Puglia and Basilicata: rehabilitation services on the brink of collapse and care for the vulnerable and children at risk

Non-profit religious organisations in Puglia and Basilicata are sounding the alarm over the sustainability of services for vulnerable people. According to Aris, a religious association of social and healthcare institutions, care for thousands of people with disabilities, the elderly and children is at risk, caught between unsustainable rates – which have remained unchanged for twenty years – and a restructuring plan based on needs that are ten years out of date. “These facilities are being forced to accept – without any tariff coverage,” denounces the head of Aris Puglia, Monsignor Domenico Laddaga – “a contract that does not apply to the rehabilitation sector but to the more costly private hospital sector. So the Region is demanding higher standards, but is making it impossible to meet them, and on top of that is imposing a contract on us that isn’t even ours.”

The continuity of services is at risk and “it is not the healthcare facilities that will suffer, but the patients, their families and the staff”. Laddaga identifies four structural issues that need to be addressed. Firstly, there are the unsustainable rates, which have remained unchanged for twenty years apart from a single, insufficient 7 per cent adjustment in 2022 – an increase that was not even applied uniformly by all local health authorities – against a backdrop of inflation that has exceeded 43 per cent since 2007. The contract currently applied is not the sector-specific one, but a more onerous alternative: the region ‘imposes’ – and this imposition is currently under review by the Constitutional Court – the private hospital contract as a requirement for the accreditation of facilities; yet rehabilitation centres have their own national collective agreement, the ARIS National Collective Labour Agreement for Rehabilitation Centres and Residential Care Homes (RSA), signed in 2012 and renewed under the Interim Agreement of January 2024, which the trade unions are currently in the process of renewing at the national negotiating table. And where it has been applied, Laddaga adds, “staff costs have exceeded 80 per cent, peaking at up to 90 per cent of turnover”.

And then there is the proposal for a restructuring plan described as ‘unrealistic’, set out in Apulia Regional Council Resolution No. 1933/2025, which mandates an adjustment within 18 months based on staffing requirements dating back 11 years and calls for additional specialist staff who are extremely difficult to recruit – such as specialists in child neuropsychiatry and physiatry, speech and language therapists, and all other rehabilitation professionals. Finally, there are the unfulfilled trade union commitments: in January 2024, the national ‘Ponte’ agreement provided for a path towards a sustainable contractual balance, with an adjustment to fees, but ‘to date, this has been ignored’.

Aris therefore refuses to accept that the Apulia region’s healthcare deficit should be passed on to the most vulnerable and calls, in the following order, for the immediate establishment of an institutional forum to find concrete solutions, the suspension of the 18-month deadline set out in Regional Council Decision 1933/2025, the immediate revision of tariffs to bring them into line with actual costs; and, finally, the implementation of the sectoral contract, ensuring that every obligation is matched by corresponding tariff coverage. “We are ready for dialogue, but we will not stand by in silence whilst Apulia’s rehabilitation healthcare system is dismantled. This is not a matter of sectoral interest: it is a battle,” concludes Monsignor Domenico Laddaga, “for people’s dignity and for the right to care”.