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Public health assets: the regions are struggling to spend the funds allocated. Reports

12 months ago babelfish

Public health assets: the regions are struggling to spend the funds allocated. Reports

Public health assets: the parliamentary hearing of the Court of Auditors on building renovation and technological modernization

The Covid 19 pandemic has turned the spotlight on the health conditions of the national health system. The stress test to which our country has been subjected has highlighted the need for interventions in the field of building renovation and technological modernization of the public health heritage, in addition to the construction of residences for the elderly and non self-sufficient people, interventions, moreover, already started more than 30 Years ago. The renewal of healthcare facilities is one of the chapters of the PNRRhttps://www.startmag.it/economia/ecco-come-la-corte-dei-conti-si-spacca-sul-pnrr/ and, in fact, on these issues it is the Court of Auditors intervened during the " Hearing in the context of the fact-finding investigation on the building renovation and technological modernization of the public health assets in the framework of mission 6 of the PNRR ".

THE DELAYS OF THE REGIONS

During its hearing, the Court underlined that not all regions have drawn up a careful inventory of existing structures and equipment in order to define " a mapping that feeds intervention plans consistent with needs ". The Court traces the reasons for these shortcomings to the shortcomings of the "technical capabilities of its structures", which have caused delays "in the management of program agreements".

The accounting magistrates list the reasons that ask for an efficient planning of interventions to improve assistance, among these:

  • reduce maintenance costs;
  • adequately respond to the thrust of environmental and energy policies;
  • calibrate interventions on the need to strengthen territorial assistance;
  • overcome critical issues related to the age of the heritage;
  • economize on the costs incurred for the rents of the premises used;
  • to secure the structures from seismic risks.

THE NUMBERS OF PUBLIC HEALTHCARE ASSETS

The building stock of the NHS companies, as illustrated by the hearing data, is made up of 4,058 structures for a total area of ​​over 17 million square metres. The average size of the real estate units intended for welfare activities is equal to 4,240 m2. This heritage is not uniform but has numerous territorial differences: the regions of both the North-West and the North-East have the largest dimensions (with the exception of Liguria). “Lombardy (8,879 m2), Piedmont (8,469 m2) and, even if to a lesser extent, Emilia-Romagna (6,400 m2) are the regions that record the highest values ​​- reads the hearing -; the dimensions of the structures of smaller regions (Molise, Friuli and Trentino-Alto Adige) are also relevant”.

HEALTHCARE COMPANIES HAVE USED CURRENT RESOURCES FOR INVESTMENTS

Some aspects, more than others, attract the Court's attention. In recent years, many healthcare companies have used their own resources to meet investment and equipment needs. “This translated into the use of current account resources transferred to be used for investments – reads the Court's report -. A solution which, considering the growing needs for the coverage of health needs in the face of resources that tend to return to more contained profiles, such as those prior to the pandemic, risks affecting the quality of services".

FUNDS RESERVED FOR THE COVID 19 EMERGENCY

The Court also highlights how difficulties have also emerged in the implementation of projects associated with particular emergencies, as happened during the Covid 19 pandemic. For the strengthening of the hospital network, the Relaunch decree (legislative decree 34/2020) authorized "a total expenditure of 1.5 billion, of which 1,413 million for the construction of intensive and semi-intensive care beds, for electro-medical equipment and medical aid vehicles and 54.4 million for the construction of movable intensive care structures " . The loan can be used for:

  • interventions on new or existing buildings;
  • the acquisition of electromedical equipment, aimed at increasing the structural endowment on the national territory by at least 3,500 intensive care beds , bringing all regions to an endowment of 0.14 beds per thousand inhabitants;
  • redevelop 4,225 beds in a semi-intensive area, with the relative plant equipment suitable for supporting ventilation aids, through the adaptation and restructuring of units in the medical area, providing that these stations are usable both in the ordinary regime and in the treatment regime intensive care infectious diseases.

THE DIFFICULTIES IN IMPLEMENTING PROJECTS ASSOCIATED WITH COVID 19

At the end of March 2023 only "234 requests for the disbursement of funds arrived, of which 31 for the reimbursement of expenses incurred during the first health emergency and, in any case, pertaining to the regional plans for the reorganization of the hospital network, 203 for the transfer of funds necessary for the launch and progress of the interventions to strengthen the hospital network". 365.2 million were transferred to the regions against the 422 million requested . Furthermore, in "three years only 30 per cent of the resources have been paid and with strong differences at the territorial level". And “of the 255 projects surveyed relating to 234 implementing subjects, 185 presented the first request for funds, but only 37 the second, indicating a still unsatisfactory state of progress”.

DELAYS OF PROJECTS ALREADY SUBSCRIBED

Delays have not only accumulated in the use of resources not yet assigned but in the implementation of projects already signed. “We need to work on project implementation times, studying how to improve and speed up all the different phases – reads the text of the hearing -. The examination of the agreements defined before 2010, based on the resources allocated by the CIPE, presents a somewhat worrying situation”. The Court then goes into the details of the figures. “Of the 10.8 billion allocated to the agreements, 9.2 billion have been subscribed to date (net of waivers). These are agreements that provided for 2,369 interventions. To date, the number of interventions admitted to financing are 1,962 for an amount of 8.7 billion – the magistrates continue -. More than a decade later, more than 500 million remain to be financed on this front. Of the interventions admitted, just over 84 percent (on average) are now operational with start-up”. These percentages are not valid throughout the national territory, the operating rate "drops to less than 67 per cent in the Center and 74 per cent in the South" and this "compared to values ​​above 95 per cent in the North".

This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/economia/patrimonio-sanitario-pubblico-le-regioni-fanno-fatica-a-spendere-i-fondi-stanziati-report/ on Sun, 04 Jun 2023 06:07:43 +0000.