Public healthcare: a 33 billion cut to staff numbers over 12 years – burnout, low pay and casual staff are taking their toll

“Between 2012 and 2024, of all the items of public healthcare expenditure, staff costs were the hardest hit. The proportion allocated to permanent and contract staff fell from 39.7 per cent in 2012 to 36.6 per cent in 2024.” This is the assessment presented by the president of the Gimbe Foundation, Nino Cartabellotta, during his keynote lecture in the Aula Magna of the Rectorate at Sapienza University of Rome, as part of the #GIMBE30 event entitled ‘The right to health and the sustainability of the National Health Service: the challenge of human capital’. Assuming that the proportion of expenditure on staff recorded in 2012 (39.7 per cent) remained constant throughout the period 2012–2024, according to Gimbe the full gravity of this reduction becomes apparent: over 12 years, NHS healthcare staff have collectively ‘lost’ over 33 billion euros, of which 38 per cent (12.47 billion) will be lost in the three-year period 2022–2024. ‘A plundering of public resources on such a scale,’ comments Cartabellotta, ‘has progressively weakened and demotivated the NHS’s human capital, fuelling an exodus from the public service and growing disaffection towards certain professions and specialities that are crucial to the functioning of the system.’ For Cartabellotta, “the crucial question is no longer simply how much public funding to invest in healthcare, but who will look after Italia’s health in the future.”

According to the Gimbe analysis, the crisis in the National Health Service can no longer be understood solely in terms of waiting lists, overcrowded A&E departments or regional inequalities. The most critical issue today is human capital: doctors, nurses and healthcare professionals who are leaving the public sector, not even joining it in the first place, taking early retirement and turning to the private sector in search of more lucrative and less gruelling forms of employment. ‘An NHS without professionals,’ says Cartabellotta, ‘is not simply a system in difficulty, but a constitutional right that is progressively losing its ability to translate into care for people. For years we have been discussing funding, facilities, reforms and technologies. But today we are crossing the red line: without staff, financial resources cannot provide care, buildings remain empty, technologies end up as unused investments, and the right to healthcare is being eroded more and more every day.”

“The National Health Service is one of the Republic’s most important assets,” says Antonella Polimeni, Rector of Sapienza University, “because it gives tangible form to the right to healthcare enshrined in the Constitution. It is now clear that its sustainability requires adequate financial resources – which are essential for the functioning of such a vital service – and the full realisation of its human capital: the men and women who, every day, provide care, support, research and a personal touch to people. As a university, we have a duty to train capable, competent professionals who are aware of the social responsibility inherent in healthcare. This is why Sapienza regards healthcare education as an essential driver for the country’s future.”

With 5.4 doctors per 1,000 inhabitants, Italia ranks second among OECD countries (average 3.9). “The paradox,” explains Cartabellotta, “is that over 90,000 doctors do not work within the National Health Service (NHS) as employees or under contract, nor as doctors undergoing specialist training.” The shortages, in fact, are selective and concern general practitioners (over 5,700 of whom will be missing by 1 January 2025) and numerous specialities that are not particularly attractive: emergency and acute care, laboratory disciplines, radiotherapy, nuclear medicine, palliative care, community medicine and primary care. ‘Young doctors,’ Cartabellotta notes, ‘are voting with their choices and are telling us that certain specialities, which are key to the functioning of the NHS, are unattractive, too high-risk, too demanding and undervalued.’ The crux of the problem, therefore, is not just the number of doctors to be trained, but how many we manage to retain in the public sector. “Today,” the President reiterates, “the real emergency is the gradual hollowing out of the NHS: professionals are moving to where they find better economic, organisational and professional conditions that are more compatible with the quality of their private lives.”

But the most critical situation concerns nurses: Italia ranks 23rd out of 31 European countries in the OECD, with 6.9 nurses per 1,000 inhabitants (the OECD average is 9.5). “Above all,” explain representatives from Gimbe, “the profession is no longer attractive and there are fewer and fewer graduates: in the 2025–2026 academic year, the number of applications for places on nursing degree courses was actually lower than the number of places available.” Certainly, the decline in the profession’s appeal is not solely down to pay, although this is certainly a significant factor: in 2023, hospital nurses in Italy earned an average of $45,434 a year, compared with the European average of $63,417, a gap of almost $18,000. Furthermore, since 2013, whilst their real wages have risen in many countries, in Italia they have actually fallen. The most telling indicator of this reduced appeal is the ratio of applications to available places on nursing degree courses: it has plummeted from 1.6 in the 2020–2021 academic year to 0.9 in 2025–2026. ‘When a profession that is essential to the National Health Service can no longer attract young people,’ comments Cartabellotta, ‘the problem lies not with the university, but with the country. It means we are extinguishing the future of public healthcare.’