Gimbe: invisible cuts to the National Health Service, delays in treatment and disillusioned doctors

“The National Health Service continues to deliver good health outcomes, in particular high life expectancy and low preventable mortality, but it has lost its ability to provide care in an equitable and timely manner. Structural underfunding, regional and social inequalities, and a severe staffing crisis are progressively eroding the principles of universality, equality and equity”. This is how Nino Cartabellotta, president of the Gimbe Foundation, presented the 9th Report on the National Health Service to the Chamber of Deputies, adding that “today, those who can afford it pay, whilst those who cannot either wait or forgo consultations and tests”.

“Nominal funding has certainly increased,” explains Cartabellotta, “but the share of national wealth allocated to the National Health Service has fallen. This is the phenomenon of ‘invisible cuts’: not nominal cuts, but fewer resources than the NHS would have received had the 2022 ratio of the Health Fund to GDP remained unchanged.” Over the period 2023–2026, the National Health Fund (FSN) increased by 17.5 billion, rising from 125.4 billion in 2022 to 142.9 billion in 2026. However, the picture changes if funding is measured against the wealth generated by the country: in 2022, the FSN accounted for 6.27 per cent of GDP; in subsequent years, this share remained around 6 per cent, with the exception of 6.14 per cent in 2026. If, during the period 2023–2026, the FSN/GDP ratio had remained constant at the 2022 level, the National Health Service would have had an additional 18.8 billion at its disposal. Furthermore, according to Cartabellotta, there is another figure that should not be overlooked: between 2010 and 2026, the nominal National Health Fund (FSN) grew by 37.5 billion, but, when adjusted for general ISTAT inflation, funding in 2026 has essentially returned to 2010 levels. “Meanwhile,” continues Gimbe’s president, “the needs of an ageing population have increased, as have the costs of pharmaceutical and technological innovations. Merely publicising the billions allocated is not enough to demonstrate that the NHS is adequately funded.”

The 2026 Public Finance Policy Document (Dpfp), approved on 2 October, forecasts an increase in healthcare expenditure in nominal terms, but a decline from 6.4 per cent of GDP in 2026 to 6.3 per cent in 2027–2029. The estimates confirm that there is no reversal of the trend: on the contrary, the proportion of the country’s wealth allocated to healthcare is decreasing. Furthermore, over the three-year period 2027–2029, the gap between expenditure forecasts and the size of the National Health Fund (FSN) widens further: 7.6 billion in 2027, 10.7 billion in 2028 and €14 billion in 2029, amounting to a cumulative shortfall of 32.3 billion. “Since it is the State’s responsibility to ensure the funding of Essential Healthcare Services (LEA),” notes Cartabellotta, “the crux of the matter is to understand what resources will be used to bridge this gap. In the absence of further funding, the burden will fall entirely on the regions’ budgets, which, in order to keep their accounts in order, will have only two options: to raise taxes or to cut services. In both cases, the cost will once again be borne by the public.”

In 2025, total healthcare expenditure stands at 190.1 billion: 140.8 billion in public spending, 42.4 billion borne by households and almost 7 billion channelled through healthcare funds, insurance companies and other bodies. Compared with 2024, the Gimbe report notes, out-of-pocket expenditure falls by 1 per cent (-434 million), whilst expenditure channelled through intermediaries rises by 10.1 per cent (+642 million). In particular, expenditure on voluntary health insurance rose by 12.7 per cent, from 4.69 to 5.29 billion. “If the public service is scaled back,” Cartabellotta points out, “funds and insurance companies risk becoming a fast track for those with cover. We need rules, transparency and oversight to ensure that supplementary healthcare complements the protections provided by the National Health Service, without replacing them or exacerbating inequalities.”

In 2025, expenditure on permanent and contract healthcare staff totalled 52.2 billion, but its share of public healthcare expenditure fell from 39.7 per cent in 2012 to 36.9 per cent. If this proportion had remained unchanged over the years, according to Gimbe, an additional 36.8 billion would have been allocated to staff between 2012 and 2025, of which 23.9 billion would have been allocated between 2020 and 2025. The report clarifies that this is not a nominal cut, but rather the cumulative difference compared with a hypothetical scenario. The figures indicate that, by now, one in four doctors and one in five nurses do not work within the National Health Service.