Adnkronos (Adnkronos) – The bill delegating powers to the Government to reorganize and strengthen local and hospital care and to revise the organizational model of the National Health Service (NHS) demonstrates a desire to modernize the NHS, but presents critical issues of method and substance. It lacks "a correct and shared diagnosis, the objectives to be achieved, and the necessary reform actions."
This is what Salutequità highlighted during the hearing before the Senate Committee on Social Affairs, Health, Public and Private Employment, and Social Security on Delegated Bill 1825, regarding the reform of the National Health Service.
According to Salutequità, the main limitation of the measure is the lack of an updated diagnosis of the country's and the National Health Service's health status.
The bill is being presented without a new Report on the country's health status, which is limited to the years 2017-2021 and published in 2022, despite it being an essential tool for assessing the population's health, resources employed, results achieved, implementation of regional plans, and guidelines for healthcare programming.
Added to this is the lack of an updated National Health Plan: the last one dates back to 2006-2008, while the new 2025-2027 Plan, repeatedly heralded as a priority, is not yet available in a public draft. The Health Pact is also stuck in 2019-2021 and has been extended by law. "We proceed directly to the treatment to be administered by the National Health Service without first sharing the diagnosis," observes Tonino Aceti, president of Salutequità.
To be effective, a reform of this magnitude should begin with an updated, transparent, and participatory assessment of the healthcare system's needs, critical issues, and objectives. Among the main critical issues, according to Salutequità, is Parliament's limited role. The bill requires draft legislative decrees to be submitted to parliamentary committees for a non-binding opinion, with a deadline of just thirty days. For Salutequità, a structural reform of the NHS requires full centrality from Parliament, along with the involvement of the Regions, patient associations, and all healthcare system stakeholders. Another issue is the timing, which is difficult to sustain in the version currently in the bill. The December 31, 2026, deadline for adopting the legislative decrees is unrealistic, considering that the bill is still being approved, the implementing decrees must be written, the economic impacts must be quantified, the coverage identified, the approval from the Ministry of Economy and Finance must be obtained, an agreement reached at the State-Regions Conference, and parliamentary opinions must be gathered.
Another critical aspect is the provision that implementing the mandates should not result in new or increased burdens on public finances. For Salutequità, this approach risks rendering the reform ineffective or destined to remain on paper. The bill envisages significant interventions, such as updating community care standards, introducing tertiary hospitals, establishing staffing standards for residential and semi-residential care, and new standards for the care of complex chronic patients. These measures are difficult to implement without additional, reliable resources. Salutequità also highlights a hospital-centric bias in the measure. The most specific and concrete guidelines concern hospital care, with the introduction of tertiary hospitals, elective hospitals, and new time-dependent networks.
Even the only financial resources earmarked for this purpose are concentrated in this direction, while community care, citizens, and the principle of equity are marginalized in the text. "The bill," Aceti adds, "also contains few truly structural innovations. There is no mention of revising healthcare reimbursement mechanisms, shifting from a performance-based approach to one based on diagnostic-therapeutic pathways and health outcomes. There is also a lack of strengthening systems for monitoring and evaluating the performance of healthcare services and treatment outcomes, especially in the community." For these reasons, Salutequità proposes three priority steps.
First: rapidly draft and publish an updated report on the country's health status, to provide certified evidence on the population's health, the implementation of health policies, and the necessary guidance for planning interventions. Second: rapidly approve the new National Health Plan, accompanying it with resources dedicated to its implementation, with a central role for Parliament and the effective involvement of Regions, patient associations, and other NHS stakeholders. Third: develop a legislative reform of the NHS based on realistic timelines, a leading role for Parliament, the participation of institutional and social stakeholders, a multidimensional impact assessment, and secure financial coverage. "The National Health Service needs reform, but not reforms in the dark," Aceti emphasizes. "First, we need to update the diagnosis, define shared objectives, measure the impact on citizens' rights and system accessibility, and secure the necessary resources. Only in this way can the reform truly strengthen the NHS and not simply enunciate principles destined to remain unimplemented," he concludes.
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