Caregiver protection, integrative welfare and social prescription anti-crisis levers in healthcare

The ageing of the population, the disintegration of family and social networks, and the growing pressure on health services outline a scenario in which the National Health Service alone can no longer bear the weight of the demand for health. The IV Report of the Health Observatory, through the Health Proximity Index, provides a multidimensional reading of this trajectory: a framework that crosses health, social and economic domains to measure how effectively the system is able to respond to people's real needs, and not only those intercepted by the services. From the integrated analysis of these domains, three lines of reform emerge clearly, which can no longer be postponed, and which are united by the same basic logic: to shift the centre of gravity of the care provision from the strictly health perimeter to the extended social and health system, going beyond the trajectory already traced by Ministerial Decree 77, which reorganised care at the territorial level.

The intersection between the erosion of social cohesion and the signs of the system's unsustainability, starting with the now structural overload of general practitioners, makes full recognition of the figure of the family caregiver, the silent pillar of care for the non-self-sufficient elderly, a matter of urgency today. An organic reform must go beyond the necessary economic and contributory support, building an infrastructure of skills that also enhances intermediate professional figures: social and health workers with expanded responsibilities, capable of intercepting and managing the social needs of the frail population before they become clinical needs. It is in this intermediate band, between informal assistance and medicalisation, that a widespread care provision can be enabled, relieving the SSN of the avoidable accesses that today saturate emergency rooms and short admissions, and that originate from the social, non-health components of the elderly condition.

When one reads together the signs of isolation and loneliness (of the elderly population as much as of the young), the data on the economic fragility of families, and the persistent gaps of territorial homogeneity in the supply of services, social prescription emerges as a reform tool with low marginal cost and high preventive potential. It is a matter of prescribing, with the same dignity as a drug or an examination, inclusion in community activities, walking groups, cultural paths, voluntary experiences. Social prescription is structurally integrated with urban planning and territorial services, restoring centrality to the role of municipalities and social workers, and requires rethinking public space in opposition to the 'one-size-fits-all' model that has fragmented contemporary sociality. The objective is to intercept loneliness at an early stage, support the construction of a life plan and prevent acute drift in terms of mental health, depression, cognitive decline of the elderly. It is not additional welfare: it is health prevention in the strictest sense of the term.

The intersection between the growing burden of chronicity, the increase in the renunciation of treatment for economic reasons and the now evident limits of sustainability of the public health welfare system places integrative welfare among the resources that can no longer be postponed in the national health ecosystem, to be promoted in its most authentic form: that of solidaristic, inclusive and intergenerational mutuality. It is worth remembering that before the 1978 reform, mutual insurance funds were the original form of implementation of the mandate of Article 32 of the Constitution: mutuality is therefore not a foreign body to the constitutional design, but a fully compatible historical declination of it. Today it can represent the structural complementarity that the system lacks, on condition that it overcomes the restrictive 'integrative' reading, expands the number of beneficiaries, valorises non-profit forms and systematically supports prevention and long-term care programmes.

Reformed caregiving, social prescription, mutualistic welfare are the components of a single redesign of the care pact, in which the NHS returns to its essential core and the enlarged social and health system takes over what today's health system improperly absorbs. These perspectives will be discussed on 11 June 2026, at the ISMA Room of the Senate of the Republic, on the occasion of the presentation of the IV Report "Health that changes: new needs, new answers" by the Health Wellbeing and Resilience Observatory, at the initiative of Sen. Francesco Zaffini. An opportunity to bring back to the public debate the complexity and urgency of a reform that does not only concern healthcare, but the overall resilience of our model of social cohesion.