Lombardy: green light for integration between universities and hospitals

The hospital doctors' unions (Cimo and Anaao) were against the more or less creeping clinicalisation of the activities of hospital professionals, especially in Lombardy. But Palazzo Spada, the Council of State, has legitimised the system of functional integration between assistance and teaching carried out in Lombardy without recourse to the Aou, in its ruling no. 904 of 3 February 2026.

The case originates from the challenge to the organisational structure wanted by the Lombardy Region, which does not provide for the establishment of AOUs as typical bodies of the Regional Health Service. Instead, the Lombardy system regulates integration relations through protocols of agreement between the Region and the University, with the performance of care, teaching and research activities within the ASSTs. University integration therefore takes on a functional and conventional nature, based on protocols and agreements, without turning into institutional integration. A model that the plaintiffs considered in conflict with the national regulatory framework outlined by Legislative Decree No. 517/1999 and with the constitutional division of legislative powers.

"We need a guarantee of transparent and merit-based rules for access to senior appointments in university hospital trusts, university polyclinics and IRCCSs'. This was the request that the doctors' union Cimo made to the Working Group on University Hospital Trusts set up at the Ministry of University and Research. Together with a request for a national regulatory intervention to overcome the disparities between university staff and SSN employees. Something is moving on this front. The working group - which listened to the regions, universities, trade unions and operators - has developed a two-level strategy. On the one hand, a National Memorandum of Understanding (pursuant to Article 6, paragraph 7, of Law 240/2010) to stabilise the system pending a broader reform. On the other, the launch of a path for a delegated law that would radically rewrite the relationship between the university and the health service.

"The figure of the hospital doctor is being devalued, exalting instead the figures of academics who appear to be the anchors of rescue for the national health system." This is the alarm cry of the Anaao: "If the health system has not sunk completely, it is due to the work of the managers of the public system who have withstood the shock by providing, over all these years, hundreds of thousands of public health services every day. This is a situation of great unease felt by medical trade unions and important technical-scientific associations, so much so that it has even prompted them to take legal action against administrative, regional and company measures aimed at revising the current negative conditions.

In fact, provision had already been made in the past (law 240/2010, Article 6, paragraph 13), for the drafting of an outline-type convention aimed at defining the relations between universities and the regions with regard to integrated teaching, research and assistance activities. The 'clinicisation' process today seems to know no obstacles, ready to go beyond the walls, and the concept, of the reference hospital, to embrace other hospitals and the territory itself, in the passive acquiescence, if not complicity, of the Regions. In practice, the way is given to generating regional university systems. It is barely worth noting that such a configuration, both organisational and legal, is only permitted by law to special statute regions.