Another worrying emergency: fewer and fewer specialist doctors in Lombardy. The Italian inability to plan and prevent catastrophic events manifests itself not only in earthquakes, fires, collapses, but also in postponing the taking of decisions which then confront dramatic and difficult to resolve situations, such as the lack of doctors and nurses in public hospitals in Lombardy. The alarm was raised by the regional councilor Julius Gallera, and is aggravated in Lombardy by serious staff shortages caused by a level of expenditure for personnel employed by the National Service which is approximately 5% lower than the national average, not to mention Regions such as Umbria, where the differential reaches almost 10 points.
What is happening? From this year in Lombardy an average of 2000 hospital doctors will retire but only a thousand young professionals will be available to replace them (if there is the money to hire them). And, if things don't change quickly, a very serious crisis of lack of specialists in a health system that has always been appreciated (and frequented by all of Italy) for its excellence is emerging.
For this reason it is absolutely urgent to adequately increase training contracts in specialization schools recognized by the Ministry of Public Education and University, to which medical graduates are required to enroll in order to acquire the specialization in five years. The Ministry has recognized 1040 to which were added, in the year 2018-19, 55 scholarships funded by the Region. But another thousand are missing to ensure generational change.
The state contribution is not even one to make your head spin: to guarantee specializations, the Faculties of Medicine receive 1652 euros per month for the first two years, 1710 in the last three. Paradoxically, our universities train well-trained doctors who, in large numbers, unable to specialize or due to recruitment constraints, only find work abroad, especially in European countries, at the expense of the Italian taxpayer. The fact remains that in hospitals the lack of personnel puts the quality of the service at risk.
On the other hand, an increase in personnel expenditure of a few percentage points would require an unsustainable financial effort from the Lombardy Region's own finances. On the other hand, the "Government contract" between the League and 5Stelle on health matters seems very explicit in this regard and considers it "essential to hire the necessary medical and health personnel" in consideration of the fact that "the problem of waiting times also following the widespread shortage of specialist doctors, nurses and health personnel". According to the document signed by Matteo Salvini and Luigi Di Maio “places for specialist training of doctors should be determined by real healthcare needs and also taking into account retirements, thus ensuring a harmonization between places in degree courses and places in specialization courses.
The reality is that this harmonization does not exist, and places for specialist training are in fact determined by two factors: the capacity of universities to welcome doctors in training and the funding of scholarships by the MIUR. Therefore, if on the one hand it may be necessary to increase the number of graduates in medicine, also by reviewing the capped number, on the other hand it will be necessary to increase the scholarships for postgraduates. It is necessary to more widely allow the newly graduated doctor to have access to the health facility in order to obtain the theoretical and technical-practical skills necessary for carrying out the chosen medical specialization. The analysis is correct but at this point we should move from words to deeds. The Head of Government should start, with the inevitable gradual steps, the implementation of his program. The emergency today is Lombard but in reality the future of public hospitals is being put at risk in our country. In Lombardy one would expect an outcry not only from the councilor and the entire junta, but also from the opposition councilors, starting with the 5 Stars and the PD.
Alongside the political battle with the central government, Lombardy itself, without going down the road of pure and simple cuts, could autonomously choose to immediately rationalize the hospital system, at least mitigating the critical staffing issues and guaranteeing continuity and quality of service. This means, despite the localisms often fomented by a political class incapable of building the future, preparing a plan for the conversion of small hospitals from acute care facilities to centers for chronic diseases, especially for the elderly, for on-call medical care and to prevent citizens from clogging up the emergency rooms of hospitals that have to treat acute cases. To give an example and without wanting to "import" models, it would be useful to reflect on the reality of the health service in Great Britain which, with 63 million inhabitants, has 387 hospitals while Italy, with 60 million, has 1400.
At present there are about twenty structures in Lombardy that could be reconverted. From this point of view Lombardy lags behind other neighboring regions who have already started a reorganization of the hospital system. Providing a quality service in hospital centers capable of treating patients who manifest acute forms of illness must be the result of a serious reorganization project that closes nothing, increases the offer of services for chronic pathologies and allows "real" structures hospitals to have adequate staff to ensure quality and efficiency of services. In the "trustful expectation" that the "Government contract" on healthcare will produce its effects, the reorganization of the network could be carried out to make the best use of resources. The negotiation with the Conte government on regional autonomy, which has already begun with the Gentiloni government, will not bring a river of additional money into the regional coffers, but only a transfer of powers. The existing critical issues would advise the Lombard institutions to make timely and courageous decisions involving all the political and social forces in a constructive confrontation. Equal responsibilities also fall on the oppositions, PD and 5Stelle, which in Lombardy could emerge from a condition of objective minority by challenging the majority precisely on the implementation of the government "contract" on such an important issue as that of the efficiency of the public hospital network.
