Healthcare chiefs, because between precariousness and replacements, essential care is at risk
The provisional nature of appointments still unresolved by the national collective agreement shakes not only the right to stable appointments but also the proper provision of essential levels of care and the smooth running of the structure
The system of managerial appointments is a cornerstone of the employment relationship of managers in the National Health Service, both healthcare managers and professional, technical and administrative (Pta) managers. The system has its origins in the first collective contracts of 1996, but it found its structuring especially in the national collective contracts of 8 June 2000, especially for healthcare executives for whom just a few months earlier legislative decree 229/1999 - the delegated Bindi decree - had completely overhauled the structure of healthcare management by introducing, as is well known, the principle that 'healthcare management is placed in a single role, distinguished by professional profiles, and in a single level, articulated in relation to the various professional and managerial responsibilities'.
All the contracts subsequent to 2000 have intervened on the system of appointments, with modifications and adjustments, but it remains a work in progress, so much so that in paragraph 3 b) of the Guideline Act of 26 February last, it is specified that "bargaining will have to complete and make the system of appointments fully operational", a system that has existed for thirty years.
The "replacements" node
A peculiar aspect of the system is the institution of 'substitutions', an indispensable tool to ensure the continuity of administrative assistance and action. Nonetheless, the contractual clauses regulating substitutions have long had obvious criticalities that, for a variety of reasons, cannot - or will not - be overcome. Insiders are more or less aware of the real or latent reasons for this state of affairs, but what one read on 9 March in a national newspaper has something special about it. It concerns a large Tuscan hospital-university company where there are 23 complex health structures assigned to acting managers, about 20% of the organisation chart.
The reasons are various and also involve situations external to the company, but the rather anomalous fact remains that it could also call into question the proper provision of the Essential Levels of Care (LEA), the serenity of care, and the smooth running of the structure. Like all forms of precarious work, this one too generates organisational criticalities and, in the event of accidents or events with a criminal profile, the provisional nature of the assignment - which is sometimes long - certainly does not put the Public Prosecutor's Office of the Court of Auditors and the Republic in the best position to clarify the facts that have occurred.
The right to a stable assignment
Of course, apart from the sacrosanct rights of the person concerned to have a stable assignment of at least five years, as prescribed by the employment contract, internal interpersonal relations can also be critical: an acting head may have weaknesses in running the structure or in relating within the department with the other head teachers. They are also critical in terms of the internal interpersonal relations, which can be critical in terms of the way the head teacher manages the structure or in relating within the department with the other head teachers
The situation is certainly not isolated or exceptional: there are dozens of 'acting' 'primari' in Italian healthcare companies for six, seven or more years. In a major structure in the north of Italia, there is a director of a complex structure who accumulates six positions, and even in the strategic directorates there are acting administrative or health directors, or who even have interim responsibility for line structures.
