Access to care, from Salutequità 19 actions to make the LEAs effective

Better measure organized screening programs, also considering the lesions identified, as well as the coverage achieved for the elderly not only in the flu vaccination, but in all those provided for by the new National Plan (antipneumococcal and against Herpes Zoster). And again: guarantee complete compliance with the rules of the National Waiting List Government Plan, recovering the services missed during the pandemic. These are just some of the “19 actions” proposed by Salutequità to guarantee greater equity with the New Guarantee System (NSG) of the Essential Levels of Assistance, contained in a report created thanks to the unconditional contribution of the Servier Group in Italy and presented today in Rome .

For waiting lists – we read in the report – there are only two indicators, one 'core' and one 'non-core', and neither of the two verifies and guarantees complete compliance with the rules of the National Waiting List Government Plan, and there is nothing on the recovery of lost benefits during the pandemic. The level of renunciation of care for the measurement of social equity is still considered 'no core', while for Salutequità experts it should become 'core' due to its ability to provide robust information on the role of the Regions in eliminating or reduce health disparities to a minimum, as well as guarantee access, without any discrimination, to healthcare services. Also missing from the 'core' indicators – continues the report – are those on the prevention and management of clinical risk and the various levels of safety in hospitals, on the monitoring of healthcare-related infections, on the humanisation of care in hospitals and, a very hot topic at this moment, on waiting times in the emergency room (where not even the application of the triage guidelines is 'under control') and for hospital admission. Nothing among the 'core' indicators on adherence to therapies, on the implementation of the National Chronicity Plan also with indicators of the diagnostic-therapeutic care pathways (Pdta) and with the verification of the quality, accessibility and equity of assistance for people with illnesses rare.

We must then introduce and put in the foreground – underlines Salutequità – the verification of territorial assistance (family doctors and paediatricians, family and community nurses, continuity of care, compliance with decree 77/2022 for the reorganization of territorial assistance for as regards additional nursing, medical and other healthcare profession personnel) and, for integrated home care, among other checks, the composition of the teams and the hours of patient care. Just as it should be included among the 'core' indicators – the report continues – those on compliance with the standards and staffing needs in all the structures designed by the Pnrr (and indicated in the application decrees) and for the palliative care network, also with the related financing. Then the stratification of the population (demography changes the horizons of care) and the whole chapter of telemedicine, teleassistance and the electronic health record.

To avoid inequalities, Salutequità recommends providing an agile, flexible and dynamic updating system for the monitoring indicators currently envisaged by the decree; integrate the composition of the Lea Committee with the participation of lay members (today “the controller is also the controlled”); guarantee greater timeliness and dynamism in the publication of Lea scores, reviewing the current 'final' timing (31 December of the following year and not as now that the data still refers to 2019); implement the provision of the 'Lea strengthening intervention' by the Regions as envisaged by the 2019-2021 Health Pact; define the thresholds of each indicator in a challenging way, verify all further Lea obligations in a substantial way; modernize, strengthen and integrate the 'core' subset of the New LEA guarantee system with new indicators.