Budget Bill: Doctors and regional authorities sound the alarm: ‘With just an extra 2.4 billion, the health service cannot cope’

In 2027, thanks to the budget measures, the Health Fund that underpins the National Health Service will increase by 2.4 billion, less than half of the 5.5 billion requested by Health Minister Orazio Schillaci to recruit staff and pay doctors and nurses more, and also a far cry from the extra 6 billion or so per year for three years that the regions had requested to prevent the NHS from collapsing. With the additional 2.4 billion and the 1 billion carried over from last year’s budget, the Health Fund will rise to 146.3 billion in 2027 (just over 6 per cent of GDP), representing growth, in one year, of just over 2 per cent – not even enough to offset the effect of inflation. These figures risk plunging the health service into an even deeper crisis, to the extent that doctors and the regions have already sounded the alarm because ‘the very stability of the public health system’ is at stake. Resources are therefore scarce, whilst the budget simultaneously allocates a full 1.6 billion to fund a card for the over-75s to be used for healthcare purchases.

The Medical Association, the Anaao Assomed trade union and the Cimo-Fesmed Federation, whilst expressing themselves in different tones, have made no secret of their criticisms and concerns following the passing of the Budget Bill. According to Filippo Anelli, president of the National Federation of Orders of Physicians, Surgeons and Dentists (Fnomceo), “professionals were calling for extraordinary measures to unblock recruitment and, above all, to bring salaries into line with the European average”, whilst the additional funds will “cover the increases in energy costs” without allowing for other measures, “such as reducing waiting lists”, Anelli points out. He also expresses “bewilderment at the decision not to involve the Ministry of Health in defining the services that can be purchased using the Health Card for the elderly”, so much so that the president of the Medical Association proposes allocating the 1.6 billion earmarked for the Card to “implement measures to tackle waiting lists”, for example by providing the option of receiving treatment from private practitioners within the NHS when waiting times exceed the stipulated limits. “Once again,” concludes Anelli, “there is a lack of a comprehensive strategy for the healthcare professions. Whilst acknowledging the funding allocated for A&E allowances and additional services, we need a policy capable of making work in the public sector attractive.”

According to Pierino Di Silverio, national secretary of Anaao Assomed, healthcare expenditure continues to be capped at around 6.3 per cent of GDP – a figure that is “entirely inadequate to ensure the sustainability of the National Health Service”. According to Anaao, the overall framework of the Budget Bill does not decisively address the sector’s main critical issues, foremost among which are the exodus of healthcare professionals and staff shortages: there is a lack of truly effective measures to halt the exodus of doctors and healthcare managers from public hospitals to the private sector or abroad, driven to despair by unsustainable workloads and uncompetitive pay. “The hope is that, during the parliamentary process and in subsequent discussions, there will be scope for substantial amendments. Otherwise, we are ready to take every form of action to protect the profession and public health,” states Di Silverio. According to Guido Quici, president of Cimo-Fesmed, “it is clear that the problem is not merely how much is invested in healthcare, but where those resources are channelled. If we subtract from the allocated amount what is earmarked for the payback scheme, energy efficiency measures, the updating of DRGs and measures for A&E doctors, there is likely to be very little left for healthcare provision. Added to this is what, frankly, looks like a pittance for the over-75s. These are measures that may be necessary and worthy of support, but they do not address what have always been the real priorities identified not only by doctors’ unions but by Minister Schillaci himself: investing in staff and strengthening the National Health Service,” continues Quici.

The position of the presidents of the six regions led by the centre-left is also clear; they have sent a joint letter to the president of the Conference of Regions and Autonomous Provinces, Massimiliano Fedriga, calling for an urgent meeting of the body. At the heart of the request made by the presidents Eugenio Giani (Tuscany), Antonio Decaro (Puglia), Michele De Pascale (Emilia-Romagna), Roberto Fico (Campania), Stefania Proietti (Umbria) and Alessandra Todde (Sardinia) are the serious concerns surrounding the Finance Bill, starting precisely with the sustainability of the National Health Service. The six presidents emphasise that the €2.4 billion earmarked for healthcare in the budget represents “less than half of the €6.8 billion that we, as regions, had indicated was necessary to top up the fund”. This issue of insufficient funding for healthcare is, it is understood, shared by the Conference of Regions itself. The body’s call is therefore to “avoid confrontation” and instead seek a “common position”. The general demand is that the budget be amended. The alternative, warns De Pascale, is “a clash between regions, between the north and the south. At this moment, the northern regions are providing excellent healthcare services to the whole country and must not be weakened”. The point, as Massimo Fabi, Councillor for Health Policy in Emilia-Romagna, also highlights, is that the current allocation of 3.4 billion “does not even allow us to maintain what we have, namely essential levels of care. Two billion are needed just for staff in residential care homes”.