Nurses and the flat tax on overtime: how to clean up the mess in the budget law

There is no end to the puzzling events surrounding the taxation of nurses' overtime. After the raising of shields by almost all the trade unions against the Revenue Agency's answer no. 272/2025, news began to appear in the press concerning the recoveries that health agencies are activating, especially in Veneto and Piedmont, but there is no reason to believe that these operations are not taking place throughout Italy.

The opportunity to disguise the recovery of undue payments is provided by the payment of arrears due from the entry into force of the 27 October Ccnl. It was evidently felt that it would be less penalising for nurses to recover Irpef - even up to EUR 1,500 - if it were implemented and balanced with the arrears of the contractual renewal. But there is important news, because on 7 November the largest trade union in the health sector had written a formal note of observations to the Agenzia delle Entrate, asking for the opinion to be corrected. The central director of the AdE replied to the CISL that, on 14 November 2025, a request for an opinion had been sent to the Ministry of Health, 'in order to establish whether the compensation paid for 'Hours of readiness' and for 'Services carried out during elections' can be included among the overtime hours referred to in Article 47'.

All well, then? Not by a long shot, because the issue is becoming even more entangled in both method and substance. Regarding the method, the decision to ask the Ministry of Health for an opinion is formally outside the institutional rules. In fact, that ministry has institutional competence over the health professions, the competition regulations of the NHS (decrees n. 483/1997 and n. 220/2001), including the equivalence and affinity of disciplines, but certainly not over collective agreements, the interpretation of which is officially reserved to Aran.

In this regard, a recent opinion on institutional competences regarding the interpretation of rules is interesting. The Court of Auditors, Regional Control Section for Sardinia, in its resolution no. 223/2025/PAR of 15 October 2025, declared inadmissible a question on the Ccnl Funzioni Locali (National Collective Labour Agreement), and the Accounting Body stated that 'the competence lies exclusively with Aran'. In any case, the Mef could have been heard, which is the supervising Ministry of the Agency and, essentially, the custodian of the correct interpretation of the substitute tax. But the interpellant company's interpretative doubts did not concern the purely fiscal aspects but rather the nature of the two forms of overtime, which they presumed to be 'different'. And this contractual issue is outside the knowledge of both ministries.

On the merits, we arrived at the opinion on the opinion, like a second opinion on a complex clinical case. The decision to save itself on the back foot by practically delegating the decision to someone else confirms, in fact, the obvious error of assessment committed by the tax administration. If anything, the opinion should have been sought before issuing Response 272/2025, if one did not know or understand the contents of the collective agreement. Instead, the drafters of the reply considered that they had read the contractual clauses correctly and generated a spiral of controversy from which, in the end, everyone will come out badly.