As of 31 December 2023, the European deadlines for the Pnrr Health mission which affect the payment of the installments have all been respected.
And of the national deadlines, the only one to "pay attention to", among the three deferred, concerns integrated home care (ADI) for the over 65s, but "other obstacles are on the horizon: serious shortage of nurses, role of family doctors and North-South gap".
On this last point, the Calderoli bill "goes in the opposite direction to the Pnrr's objective of reducing inequalities".
This is what emerges from the independent monitoring of the progress of the Pnrr Health Mission, conducted by the Gimbe Foundation and "initiated - explained the president of the Foundation Nino Cartabellotta - in order to provide an objective picture of the results achieved, to inform citizens and avoid political exploitation".
"At the moment the delays on national deadlines are not particularly critical - underlines Cartabellotta - except for new patients receiving home care. However, once the 'grounding' of the Health Mission has been completed, compliance with subsequent deadlines will be conditioned above all by critical issues of implementation of Ministerial Decree 77 in the 21 regional health services, linked both to the key figures of the health personnel involved in the reorganization of territorial assistance, and to the enormous regional differences, which risk being amplified by differentiated autonomy".
The only one of these critical issues that needs to be paid attention to is integrated home care: by March 2023, 296 thousand patients over 65 should have been assisted in Adi, a deadline postponed by 12 months due to the enormous regional differences in the ability to provide the home care, an area in which the Centro-South was already far behind". In fact, the Gimbe Foundation specifies, "according to the provisions of the decree of the Ministry of Health of 13 March 2023, to assist at least 10% of the over 65 population in Adi, the Pnrr sets the objective of increasing the number of people taken into care from over 640 thousand in December 2019 to just under 1.5 million in 2026, for a total of over 808 thousand more people".
"However – explains Cartabellotta – if on the one hand reaching the national target is realistic, on the other it is much more difficult to fill the regional gaps. In fact, if Emilia-Romagna, Tuscany and Veneto must increase the number of patients treated to reach the 2026 target in Adi by 35%, 42% and 50% respectively, in some regions of the Centre-South the gaps are abysmal: Campania must increase them by 294%, Lazio by 317%, Puglia by 329% and Calabria even by 416%".
Among the obstacles on the horizon, first and foremost, the Foundation specifies, there is the very serious shortage of nursing staff: the latest data relating to 2021 document a number of nurses in Italy equal to 6.2 per 1,000 inhabitants, compared to the OECD average of 9 ,9, with significant differences between Regions which mainly penalize those in the Centre-South subject to the Recovery Plan.
A shortage that clashes with the needs estimated by Agenas to implement Ministerial Decree 77: a range from 19,450 to 26,850 nurses.
Secondly, the limbo in which the methods of involvement of family doctors in Community Homes remain.
Finally, all the regional differences which, in addition to the aforementioned ADI, concern the organizational models of territorial assistance, the initial provision of community homes and community hospitals and the implementation of the electronic health record.
But above all, continues Cartabellotta, "the citizens' demand for organizational improvements and new services is also receding due to the downward remodulation and the 18-month postponement of the deadline for renewing large equipment, also motivated by minor critical issues, such as the disposal of old equipment and adaptation of the premises".
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