How will the National Health Service change after the PNRR interventions? In 2026, once the implementation of Mission 6 Health of the National Recovery and Resilience Plan is complete, the old NHS as we know it will have a new face: services closer to the citizen, less recourse to hospitals and fewer waiting lists. But where are we at? Taking stock for Adnkronos Salute is Alessio Nardini, Director General of the Mission Unit for the Implementation of the PNRR Interventions of the Ministry of Health. Among the topics discussed, how will the care of citizens change, whether there will be staff for the new structures that will act as a filter for the hospital, the Community Houses and community hospitals and finally whether Italians have really understood how public health will change.
In mid-2024, where are we at Director Nardini? “We have reached all the targets for the Territorial Operations Centers (Cot), Community Houses (CdC) and Community Hospitals (OdC), which were due in the last period of 2023. In the current phase, the data relating to the physical, procedural and financial progress of the individual interventions is being collected, with particular interest in the projects relating to the Cot. The overall remodeling of the Plan provides for the construction and commissioning of at least 480 Cot by 31 December 2024. As of 20 June 2024, work had started and/or supplies were in progress for a total of 1,104 interventions. Of these, 500 refer to projects relating to Cot, 468 to CdC and 136 to OdC”.
“At present, there are 16 CdCs and 5 OdCs for which a test of the correct execution of the works has been carried out and the structures on the territory are gradually being activated, with the implementation of the various assistance provision functions, on the basis of the standards outlined by Ministerial Decree 77/2022, in view of the expected deadline by June 2026 – he continues – As regards the Cot, as of 20 June 2024, 359 had been tested compared to the target of at least 480 operational and functioning by December 2024. More up-to-date data relating to the investment, as of 30 June 2024, show: the start of construction sites/supplies for 530 interventions (Cup or Single Project Code); the conclusion of the works/execution of supplies for 457 interventions (Cup); the testing of 391 interventions (Cup). We have asked the Regions – he specifies – for clarifications regarding the documentation to be produced to satisfy the mechanisms of verification referred to in the Operational Arrangements, aimed at proving the achievement of the European Target M6C1-7, accompanied by a subsequent note containing specific checklists and documentary formats necessary to prove the achievement of the aforementioned target. The requested documentation is currently being acquired – Nardini observes – and will be subject to subsequent evaluation. At present, therefore, it is believed that there are no critical issues preventing the achievement of the outlined targets”.
How will citizen care change? Director Nardini, can you give us a concrete example of the problems Italians have today regarding chronic conditions? “The Ministerial Decree of 23 May 2022, number 77, containing ‘Regulation containing the definition of models and standards for the development of territorial assistance in the National Health Service’, effectively designs a new model of assistance organization. The Regulation will not only affect the territorial level, for which it outlines new organizational models and standards as well as clarifying and ordering the standards for existing assistance settings. The construction of an organizational archetype of assistance that places the person at the center of the entire health system will change the way they are taken care of – he replies – The definition of organizational models such as Community Homes and of professionals employed in the latter, such as Community Nurses, effectively provide for the taking care of all citizens, regardless of their ability to perceive and/or express their need for assistance – he continues – In fact, it is expected to act on the community as a whole, promoting an initiative medicine that, thanks to the aforementioned models and standards, allows in the long term to provide assistance responses also to health and social-health needs unexpressed. This is even more true when referring to chronic or multi-chronic conditions, events that are more present in our national territory, especially following the progressive aging of the population, which has now been underway for several decades”.
A concrete example for the management of chronicity could be represented by the Territorial Operations Centers (Cot). “This center fulfills its role of connection between the various services through specific distinct interdependent functions, which concern the coordination of the care of the person between the services and healthcare professionals, involved in the various care settings, as well as the coordination of the interventions to be provided, also providing for the activation of the subjects and resources of the care network. The Cot – Nardini explains – is therefore also responsible for tracking and monitoring the transitions from one place of care to another or from one clinical care level to another of the patient taken care of, also through information and logistical support to the professionals of the care network. In this context, it therefore provides for the collection, management and monitoring of health data, also through telemedicine tools, of the integrated chronicity pathways (Pic), of patients in home care and the management of the technological support platform for the care of the person. To give a concrete example, consider an elderly patient with chronic or multi-chronic conditions, for whom it is necessary to manage the transition between different levels of care several times in a time frame, even in the short term: home; hospital; residential”.
“The Cot will be responsible for intervening by coordinating all the actors in the system, both district and hospital staff, as well as managing relationships with the emergency/urgency network, to meet all the needs of the patient. In this context, the healthcare workers belonging to the Cot (according to the personnel standards of Ministerial Decree 77/2022: 1 Nursing Coordinator; 3-5 Nurses; 1-2 Support Staff units) will manage the patient’s path, also having the possibility of monitoring their health data, including through telemedicine tools, tracking and monitoring admissions and discharges from one care setting to another”.
#National #Health #Service #change #Pnrr #Whats
