Health professions

Sociologists and social workers, management and contract still uncertain

Amid regulatory gaps and delays and inter-professional conflict, thousands of NHS workers are still waiting for clear rules on the contractual area of reference and on profile and access to top positions

by Stefano Simonetti

5 September 2025

5' min read

5' min read

For the 700,000 public health workers, all kinds of problems and inconveniences arise every day. The contractual and salary problems are well known, as well as the problem of staff shortages and deserted competitions for certain profiles. There is also a certain inter-professional conflict that has found its deflagration point in Article 1 of the 'Health Care Benefits' Bill (AS 1241). No one is excluded from these issues, even though it seems that the collective imagination and insiders count almost exclusively on doctors and nurses.

Widespread Diseases

The other health professions in the sector also often make claims, and the case of social and health workers (Oss) is emblematic. Who are unhappy about everything. It was a few weeks ago that another profession, that of social workers, raised its shields. The National Council of Associations of Social Workers (Cnoas) published a document on the 'Guidelines on the Management of the Professional Social Service and on the Social Worker Manager in Health Authorities and Hospitals'.

There are almost 48,000 social workers in Italy and about 5,000 of them work in health care companies. The Council is a public body and has no trade union prerogatives within its functions. The document was taken up by the president of Sunas - this is a trade union - who reviewed all the problems currently affecting the social work profession. It should be pointed out, however, that the critical issues do not concern the social workers in the sector but rather the few who have been granted access to management. And, in this last regard, it is necessary to take a few steps back, because the situation is really complicated.

The Management Law

Articles 6 and 7 of Law No. 251/2000 established the new professional profile of manager for each of the four areas envisaged by the same law (nursing-obstetrics, technical-healthcare, rehabilitation, prevention), delegating the Government to adopt the regulations for competitions in the new single qualification of manager of the health role, which could be accessed with requirements similar to those required for access to the management of the SSN as per art. 26 of Legislative Decree No. 29/1993 (now 165/2001), i.e. management of the professional, technical and administrative roles.

This assimilation should come as no surprise, since for healthcare management regulated by Article 15 of Legislative Decree 502/1992, access requires a master's degree and specialisation. The regulatory framework was completed - after a good eight years - with the entry into force of the Dpcm of 25 January 2008, which dictated, precisely, the competition regulations for access. It was only by virtue of a later amendment that the professional social service manager was also provided for. The amendments to Law 251/2000 were made by Article 2-sexies of Law 138/2004, which assimilated the managerial figure of the social worker with the health care figure established four years earlier. Nonetheless, the changes only occurred in Article 7, which is the transitional rule, and not in Article 6, which is the regime rule.

This unfortunate loophole led to the failure to define the competition regulations. The aforementioned Law 138, on the other hand, was the conversion of Decree-Law 81/2008, the same decree that introduced the reversibility of the option for intramural freelancing, one of the qualifying points of the Berlusconi Government 2. Probably, the legislator was more attentive to the affairs of the doctors and the issue of the assistant manager was dealt with superficially because it is true that the profile was established during the conversion, but, as mentioned, the law lacked the delegation of powers relating to the competition regulations.

What management for social workers

The situation to date is controversial, if not discouraging. The management profile mentioned suffers from certain pathologies that no one is resolving:

- for the holding of open competitions for permanent social worker managers, recourse is made 'by analogy' to the already mentioned 2008 Dpcm, in the absence of specific legislation;

- with regard to recruitment with fixed-term appointments - permitted by Article 7 of Law 251/2000 - the impediments for public notice are the same as for competition. This leaves only recourse to Article 15-septies, where, however, there is a further difficulty, which in my opinion is insurmountable. Having discounted the obvious inapplicability of paragraph 1, one would have to use paragraph 2, which refers to "five per cent of the organic endowment of professional, technical and administrative management", and the social worker, as is well known, is placed from 2021 in the new sociomedical role together with the sociologist and the OSS, who was, moreover, the real recipient of the hasty amendment to Article 34, paragraph 9-ter, of Law 106/2021.

- Finally, the reference to the new role opens up the, to say the least, controversial scenario of contractual placement.

The role of Aran

With regard to what was specified in the last point, it is worth mentioning the Aran note prot. E 0003497/2020 of 26.5.2020, in which a reply was given to a query of the Cnoas and it was established that provisionally, until the relative competition regulations are issued, the managerial coordination appointments of social workers would fall within the appointments of the health professions and therefore subject to the contractual regulations of the Ccnl of the Health Care Area. Incredibly, this opinion continues to be the only applicative reference, since even the Ccnl of the Health Care Area of 23.1.2024 did not include the figure of the Executive Social Worker in the declaratory list of executives covered by the contract. The content of the note referred to above was repeated in Application Guideline ID 25626 (Previous ID: Asan25a) of 4.11.2020.

The Aran opinion of 2020 is entirely interlocutory, speaks of a transitional phase and uses the conditional. The exclusive competence to specify where the new profiles go lies with the CCNQ for the definition of sectors and areas, which until a few weeks ago had said nothing on the issue, as for the sociologist. But in the most recent CCNQ signed in Preintesa on 17 June, the situation has changed and it is enough to read Article 7, whose paragraph 5 continues undaunted to provide in the Health Area the traditional 8 profiles to which only the managers of the nursing and technical health professions are added. Conversely, what is new is the inclusion in the Area of the health executives of the former university polyclinics that were previously placed in the Education and Research Area, while it is clearly stated 'with the exclusion of administrative, technical and professional executives and of the socio-health role', in line with what was previously said in paragraph 3.

The June Pre-agreement was also signed by the CSE, a confederation to which Sunas adheres, so the game seems to be definitively closed, and perhaps someone should ask themselves whether this is all accidental or unintentional, or whether the truth is that the medical unions do not want social workers or sociologists at their table.

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