The Zangrillo Bill: proposals for the healthcare sector, which is one of the ‘major omissions’

With its publication in the Official Gazette on 4 July, the Zangrillo Law on ‘merit’ came into force. This is a framework measure that does not have any immediate effects or consequences. Although it came into force on 19 July, the law essentially provides for strategic measures concerning the organisation of the public administration. On this last point, the promotion of the law and the accompanying government comments spoke of an epoch-making reform of the public administration that will change everything, make public sector work attractive to young people, guarantee the efficiency and effectiveness of administrative action, and so on – all just more smoke and mirrors.

It all sounds wonderful, but which ‘public administration’ is the Government referring to? If an instrumental synecdoche is being used – assuming it is deliberate and intentional – that may well be acceptable, but the important thing is to be clear. Months ago, when Bill A.C. 2511 was passed by the House of Commons, I had already pointed out that the health service was not in the least bit interested in the new provisions, except for that incredible and unscrupulous manoeuvre which will allow a reduction in funding for senior management in favour of frontline staff, by channelling the savings arising from less-than-excellent performance appraisals. But there is more, because one of the most significant and novel aspects of the reform is the introduction of the possibility of internal career progression, by reserving 30 per cent of managerial posts for a selection process open only to internal staff, as an alternative to the training course and competitive examination organised by the SNA (50 per cent) and the competitive examination conducted by the Ripam (20 per cent).

As mentioned, not all staff at healthcare organisations will be eligible for this opportunity. However, the reform of the procedures for access to senior management positions in the public sector also excludes the majority of local authority staff, as Law 119/2026 has no substantial impact on almost a third of local authorities – namely the approximately 7,500 municipalities without a senior management structure. Nevertheless, even municipal administrations with a medium-sized management team must necessarily have a sufficiently large number of vacancies to be filled to ensure that the 30 per cent quota allocated to career development can be met. One might speculate that the legislator focused primarily – if not exclusively – on ministries and EPNEs, as well as on regions and metropolitan cities.

Having reiterated that the major innovation of the Zangrillo Act does not apply to the health service, consideration should be given to introducing similar legislation to allow it to be applied within health authorities as well, albeit with certain restrictions. Indeed, as regards healthcare management, there is the special provision set out in Article 15(7) of Legislative Decree 502/1992, which constitutes a primary and comprehensive source governing access to healthcare management positions. For professional, technical and administrative management roles, the same TUPI contains Article 26, a dedicated provision that has always been clearly distinct from Article 28 – which has now been reformed – whilst for the healthcare professions, access to management roles is governed by the Prime Ministerial Decree of 25 January 2008.

In all the cases mentioned, promotion to management positions is granted exclusively through a nationwide open competition based on qualifications and examinations. One might therefore ask why the principle of career progression cannot also be extended to staff in the sector classified under the ‘Health Officials and Professionals’ category, namely administrative staff, social workers and healthcare professionals. It could be envisaged that a percentage of the posts provided for in the Staffing Plan could be filled via a career path similar to that for accessing the position of ministerial manager. However, health managers could not be included in this provision for two reasons: firstly, the special provision already mentioned applies to them; and secondly, because, for health executives, there is no prior service within the sector that can be taken into account, as is mandatory for open competitions for access to management roles for PTA positions and for the 22 healthcare professions within the sector.