Territorial care still on the high seas and an undefined role for the health professions

The compass of Ministerial Decree No. 77 of 2022 is not enough to redefine the care offer for a care requirement that has changed profoundly since its enactment. Today the territories have to reckon with a Pnrr that has no funds for personnel, Community Homes and Hospitals that are not known how to populate with healthcare personnel (not only nurses and family doctors but also the 18 professions we represent), planned without specific funds for recruitment, with the unknowns of the new digitalisation set-up that poses a further need for governance, rules and dedicated personnel that cannot disregard the relationship with patients, since they are individuals and not machines.

The opportunities of digital care and innovation from this point of view is a scenario still to be composed: health education, preventive medicine, diagnosis, treatment and rehabilitation of first level and first aid. Let's face it, the reform of territorial care in our country is still a hypothesis, a model to be built net of pilot experiences that work in some more organised regions. It is an open building site with too many unknowns and unresolved knots, from the role of general medicine to the models and standards to be attributed to the new-born organisational articulations defined by the NRP, but only from a theoretical point of view without entering into the organisational and personnel merits.

The role of our 18 health professions is still to be defined, left on the sidelines. Nor does it help that the Regions are doing their own thing in a scenario made up of lights and shadows that light up across the boot, in which the beacon represented by home care - as the first place of care and a protected space with an infinite availability of beds and opportunities for care - still appears tenuous and incapable of univocally directing the reorganisation of this crucial part of health and social care for the elderly and frail disabled. This is a crucial game that must be played by 2026 to avoid improper hospitalisations, encourage protected discharges, and improve the autonomy and functional recovery of so many elderly and frail patients today entrusted to a grid of Levels of Care to be updated and innovated.

Not to mention the territorial imbalances: today, of the 485 community homes with at least one active service, 138 are in Lombardy, 125 in Emilia-Romagna, 62 in Veneto, 42 in Tuscany and 38 in Lazio. Emilia-Romagna is the region with the highest number of Community Houses with doctors and nurses (13 active). The region with the most community homes with all the mandatory services but without the presence of doctors and nurses is Lombardy (46), followed by Emilia-Romagna (26), Latium (13) and Tuscany (11). As far as Community Hospitals with at least one active service are concerned, Veneto is in the lead with 43 out of 71 facilities. They are followed by: Lombardy (25 out of 64 planned); Emilia-Romagna (21 out of 48); Tuscany and Umbria (7 out of 16 planned); Sicily (3 out of 48); Abruzzo, Liguria, Marche and Molise (2 out of 1), Campania and Sardinia (1 out of, 61 and 33 planned). Only the territorial operating centres (Cot) appear to be fully functional and certified. Exceptions are Campania, which has 73 Cot out of 80 and Calabria (20 out of 21); Sardinia (16 out of 24), Tuscany 45 out of 37.

In this scenario, the future of the health professions of the 18 profiles represented by the Tsrm Pstrp Order passes through the relaunch of care in the territory. There are two knots to be unravelled: the lack of a recruitment plan suited to emerging needs and multi-professional assets to be built.