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From foreign nurses to autonomy: Lombardy thermometer of personnel choices

The final halt by the Regional Administrative Court on the recognition of foreign medical qualifications and the resumption of the Calderoli bill signal that the exercise of the health professions will continue to be regulated uniformly throughout the country

by Stefano Simonetti

3 April 2026

3' min read

Translated by AI

Versione italiana

3' min read

Translated by AI

Versione italiana

In the past few days, two events concerning healthcare in the Region of Lombardy have hit the headlines, albeit in rather different terms. These are the ruling of the Regional Administrative Tribunal on the recognition of the qualifications of foreign health workers and the resumption of the path for the implementation of differentiated autonomy. In reality, the two events could in the future overlap and, like an institutional matryoshka, be one contained within the other.

The stop on foreign securities

Judgement no. 2941 of 15.9.2025 of the Lombardy Regional Administrative Court, section III, has now become final, since six months have passed since it was filed without an appeal by the Region. This ruling, following an appeal by the National Federation of Physicians' and Dentists' Associations (Fnomceo), annulled the Lombardy Region's decisions on the recruitment of foreign doctors and specialists through a merely formal recognition of qualifications obtained abroad, without a substantial assessment of the skills acquired.

The administrative judges held that the regional resolution, which was the subject of the appeal, had exceeded the limits of the derogation provided for by Article 15 of Law 56/2023, converting the so-called 'bills decree', by introducing an alternative regulation to the national one that did not require aptitude, competence, substantial capacity and registration in a professional register by professionals with qualifications obtained abroad.

The collective interest

The judgement in question annulled Lombardy Regional Council Decree No. XII/3392 of 11 November 2023, which had introduced a highly simplified procedure for the authorisation of the temporary exercise in Italia, with qualifications obtained abroad, of a list of medical specialisations, later extended by a subsequent executive decree. This was in order to protect the public's interest in not being exposed to the exercise of the medical art by 'potentially unqualified' subjects.

According to the administrative judges, the Region had, moreover, exceeded the limits of the derogation provided for by the legislation, introducing in substance 'an alternative discipline to that dictated by the national legislature, which obliterates in practice the substantive verification of the competences of professionals with qualifications obtained abroad'.

It is only worth mentioning that the conversion into law of the 'Milleproroghe' decree has in fact provided that the provisional and precarious regime for the recognition of foreign health qualifications will be in force for another four years - six in total.

L’Autonomia

With regard to the second event, it should be noted that on 2 April last, eight favourable opinions were rendered (points 5 to 12 of the minutes of the meeting) by the Unified Conference on the preliminary draft agreements between the Government and the Regions of Liguria, Lombardy, Piedmont and Veneto, approved by the Council of Ministers on 18 February last and concerning the subject 'protection of health - coordination of public finance', pursuant to Article 116, paragraph 3, of the Constitution and in implementation of Law 86/2024, the so-called 'Calderoli Law'. The texts in question - all seven articles are essentially the same - concern five specific aspects: the identification of reimbursement rates, the autonomous management of resources transferred by the State for investments, the establishment and management of supplementary health funds, the allocation of resources to health companies for the recruitment of health personnel and for the increase of additional services, and a different allocation of national tied resources.

Professionals at the centre

Why was it said at the beginning that the two subjects might overlap? For the simple reason that among the 23 subjects that may be the subject of differentiated autonomy agreements, contained in paragraphs 2 (3 subjects) and 3 (as many as 20 subjects) of Article 117 of the Constitution, is that concerning the 'professions'. Nevertheless, in a further outline of an agreement to be dealt with in the CU, three particular subjects are identified, namely civil protection, the professions and supplementary social security. And it is interesting to note that in Article 7 concerning the 'Discipline of the professions of regional importance', paragraph 2 states that 'health professions and their typical activities are excluded'. In essence, the exercise of the profession of doctor or nurse will continue to be regulated in a uniform and mandatory manner throughout the country. The decision taken by the Lombardy Administrative Judges regarding the issue referred to at the beginning is therefore even more interesting.

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