After several months spent debating on the proposed National Recovery and Resilience Plan, on 30th April 2021 the NRRP was sent to the European Commission (Chamber of Deputies, 2021). The Plan is entitled “Italy tomorrow” and is divided into four parts: the first describes the general objectives and the structure of the plan itself, the second concerns reforms and investments and contains six missions on which the action of the NRRP focuses, the third part examines its implementation and monitoring and the last section carries out an assessment of the macroeconomic impact of the plan.
The six Missions on which the Italian reform plan intends to focus are: digitisation, innovation, competitiveness and culture; green revolution and ecological transition; infrastructure for sustainable mobility; education and research; inclusion and cohesion; health.
Let's look at the configuration of the last mission: health. Several critical issues have emerged during the last year, characterised by the explosion of the Covid-19 pandemic. These include a strong territorial disparity in the provision of services, poor integration between social, hospital and territorial services, high waiting times and inability to achieve safety strategies in the face of environmental, climatic and health risks. Taking all these critical issues into consideration, we intend to respond through an action to modernise the system, guarantee equal access to health services throughout the national territory and funding of scientific research. The final goal is the strengthening of the National Health Service (NHS), to better respond to the needs for care of citizens. The amount of resources dedicated to this mission is equal to 15,63 billion euros.
The Mission is divided into two components. The first is entitled “Proximity networks, intermediate structures and telemedicine for territorial health care” and aims to strengthen the services provided by strengthening local structures and home care. The planned investment for this component is equal to 7,0 billion euros. The second section of “Innovation, Research and Digitisation of the National Health Service” and aims to enhance the NHS in terms of human and technological resources, improve the scientific research sector in the medical field and, finally, identify a center of excellence for pandemics. The investment for this intervention is equal to 9,63 billion euros.
The first component envisages a reform that aims to define the organisational and technological standards for structures and local assistance (by 31st October 2021) and a new institutional set-up for health policies and activities (by the end of 2022). The reform was accompanied by three investments. The first aims at the activation of 1,288 Community Houses, within the first half of 2026, so that they act as a reference center for the management of the care of the sick at a territorial level. The second investment, on the other hand, aims at enhancing the provision of home care services, with the aim of reaching at least 10% of the population at the regional level and, above all, individuals over 65 with chronic or non-self-sufficient diseases. The activation of 602 Territorial Operational Centres (COTs) which coordinate home services with other health services is also expected to strengthen home care services. The third investment involves the development of intermediate care, that is the activation of Community Hospitals: health facilities able to accommodate patients who need “medical interventions of medium/low clinical intensity and for short-term hospitalisations” (PNRR, 2021) with few beds available, managed almost entirely at the nursing level.
The second component of the Mission includes a reform action that aims to reorganise the Scientific Hospitalisation and Care Institutes (SHCI) and to update the research policies of the Ministry of Health through a review of the regulatory and legal framework. The reorganisation of the SHCI will see a division of competences of a more competitive type and will aim at the creation of a network between Institutes, aimed at guaranteeing a continuous exchange of specialist skills between the SHCI and with the structures of the NHS.
Together with the reform, the second component envisages, as the first objective, to bring a technological and digital modernisation to the National Health System through the purchase of new equipment, interventions for the enhancement of the safety of hospital structures and the strengthening of the technological infrastructure and tools for data collection and processing. This will be possible through the integration of the patient’s health documents into the Electronic Health Record and the strengthening of the New Health Information System (NHIS). The latter is responsible for conducting analyses for the Ministry of Health, in order to monitor the ELA (Essential Levels of Assistance) and plan health care services for the population.
The second objective of Component 2 is to work on Scientific Research and technology transfer, aiming at the development of technical, professional, digital and managerial skills of the health system personnel. This provides funding for: research projects in the field of rare diseases and oncology; Proof of Concept (PoC) projects that aim to reduce the gap between the research sector and the application for industrial purposes; post-graduate specialisations for medical graduates, scholarships in general medicine and the activation of courses for the acquisition of skills, addressed to the directors of NHS bodies.
Finally, returning from the pandemic year, the need was felt to identify a centre of excellence for epidemics, specialised in the treatment and containment of these diseases.
Translated by Lucica Oana Maris
Sources consulted for the drafting of this article:
- Piano Nazionale di Ripresa e Resilienza (PNRR), Roma, 25/4/2021: https://www.governo.it/sites/governo.it/files/PNRR.pdf;
- Piano Nazionale di Ripresa e Resilienza (PNRR), Documentazione Parlamentare, Camera dei deputati, 7/05/2021: https://temi.camera.it/leg18/provvedimento/piano-nazionale-di-ripresa-e-resilienza.html;