the PNRR. "We believe that this would be a unique opportunity for healthcare to use a large amount of funds already donated to local medicine and unfortunately destined not to achieve the expected results, precisely due to the extreme shortage of medical and nursing staff", they declare, adding that “The 1350 Community Houses envisaged by the PNRR are not enough to solve health problems, if the central nodes of the profound crisis of the hospitals and resources for personnel recruitment are not addressed. If it is impossible to transfer these economic resources from the PNRR, it will necessarily be necessary to provide otherwise. The OECD has also declared itself very concerned about new health crises in countries that invest fewer resources in health care and for Italy it expects 'an investment equal to at least 1.4% more than the 2021 GDP', which is equivalent to an annual increase of no less than 25 billion euros”.
The weakness of our hospitals
To understand why we are in this weak situation today, it must be remembered that Ministerial Decree 70 of 2015 established qualitative, structural, technological and quantitative standards of hospital care without any consideration of what were already then the parameters in force in other European countries. “All of this - underline the Scientific Societies - has inevitably produced an extreme weakness of our hospital system, exacerbated by the pandemic. In these conditions it will be impossible to implement what is foreseen by the PNRR on territorial medicine. The construction of new buildings, such as community houses, is not enough, as they do not respond at all to the idea of proximity to care and risk remaining cathedrals in the desert with no connection to the hospital. The number of beds for ordinary hospitalization must grow well beyond today's 350 per 100,000 inhabitants until it reaches at least the European average of 500. The number of beds in intensive care must also exceed 14, which remained on paper and never reached, to reach at least 20-25 per 100,000 inhabitants. In this situation, we believe it is unthinkable to divert staff from hospitals to the territorial structures envisaged by the PNRR, i.e. community homes or hospitals".
An increasingly less public health service
The National Health Service is less and less public and the participation of private citizens in health expenditure has gradually become more and more impressive until last year it reached the figure of 37 billion, with a lower number of hospitals and staff, without adequate strengthening of the territory. “We must definitively abandon all the dehospitalization policies that have affected the sector in the last 40 years – conclude the Scientific Societies. A large number of doctors and nurses must be hired to upgrade hospitals. Furthermore, 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, running away from the emergency room”.
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The phenomenon of tokenistic doctors
The shameful problem of coin-operated doctors must also be resolved, who represent the desperate response to a dramatic shortage of personnel. “Token holders are sent 'into the fray' in the Emergency Department through hiring in private cooperatives that enter into relationships with many hospitals and with double or triple emoluments compared to colleagues who have been established for many years. The effect of this situation, which by now seems uncontrollable, as well as producing an enormous outlay of public resources, represents an incentive for the exodus of hospital employees and can cause incalculable harmful effects for patients".