Community homes get underway: a flurry of openings in the final stretch, but there’s the uncertainty over doctors

The target is very close – in fact, it has practically been reached: over 1,300 community health centres and hospitals are officially open in time for the final whistle, set by the EU for today as the deadline for spending the three billion allocated under the NRRP to build these new local healthcare facilities.

The 30 June deadline set by Brussels had, in fact, set a minimum target of opening at least 1,038 community care homes and 307 community hospitals, and the data currently being verified by experts at the Ministry of Health is giving cause forsense of cautious optimism that this target will be met. The focus is on those facilities that have declared themselves fully operational, with the collection of documentation set to continue over the coming days – for community care homes alone, over 17,000 ‘documents’ are expected to be sent to Brussels – but the latest official figures are positive: whilst in mid-June there were just over 800 community homes for which the regions had officially declared operational status, by last Friday the figure had reached 900, suggesting that the target of 1,038 facilities might just be met. In fact, health officials estimate that the European target could be exceeded, with a total of 1,200 facilities opening immediately (there are over 1,700 community homes in the pipeline, though without specific deadlines). The situation is very similar for community hospitals, which had already reached 290 last Friday against a target of 307; in short, here too the target is truly within reach.

This is why the Ministry of Health is breathing a sigh of relief, as demonstrated by the satisfaction expressed by Minister Orazio Schillaci, who told *Il Sole 24 Ore* that they had “worked hard on this target. We have always been optimistic. The work we are doing involves supporting the regions and carrying out continuous monitoring. I would like to thank the Ministry’s departments for their great commitment, but also the regions. The challenge posed by the NRRP was immense and far too important to let the opportunity slip away. When it wants to, this country knows how to stand united and can focus squarely on the goal. Now we’re working flat out on staffing. We’ve finalised the agreement with GPs, but we must all work together with conviction to turn a new page for local healthcare.’

It is precisely this agreement with GPs – which was finalised at the eleventh hour and provides for a maximum of six hours’ work per week in community care homes, with shifts of no less than three hours for those doctors not already working in the district – that could prove to be a thorn in the side. The crux of the matter, as shown by Agenas’s monitoring, is managing to staff these facilities and ensure all services are up and running – last December, only 4 per cent of community care homes had all their services fully operational – and the government’s U-turn on the reform decree, which also provided for the employment of GPs to be hired for the new facilities, could put more than one community care home at risk of failure. The agreement may not be enough, as Lombardy’s Welfare Councillor Guido Bertolaso explained in recent days, describing it as a ‘stopgap’ given that, at present, only 17% of medical staff are guaranteed to be GPs: ‘We will try to ensure the agreement, which was reached at the eleventh hour, is implemented. If anything can be achieved by the end of this year, it will be a great result, but we are not counting on it; in the meantime, we have organised ourselves differently to provide staff for our community homes.’

Another key issue for the new local healthcare system could be the disparity between the northern regions – where there are more facilities already up and running – and those in the south, which are lagging behind or have lower targets. Taking community homes alone as an example, as at 30 June, Lombardy already had 186 operational facilities, whilst Veneto had 102 and Lazio 115, compared, for instance, with the 42 operational in Puglia and the 48 under construction in Calabria, theoperational status is still unknown; whilst in Sicily, 54 community homes are reportedly operational out of the 146 planned, with a further 27 having been completed and currently being brought into operation.