The long goodbye to tokenists burning funds to hire nearly 10,000 doctors and nurses

Unless there are any surprises, such as an extension in extremis, this will be the last summer of the tokenists: doctors (but also nurses) paid by the pound - even up to 1,200 euro - to cover a single eight-hour shift where there are the most shortages, such as in the emergency room, where the staff 'rented' from the cooperatives on average is close to 20% of the workforce, but in some hospitals it exceeds even half of all the medical staff.

For the local health authorities it is a long, difficult and costly farewell: long because the crusade waged by Minister Orazio Schillaci against tokenists began in May 2023 with the bills decree, but then between guidelines and subsequent decrees only at the end of July came the deadline that effectively blocks the signing of new contracts that will now expire in the coming months. Difficult because emergency rooms in the middle of the summer risk not having the staff to guarantee services, even though it will now be possible to sign freelance contracts directly with doctors (without the filter of cooperatives) with costs of 85-100 euro gross per hour. But above all, they are expensive because the bill presented by the tokenists has been very high: according to the latest data from Anac, local health authorities and hospitals have spent 2.141 billion between 2019 and 2024 to cover the holes in the ward with tokenists, a good 457 million in 2024 alone. These resources would be enough to hire 3,000 doctors - which roughly corresponds to the shortage in emergency rooms - and 6,000 nurses (Italy is short of 60,000) on an annual basis, based on the costs of the contracts in force in 2024 (85,000 for doctors and 35,000 for nurses).

A great waste and a shortcut that has been taken because in Italy it is increasingly difficult to find health personnel willing to work in public hospitals. The reasons? "Many calls for tenders are deserted, especially those for emergency rooms, because working in the SSN is no longer attractive, and then there is the spending cap on recruitment, so the regions have more free hands by resorting to the procurement of services such as the use of tokenists," warns Stefano Simonetti, a health expert for Sole 24 Ore. He suggests: 'If the complete abolition of the ceiling is not feasible, a solution could be that of a partial and targeted overrun, i.e. limited to the indispensable hiring of doctors and nurses in the emergency-urgency sector and in the other restricted operating units in agreement with the regions'.

For more than 20 years, the health sector has been grappling with expenditure ceilings: from drugs to recruitment. Schillaci, in the decree on waiting lists issued a year ago, outlined the path to overcoming the one that has been holding back the entry of new doctors and nurses for years, but as often happens, the final implementation steps are missing: from the calculation of regional staffing requirements, which must no longer have the legitimacy of the MEF - as recently sanctioned by the Constitutional Court - to the definition of staffing standards to be calculated with an algorithm that Agenas has already worked on. Now the manoeuvre (see article opposite) could give an initial acceleration by intervening where it is most needed, given that the situation in Italy on health personnel seems really patchy. According to the latest data from the State General Accounting Office's annual account, which has just been published, the number of NHS employees in 2023 grew slightly (+2.8%) to 701,170 doctors, nurses, healthcare workers and administrative staff. But with very striking regional differences: against a national average of 131.57 SSN employees for every 10,000 inhabitants, there are Regions that range from 140 to almost 180 employees in ASLs and hospitals for every 10,000 inhabitants, such as Valle d'Aosta, Friuli, Liguria, Emilia Romagna and Tuscany, and others - especially those that have been under commissioner status for years or are still in the recovery plan - that have just over half, such as Lazio, Campania, Sicily, Molise and Calabria.