SSn Shipyard

Public health needs resources, programmes and personnel: the appeal of 130 associations

A ten-point document analyses the priorities between funds to be increased and the enhancement of human resources and primary care, and calls for the exclusion of health care from the subjects of differentiated autonomy

by Health Review

29 April 2025

3' min read

3' min read

A document that 'denounces the government's inertia in the face of the malaise of operators and citizens', divided into two parts: in the first part it illustrates the measures needed to relaunch the SSN - including adequate resources, staff development, strengthening of primary care, financing of the non-self-sufficiency reform - while in the second part it turns the spotlight on the 'serious repercussions that differentiated autonomy will have on health protection'.

The Civil Society Choir

It is the document 'We cannot remain silent. Civil society for public health', the result of the work of 130 associations, including Associazione Salute Diritto Fondamentale, Associazione Giovanni Bissoni, Laboss- Laboratorio Salute e Sanità, Associazione Alessandro Liberati, Prima la Comunità, Salute Internazionale, Cittadinanzattiva, Gruppo Abele, Forum Disuguaglianze e Diversità, along with many others. A text illustrated in Rome at a meeting in which, among others, doyens and well-known faces of Italian healthcare took part, including Nerina Dirindin, Vasco Errani, Rosy Bindi, Don Virginio Colmegna, Elena Granaglia and Roberto Traversa.

The text identifies ten fundamental points for the relaunch of the National Health Service and reaffirms the principles and values underpinning the National Health Service, a fundamental instrument for the protection of the constitutional right to health.

The Ten Points of the Document

1. The decline of the SSN is not irreversible. The second pillar - the so-called 'supplementary' care of funds and insurance companies - is not the solution. We need choices that are consistent with constitutional dictates, the priorities expressed by the population, and scientific evidence.

2. The SSN must be able to count on adequate resources to guarantee the 'incompressible' right to health, reduce the enormous gaps with respect to the main European countries and bridge the gaps within it, and restore confidence (and answers) to the population. It must recover planning, guidance and control capacities at all levels of government and strengthen the production and direct provision of services and care pathways by public facilities, gradually reducing recourse to private providers.

3. Resources must be allocated to priority areas of intervention, first and foremost to NHS staff at all levels, prevention, primary care and home care, particularly for dependent and disabled persons.

Personnel policies cannot continue to be subject to anachronistic spending ceilings that cause perverse effects that are all too well known. It is necessary to adjust allocations and remuneration, improve working conditions, promote training and opportunities for professional and career development.

4. Health funds must be redirected to the general interest, preventing the creation of inequities and inefficiencies, limiting tax benefits to truly supplementary funds and preserving their non-profit character even in the management of the fees paid.

5. There is a need for the development and solid reorganisation of primary care, articulated by socio-medical districts, for proximity care, against the epidemic of chronicity, which effectively takes care of people in an integrated and proactive manner, with the participation of the population through Community Homes and District government.

The implementation of the care reform for the non-self-sufficient cannot be postponed any longer: adjust the financing of the Fund for non-self-sufficiency, ensure public governance of all interventions, give effective priority to home care and overcome the severe limitations of the universal experiment.

6. The governance of pharmaceutical care requires the regular review of prices and medicines charged to the SSN, the adoption of strict criteria for the evaluation of innovative medicines, the promotion of appropriateness in prescription and consumption. It is necessary to support at European level the creation of a public infrastructure for research and production of drugs and vaccines.

7. One Health: health in all policies, to tackle the social and commercial determinants of health; to strengthen health protection in the living and working environment; to activate actions targeted at environmental risks related to pollution and climate change.

8. The Constitutional Court's ruling No. 192 of November 2024 on differentiated autonomy had a "massive demolishing effect" on the Calderoli law.

The model must necessarily be 'cooperative' (and not dual) and must take into account the inalienable principles of solidarity, equalisation, unity of policies, and equal right of access.
Entire blocks of subjects or areas of them cannot be transferred, but only individual functions and only after a thorough investigation that highlights the benefits to the community (and not to the individual region).
Lep subjects must be adequately financed to guarantee fundamental rights throughout the country. No Lep matters simply do not exist.

9. Health is to be excluded from differentiated autonomy.

10. After Judgment 192/2024, the role of Parliament is crucial. Promote a bill for a correct interpretation of Article 116(3) of the Constitution.

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