Covid-19, here’s the truth about our health system
Our health system is not adequate to deal with new clinical emergencies (Covid and beyond). The intervention of Stefano Biasoli, a retired hospital doctor
Only one thing Covid-19 has had good. He highlighted – clear, brutal, exhaustive – that the current NHS is inadequate to deal with the clinical emergencies of the 2000s.
Born in 1978, on the desired ashes of the Inam, to guarantee health to all, the NHS has never been concretely modified in these 42 years, but patched up and retouched over the decades, not always with improvements.
Two examples apply to everyone.
January 1996: “Bocconian” corporatization of healthcare.
January 2001: management regionalization of health, but associated with "deliberate" confusion between national planning / financing and regional management / spending, with consequent health responsibility for the regions.
Regions financed as a% of national GDP but forced – since 2003 – to a real chronic under-financing, with consequent (and little publicized) multi-year cuts on equipment, personnel, training activities.
National contracts signed in constant delay, postponed first from 2002 to 2009 and then from 2009 to 2018-2019.
These are the facts: under-funding, under-staffing, chronic staff discontent.
Aulss / Asl managed very often by pseudomanagers without real / specific management skills; obsolescence of diagnostic and therapy equipment; Consip as a "buffer" to health supplies and not as an entity able to standardize the cost of purchases, from Merano to Pantelleria.
In those years, 7 Regions have accumulated a chronic health deficit, not resolved by the arrival of the Commissioners, even if they are “Nordic” of origin. A wealth of statistics and studies (for example those of Social Security Itineraries) have repeatedly shown – with data – that in the last 20 years the NHS has been reduced to critical conditions due to:
– the desired national under-financing (-35 billion euro in 10 years);
– the indiscriminate cut of hospital beds, reduced to about 1,000 / million inhabitants, even in the North. Indiscriminate cut because it is absolutely free from the explosion of chronic conditions, oncological or non-oncological;
– the reduction of acute pathologies (typical of the seventies) and the increase of multiple pathologies, in single individuals;
-the terrifying cost of oncological drugs and immunosuppressants;
– the cost of radiological, enzymatic / hormonal / viral and genetics diagnostics;
– the poor hospital organization produced by Bocconi's corporatization (attention to costs and not to the quality / cost ratio). But life is priceless;
– the transformation of hospital doctors from professionals to "managers", with the abolition of the hierarchy;
– the "confused" tasks attributed to the nursing staff, especially after the batch of "short degrees" and "organizational masters";
– the lack of valorisation of first aid, pneumology, nephrology, resuscitation that is of the figures involved in the emergency-urgency, especially the most dramatic, multi-organ;
– the lack of "real" separation of the outpatient activity from the "institutional" one on patients;
– the lack of definition of the “modern” role of local doctors (Mmg, paediatricians) in the management of patients entrusted;
– the lack of reform of the health professional associations;
-the questionable professional updating (Ecm) which immediately turned out to be a botched paper and electronic system, devoid of a serious scientific logic and with heavy economic effects for organizers of various backgrounds. I know I'm not making friends with these harsh but true statements. 50 Ecm credits / year, with multiple answers, easily disseminated and copied….!
In short, at least 13 critical issues, known for years, without any politician having seriously proposed to remove them.
I will face them one at a time, calmly, knowing that each of our proposals will produce a reaction from those who do not want to touch the current status of things.
(First part of an in-depth study by Stefano Biasoli)
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/innovazione/covid-19-ecco-la-verita-su-nostro-sistema-sanitario/ on Fri, 21 Aug 2020 05:10:44 +0000.