Beyond Covid-19. Emergency after the emergency
Ever since last March 31st, Italy has been out of the pandemic emergency. However, we are in the midst of another emergency: the one generated by the lack of health services for all other pathologies, with particular reference to the most serious ones.
The Eurispes-Enpam Observatory on Health, Welfare and Legality wants to turn the spotlight on the impact of this phenomenon on the National Health System and, above all, on the lack of citizens’ right to health, which risks becoming even more acute.
Forgotten diseases: non-Covid pathologies
Several groups have already taken action to denounce and quantify this phenomenon. In the first emergency phase (of total closure), as far as the NHS is concerned, all activities not considered emergencies (outpatient and DH) were blocked, with elective admissions excluding oncological ones. There was also a decrease of up to more than 50% in the demand for services for serious pathologies such as myocardial infarction, stroke and emergency surgery, as well as a lack of/reduced assistance for chronic conditions, followed in ambulatory or DH (communication to the Ministry of Health by the Italian College of Surgeons – June 2020).
In September 2021, SIC, the Italian Society of Surgery, spoke of 400,000 general surgery operations and 1.3 million cancelled admissions in 2020 alone, with a similar trend in 2021 for specialist procedures, with around 1 million operations being frozen. Waiting lists compared to 2019 had lengthened by further months: from 3 to 6. The elective activity had decreased by about 80%.
The Federation of Oncologists, Cardiologists, Haematologists (F.O.C.E), pointed out in early 2021 the need to vaccinate frail patients regardless of their age and the risks involved in postponing screenings, specialist consultations and surgeries. The Italian Association of Medical Oncology (AIOM), called for a “recovery plan” against collateral damage caused by the pandemic.
In September, the Permanent Forum on the National Health System in the post-Covid, attested, in the “4th Salutequità Report” of June 2020, more than 1.3 million less hospital admissions compared to 2019; urgent hospitalisations also dropped: -554.123. The Report shows an 80% reduction in the elective surgical activity and up to 35% reduction in the emergency surgical activity. General Surgery, Otolaryngology and Vascular Surgery were the areas most affected, while oncological surgery admissions saw an 80% decrease in the number of elective surgical activities. Radiotherapy admissions were also reduced by 15% and chemotherapy admissions by 10%. In the cardiovascular field, the decrease was about 20%.
The estimate, based also on recent AGENAS data, is that hospitalisations in the medical area for complex and relapsing chronic patients were reduced by approximately 600,000 compared to 2019. Ambulatory specialisation saw a contraction of 144.5 million services: about 90 million less laboratory services, 8 million less rehabilitation services, 20 million less diagnostic services. Cancer screenings suffered numerous cancellations and delays, such as cervical screenings actually carried out (-43.4%), mammograms performed (-37.6%), colonoscopies for colorectal cancer (-45.5%).
AGENAS “acknowledged” in mid-2021 that in 2020 a total of 750,000 fellow citizens had to withdraw from an operation (-14% of urgent ones and -26% of ordinary ones). At the beginning of 2022 still came the denunciation of FoSsc, the Forum of Scientific Societies of Italian Hospital and University Clinicians, regarding the failure to resume cancer screening and the inability to strengthen emergency-urgent diagnosis and treatment services.
Addressing the emergency of health care deficits
It is necessary to point out that Mission 6 of the PNRR (for the reorganisation of the National Health System) does not even mention potential interventions to restore at least that quo-ante status in hospital facilities that would be decisive to be able to return to providing the most essential services to citizens. Even today (autumn 2022), Mission 6 has no feet to stand on, since the new Ministerial Decree 70 is still missing, and Ministerial Decree 77 was only approved at the end of last June.
The challenges related to the retrieval of the waiting lists created during the period of the Covid-19 emergency were addressed by the former Government with Decree-Law No. 104 of 2020, which provided for specific allocations, amounting to 112.406 million euros, for hospitalisation, and approximately 365.812 million euros for the restoration of outpatient services. In the “Sostegni-bis” decree, converted into Law No. 106 of 23 July 2021, the topic of waiting lists was once again addressed, in order to allow for a greater recovery of both hospitalisation services for acute cases in elective regimes and outpatient specialist services not provided by accredited public and private facilities in 2020. To implement these purposes, the Regions and Autonomous Provinces may use the unutilezed resources of the year 2020.
The 2022 Budget Law, in order to ensure the full implementation of the Operational Plan for the Recovery of Waiting Lists, authorises a total expenditure of 500 million euros, of which a maximum amount of 150 million euros, possibly increasable on the basis of specific regional needs, may be used to involve accredited private facilities.
Overall, almost 1 billion euros has been allocated to the recovery plans between 2021 and the beginning of 2022.
In spite of the new funds provided, which – like previous ones granted – would not be used immediately, much too little has still been done to restore an acceptable usability of hospitals and outpatient clinics.
Check-ups, visits, hospitalisation and waivers. The Eurispes-Enpam survey
An attempt was made to investigate how the health situation has influenced citizens’ relationship with the National Health System and the management of their health status over the past year. The survey was carried out on a sample of 2,026 people representative of the population aged 18 and over.
Forty-four per cent of the sample stated that they avoided check-ups so as not to be in places where there was a risk of Covid infection (hospitals, doctors’ offices, etc.). One third of the respondents have had surgery or treatment postponed due to the unavailability of healthcare facilities, slightly fewer, 31.8%, have encountered difficulties in finding healthcare after contracting Covid, and 28.5%, when faced with a health problem, have refrained from check-ups and/or examinations for fear of contracting Covid in healthcare facilities.
The Eurispes-Enpam Observatory on Health, Welfare and Legality’s recommendations
Recovering lost performance and restoring the normal flow of NHS activity is certainly one of the most important challenges the new Government has to face.
Therefore, in order to address the issue of performance recovery for non-Covid pathologies, the Eurispes-Enpam Observatory on Health, Welfare and Legality has coordinated meetings with important members of the medical world and developed a number of recommendations and suggestions on how to proceed. In particular: encouraging a greater proactiveness of the health authorities in bed management – in order to free up space, equipment and operating theatres – with specific guidelines from the Ministry and a concrete control action by the regional departments, while respecting the autonomy of the health authorities; recovering the staff of nurses and health assistants for ordinary activities and establishing an extraordinary plan that is centrally structured and managed at a regional level with the involvement of the contracted and accredited health authorities in a coordinated effort to restore health screening and diagnostics. The extraordinary mobilisation of general medicine for the compilation of criteria and lists of diagnostic priorities of their patients is fundamental, as is the provision of technological equipment for general practitioners’ offices, in accordance with the 2020 Stability Law, to make them more efficient. Furthermore, it is suggested that an institutional advertising campaign be launched by the Ministry (taken up in the local media by the Regions) that signals the need/opportunity to return to regular medical check-ups.
The full study can be consulted online at the following link https://eurispes.eu/ricerca-rapporto/oltre-il-covid-19-il-sistema-sanitario-nazionale-di-fronte-al-tema-del-recupero-prestazionale/
For info: ufficiostampa@eurispes.eu
