Merit Bill, risk of 'snatching' funds for health care executives

Over the past few days, two documents have attracted the attention of those directly concerned and those working in the public health sector. These are the resolution of the Council of Ministers, which gave the go-ahead for the text of the National Collective Bargaining Agreement for Health Care Managers (Council of Ministers press release no. 159 of 5 February 2026), and the document of the Conference of Regions, which sanctioned the principles underlying the guidelines for the next 2025-2027 bargaining round, which is to be launched shortly and concluded by the end of the year. At the Conference of the Regions, the third and final meeting was held on 4 February between the Sector Committee and the Trade Unions of both the Sector and the Senior Management of the NHS and Local Functions, in order to agree on a document of a political nature. Which consists of two protocols: one referring to all the personnel of the SSN, the other to the technical-administrative personnel of the Regions and SSN. Both protocols were approved the following day by the State-Regions Conference.

Two undoubtedly positive pieces of news to which, however, is added one that has the unbelievable: a passage of the Zangrillo DDL concerning a real expropriation of managers' accessory pay. A quick recap to understand what is happening.

On 28 January, the Chamber of Deputies approved the so-called 'Merit' bill on executive career development and performance evaluation in public administrations (A.C. 2511). This is the PA reform desired by Minister Paolo Zangrillo and now the text passes to the Senate.

On a first reading after presentation, the bill had not shown any interest in healthcare. In fact, the most important and highly publicised rule in the media is contained in Article 12 and significantly modifies Article 28 of Legislative Decree 165/2001, concerning access to the qualification of second level manager. An initial certainty that arises from reading the text is that this form of recruitment does not concern access to SSN management. In fact, for healthcare management there is the special rule in Article 15, paragraph 7, of Legislative Decree 502/1992, which is a primary and exhaustive source for access to healthcare management. For professional, technical and administrative management in the same TUPI there is Article 26, a dedicated rule that has always been distinct from Article 28. It must be assumed, therefore, that for public health personnel nothing will change, at least with regard to recruitment.

However, the text approved by the Chamber contains Article 3, paragraph 1, letter b, which, after establishing that the highest evaluation can be awarded to no more than 30% of managerial staff and another 20% can obtain an "excellent" evaluation, establishes that "the savings resulting from the reduction of performance-related remuneration of managerial staff, are allocated to the increase of resources for performance-related remuneration of non-managerial staff by way of derogation from Article 23, paragraph 2, of Legislative Decree 25 May 2017, no. 75, and distributed according to the modalities defined within the framework of supplementary bargaining on the basis of the guidelines of national collective bargaining'. This is, in practice, to hypothesise a reduction in the funds of managerial staff in favour of those of the sector, effectively limiting the performance-related remuneration of managers to 50%. Moreover, it is clear from the wording of the rule that the reduction does not refer to the year of accrual but is of a stable nature, so that within a few years the amount of the performance fund is completely reduced to zero.