Medical and nursing contracts, the long shadow of staff shortages on renewals

The contents of future contracts will always be conditioned by an independent variable that is the real problem in healthcare: the organic shortages.

It is unfortunately illusory to talk about tools such as the four-day week, age management, and work/life balance if we lack the personnel necessary to implement organisational innovations.

The malaise among health personnel is generalised and turns into dislike for the profession itself.

One thinks of the issue of the working hours of medical managers, which will plausibly be the crux of the renewal.

Article 27 of the Ccnl of 23.1.2024 tried to resolve a long-standing and very complicated dispute with the provision of the famous algorithm and no less than five different working time configurations.

But the system was already precarious and provisional at the time and did not at all resolve the issue of excess hours that are 'nevertheless' generated physiologically due to the shortage of managers, especially doctors. The solutions, as seems evident, are extra-contractual and the decision makers - State and individual Regions - will have to take note that whatever innovation the new contract envisages, its implementation is conditioned by factual situations that are external to mere normative and economic treatment.

For one thing, by the time it is realised that hospital housing is as important as, and perhaps more so than, university housing, it will always be too late.

Nonetheless, a situation bordering on the unsustainable must be pointed out, which concerns health personnel and which not even the best contractual renewal will be able to resolve. For doctors and nurses, it is no longer just a question of salary increases or better working conditions, but of completely reviewing their very presence in the public health service.

I have referred to two specific professions but, in general, the critical issues concern all NHS staff, even administrative staff.

If doctors and nurses are mentioned, it is because of their numbers (they alone make up 54% of the total number of personnel belonging to 56 different professional profiles: approximately 120,000 doctors and 270,000 nurses) and because of the absolute difficulty of recruiting them but, above all, of retaining them in the public service. It is precisely this last aspect that is increasingly critical, and with a few examples from the field the context may become clearer.

Let us start with recruitment. The attractiveness of competitions in health care companies is at an all-time low, not least because of the competition from many foreign countries and the private sector, which is ruthless and now winning. Consider the issue of service accommodation. Recently there have been dozens of job offers on the Internet for nurses with 'free accommodation', plus the 14th and various fringe benefits, while the public health service makes timid attempts, sometimes in collaboration with municipalities, to find available premises.

A local health authority recently published a notice on the market to find housing solutions in hotels and other accommodation facilities for its employees at favourable prices. A Veneto border local health authority, on the sidelines of a conference on 'Social Housing', reported that there are 438 employees of the company who have taken up residence outside the province, 45% of whom are outside the region, and resorting to a few temporary or emergency guesthouses no longer resolves the situation. It does not take much to realise that we are in two parallel universes light years apart.

Some of the interventions are appreciable, such as the pre-salary forms or training vouchers for students adopted by some regions; others are frankly unrealistic, such as the abstruse cross-border tax invented by the budget law two years ago.

Another issue in which the public sector is losing out is that of the timeliness of recruitment, indeed even of 'pre-recruitment', in the sense of headhunters searching our universities well before graduation.

As a result, nursing students - whose course cost around EUR 30,000 from the public purse - are being approached by observers from Germany, Switzerland and Norway for what one trade union has effectively called 'theft of healthcare talent'.

While the Lombardy Region invests almost one million euros to train and acquire nurses in Uzbekistan.

In conclusion, it is certainly not the contractual renewal that will be able to resolve all the existing critical issues by itself, it being understood, of course, that pay and decent working conditions are essential as a starting point and minimum basis for real improvement. But the salvation of the public health service must pass through other measures, many of which are structural in nature.

Investments are needed that certainly require a lot of financial resources but some of them can be implemented at zero cost.

The training and employment contract, to be signed in the penultimate year of the degree course, applies to everyone, but clearly the conditions are not in place to seriously and definitively tackle the problem.