Healthcare spending is rising and now accounts for 6.3 per cent of GDP: the issue of resources is now at the heart of the budget

There is also another important distinction. The 151.7 billion indicated for 2027 represents the healthcare expenditure forecast on the basis of regulations already approved. It does not constitute the new funding that the Government may decide to allocate via the forthcoming Budget Bill. And this is precisely the issue that remains unresolved. The document does not, in fact, specify how much additional funding may be allocated to the National Health Service under the 2027 budget. It will therefore be the Budget Act that clarifies whether new funds will be added to the resources already earmarked, and to what extent.

Meanwhile, the priorities remain those that have the most direct impact on citizens’ lives: local healthcare provision, staffing and waiting lists. At a local level, the document reaffirms the course set out by the NRRP: greater integration between hospitals and local services, the development of community care homes and community hospitals, and the presence of GPs in the new facilities.

The problem, however, is no longer simply about constructing buildings. The real challenge comes afterwards: making them actually work.

The document refers to the resources allocated to the Regions for local care and healthcare infrastructure, but does not specify in this chapter any new structural funding to support the operation of community homes after 2026, nor does it set out a quantified recruitment plan for the new network. And this is where a key aspect of the reform comes into play: a community care home without a sufficient number of doctors, nurses, specialists and other professionals risks remaining a facility that exists on paper but is not fully operational.

There has been some progress on the staff front. The document refers to the proposed national collective agreement for the healthcare sector for 2025–2027, which should enable the payment of pay rises, back pay and allowances, and highlights the new specialist master’s degrees for nurses, including those focused on primary and community care. There are also plans for 1,520 specialisation grants for various healthcare professions, ranging from biologists to pharmacists, and from psychologists to vets. However, the same document, citing European recommendations, acknowledges that in some key professions, staff shortages continue to hinder the provision of timely and accessible care.

Another key issue is waiting lists. The new 2026–2028 National Plan focuses on digitalisation, an increase in the number of monitored services, and the strengthening of safeguards for citizens. Once fully linked to regional systems, the National Waiting List Platform should make it possible to monitor the availability of appointments more directly, as well as ensure compliance with the ban on closing bookings. The new model also places greater emphasis on home care, community care homes and hospitals, palliative care, community pharmacy services and telemedicine.

Finally, there will also be a change in the way we assess whether the regions are actually functioning effectively. The document highlights the trial of a new system of indicators designed to complement the monitoring of essential levels of care (the LEA): not just how much is spent, therefore, but also what results are achieved. Healthcare spending is therefore set to rise, but from 2027 its share of GDP will fall to 6.3 per cent. In the meantime, a new local healthcare system, the necessary staff and a more effective response to waiting lists still need to be funded and made to function.

This is why the forthcoming Budget Bill will be crucial: it must make clear whether sufficient resources will be added to the figures already set out in the document to ensure that reforms and new structures are translated into services that are genuinely available to the public.