Gimbe Report

Pnrr Health Mission: 5 out of 14 targets are overdue and 82% of funds are unspent

As of Q2 2025, all formal deadlines are met: the country collects the instalments but a race against time is needed to ensure benefits for citizens

by Health Review

29 July 2025

8' min read

Key points

Roadmap as at 30 June 2026
Target clearly delayed
Targets with significant delays
Targets being completed or already completed
Targets not assessable due to unavailable data

8' min read

"As of 30 June 2025, the four deadlines for the NRP Health Mission have been met by the end of Q2, including two European ones. However, one year after the final reporting, beyond the formal compliance with the deadlines and the collection of instalments, the actual spending of resources and the real progress of the objectives are proceeding extremely slowly and with unacceptable inequalities between the Regions". This was stated by Nino Cartabellotta, president of the Gimbe Foundation, emphasising that of the 14 measures to be completed by June 2026, "at least 5 present critical implementation issues, while for 5 the publicly available information is insufficient to assess their progress. 4 measures are almost completed or already achieved'. According to the data published on the portal of the Ministry of Health, which monitors the implementation of the PNRR's Health Mission, on 30 June 2025 the two European deadlines on the funding of research projects and all the previous ones had been reached. "However," Cartabellotta explains, "meeting the formal deadlines, which is necessary for the go-ahead for the disbursement of instalments, is not a reliable indicator of the real progress of projects at this final stage. For this reason, one year before the deadline, the GIMBE Observatory's independent monitoring of the implementation of the PNRR's Health Mission focused on the real status of progress of the 14 European objectives still to be achieved: 3 by December 2025 and 11 by June 2026.

"We believe it is fundamental," Cartabellotta comments, "to offer citizens a clear picture based on objective data, safe from political instrumentalisation. At the same time, we urge the government, the regions and the ASLs to share responsibility, making efforts converge on a final sprint that will be a race against time".

Roadmap as at 30 June 2026

Resources to be spent. According to the Report on the State of Implementation of the NRP of the Court of Auditors, published on 15 May, as of 31 December 2024 € 12.81 billion, equal to 82% of the allocated resources, were still to be spent. A percentage that places the Health Mission in second-to-last place in terms of expenditure incurred (18%), ahead only of Mission 5 (Inclusion and Cohesion) at 15.9%. "These numbers," Cartabellotta comments, "document that a decisive impulse is needed to complete projects and transform the resources to be spent into services, with no room for delays or inertia. In fact, according to the Court of Auditors, to complete the financial implementation of Missions 5 and 6, in the absence of slippage, a spending pace more than seven times higher than that of the entire three-year period 2022-2024 will be required between January 2025 and June 2026.

Targets to be reached by 30 June 2026. The Ministry of Health website, on the occasion of the payment of the 7th and 8th instalments, reports that 13 targets and 1 milestone must be reached to complete the Health Mission: 3 targets by 31 December 2025 for the 9th instalment to be disbursed; 10 targets and 1 milestone by 30 June 2026 to collect the 10th instalment. "The real crux," explains Cartabellotta, "is that 30 June 2026 does not only mark the formal completion of the targets, but coincides with the actual delivery of all the facilities and services financed by the NRP, which should translate into a concrete improvement in healthcare.

The GIMBE Foundation, in the impossibility of public access to the ReGis system, analysed the progress status of the targets to be reached by June 2026 using all available institutional sources as at 28 July 2025: Corte dei Conti, Ufficio Parlamentare di Bilancio, Ministry of Health, Department for Digital Transformation, Agenas. 'It is likely,' Cartabellotta comments, 'that some projects are further ahead than reported. But at the same time it is unrealistic to imagine that, even for data updated to December 2024, in just six months such exploits have been made as to make up for the accumulated delays, especially in the regions that are furthest behind'.

Target significantly delayed

In addition to the expansion of intensive and semi-intensive care beds, it is the reorganisation of territorial care that is the most critical objective. In fact, the Agenas Monitoring data, updated to 20 December 2024, document substantial delays in the full activation of Community Homes and Hospitals.

Community Homes. The target is that by 30 June 2026 at least 1,038 Community Homes should be fully operational, equipped with services and health personnel. However, as of December 2024, only 164 facilities (15.8%) had activated all the planned services and, of these, only 46 (4.4%) had medical and nursing staff. In 485 facilities (46.7%), only one service was active, while the remaining 389 Community Homes (37.5%) did not have any services activated. "Beyond the delays in structural and technological completion," warns Cartabellotta, "the serious shortage of nurses and the failure to reach an agreement with family doctors to work in the Case di Comunità (Community Homes) are worrying. Thus the great challenge of territorial reform risks remaining a colossal health building project or being entrusted to the private sector'.

Community Hospitals. By June 2026, at least 307 Community Hospitals, the intermediate facilities for receiving patients discharged from acute hospitals, should be fully functional. But as of 20 December 2024, only 124 facilities (40.4 per cent) declared at least one active service and no information on healthcare personnel is reported. "It is clear," comments President Gimbe, "that the activation of Community Hospitals is even more delayed and the objective of strengthening intermediate care is in danger of foundering.

Intensive care and semi-intensive care beds. The NRP provides for the activation of 2,692 intensive care and 3,230 semi-intensive care beds by June 2026. However, as of 21 March 2025, only 890 intensive care beds (33.1%) and 1,199 semi-intensive care beds (37.1%) have been activated. 'It is surreal,' the President concludes, 'that, despite the drastic downward revision of the initial objectives, five years after the pandemic, Italy has still not managed to complete an infrastructure that is essential for dealing with future health emergencies.

Targets with significant delays

Despite the advances, 2 other targets show delays on the roadmap.

Earthquake-proofing interventions. To make at least 84 hospitals safe, the PNRR has financed earthquake-proofing interventions throughout the country. As of February 2025, 86 construction sites were active or completed, but the actual expenditure incurred stood at 11% of the total, with an even lower average in southern Italy (6%).

Adoption of the ESF in all regions. By June 2026, all regions should adopt and use the ESF. However, as of March 2025, only 6 out of 16 documents are available in all regions (hospital discharge letter, laboratory and radiology reports, pharmaceutical and specialist prescriptions, and emergency room report). Moreover, only 42% of citizens gave consent to consult their data. "Without informing citizens about the usefulness of the ESF," warns Cartabellotta, "and reassuring them about the safety of the data, despite the achievement of the PNRR target, the potential of this tool risks being thwarted by citizens' lack of consent".

Targets being completed or already completed

Four targets are at an advanced stage of implementation or completed in advance.

Projects for the renovation and modernisation of hospitals (ex Art. 20): disbursement of at least 90% of € 250 million. As of 21 March 2025, 127 projects totalling € 458.1 million had been financed. "Exceeding the theoretical funding threshold would certify that the target has been reached," Cartabellotta emphasises, "but a reconnaissance is underway because it is not clear how many projects fall within the PNRR perimeter.

Integrated Home Assistance (ADI) in the over-65s. The target is to increase patients in ADI by at least 842,000 compared to 2019. The figure for the end of 2024 certifies that the target was exceeded a full 18 months before the deadline, with 900,853 more patients being taken care of.

Large healthcare equipment. Of the 3,223 planned machines, as of 31 January 2025, 3,126 (97%) had been ordered, 2,578 (80%) delivered and 2,482 (77%) tested. The target, referring to the testing of equipment, is therefore close to completion.

Specialist training contracts. As of the academic year 2020-21, EUR 538 million has been allocated for the 4,200 medical-specialist training contracts under the target. The target is formally completed.

Targets not assessable due to unavailable data

For some targets, no up-to-date publicly available sources have been identified, making it impossible to assess their implementation status. 'We consider it indispensable,' Cartabellotta comments, 'that all data on the progress of NRP projects should be made publicly available. In a democratic country, transparency is not a technical detail, but the first instrument of public accountability and trust between institutions and citizens'.

At least 300,000 people cared for with telemedicine tools. The deadline is 31 December 2025, but no official data on the number of patients cared for with telemedicine tools are available to date. In the first quarter of 2025, data collection via the National Telemedicine Platform was started and tenders for infrastructure and workstations were completed.

Digitisation of 280 DEA hospitals. This target also has a deadline of 31 December 2025. There is no public data on the hospitals that have already been digitised, whereas as of 25 February 2025, all contracts had been awarded. However, the amount invoiced nationally is only 21% of the total.

Feeding of the Electronic Health Record (ESF) by General Practitioners. By 31 December 2025, 85% of GPs should regularly feed the ESF. However, there is no public data to assess compliance with this target. The only information available is that 95 per cent of GPs and Pediatricians of Free Choice (PFCs) accessed the ESF at least once in the last quarter monitored. "Without precise data on the feeding of the FSE," Cartabellotta observes, "it is impossible to assess the active role of family doctors. In particular, with respect to the Synthetic Health Profile (so-called Patient Summary), the document where the GP summarises and keeps up-to-date the patient's clinical history in order to favour continuity of care".

Electronic Health Card and ESF interoperability. By June 2026 the system is to be fully operational. At the beginning of 2025, the technical infrastructure for the interoperability of health data between the regions was activated and, in March, the decree establishing the new Health Data Ecosystem was published in the Official Gazette.

Training on management and digital skills for 4,500 health professionals. Even for this goal, to be achieved by June 2026, no public data are available on the number of professionals who have already completed the training. "The final sprint of the Health Mission," Cartabellotta comments, "cannot turn into a political battleground because the responsibilities fall on everyone: on the Conte government, which, due to time constraints and the ongoing pandemic, did not provide for more rigorous and closer monitoring of various targets; on the Meloni government, which first wavered on the real usefulness of some measures (e.g. Community Homes) and then hesitated on the real usefulness of some measures (e.g. the new Health Mission, which is now in its final phase). Case di Comunità) and then limited itself to celebrating the collection of the instalments, without exerting constant pressure on the Regions and ASLs, the 'implementing entities' called upon to complete the projects. The responsibility for the final sprint is collective and requires a convergence of efforts, with no room for playing the blame game'.