by Daniele Bovi
“Particularly off target”. This is how the regional network of birth centers is judged in the White Paper on regional health; a ‘photograph’ of the state of the art taken at the end of 2019 and a starting point for the elaboration of the 12 strategic lines which form the basis of the new regional health plan.
The experts The document was also produced with the support of a series of experts such as Antonella Pinzauti, general manager of Welfare enterprises (which reports to Confartigianato) for the area relating to socio-health integration, the former minister Renato Balduzzi and the Professor Francesco Longo (professor of the Research Center on the management of health and social assistance at Bocconi and member of the Higher Council of Health) for the changes to the institutional structure and Claudio Saccavini (of the Veneto Center for Research and Innovation for Digital Health), for the area of digital health promotion.
The birth points The theme of birth points, as seen abundantly in recent years in Umbria, is politically explosive. Each of them (eight in all in Umbria) must respect a series of parameters, in particular a minimum of 500 births per year; minimum volumes strictly related to security levels. According to the data in the Book, relating to the three-year period 2017-2019, in Umbria more than one in four births (27%) was registered in structures with less than 500 births per year. For example, 246 in Pantalla, 475 in Branca, 498 in Spoleto and 403 in Orvieto. In 2019 there were 6,083 births, more than half of which between Perugia (1,915) and Terni (1,097), and the numbers are decreasing (almost 6,500 births in 2017). An exemption in 2018 was granted for Branca and Orvieto, while nothing had arrived from the Ministry regarding the identical request made for Pantalla whose department, note the writers of the Book, at the end of 2019 “was still open despite the fact that the Ministry had expressed an unfavorable opinion “. Over 300, on the other hand, are women who every year decide to give birth in a nearby region, in particular Lazio and Tuscany (about 800 are those who arrive each year from another region).
Mobility Among the main critical points highlighted there is the balance – negative – between active and passive mobility, that is, the cost of Umbrians who decide to take care of themselves outside the region. The “considerable decrease” in active mobility and “the increase in the flight of patients to neighboring regions” is not a new fact: in the White Paper it is emphasized that it is starting from 2014 that, while active mobility decreases, the passive one increases, passing from a positive balance of over 20 million in 2014 to a negative one of 3.3 million in 2019. The Umbrians decide to be treated outside the region “for orthopedic services, hip and knee orthopedic prostheses, rehabilitation, surgical oncology and surgery pediatric. In some cases – it is said in the document – the flight of patients, given the volumes of activity, is “physiological”; in other cases it is possible to make corrections ».
Attractiveness and social plan Among the causes is an insufficient attractiveness of the regional health system towards professionals, who go to work in other regions or in the private sector. Two problems – lack of attractiveness and passive mobility – which could be partially solved thanks to the establishment of the IRCCS, which is one of the 12 approved strategic lines. Among the critical points is also the fact that, for the most part, the last Social Plan approved in 2017 remained unimplemented “due to the failure to draw up the area’s social plans. Other critical issues – it is written in the document – can be found in poor socio-health integration and in the lack of alignment of health planning with social planning ».
The network Central is obviously the chapter of the territorial articulation of the system, made up in Umbria of 15 hospitals and two hospitals; a network that is “excessively articulated and not in all cases compliant with the parameters set at central level”. In general, the number of beds complies with the standards (3.69 per thousand inhabitants against the 3.7 indicated), but with a slight excess of those for acute patients (3.18 against 3), while those for rehabilitation (0.51 against 0.7 per thousand inhabitants).
Fragmentation and services Another element underlined with the blue pencil is that which concerns the excessive fragmentation of the districts, 12 in all, which is why the strategic lines assume a halving. Furthermore, the territorial functional aggregations have not been implemented homogeneously, however without carrying out the assigned tasks, while the Uccp, the complex primary care units, have not been established. “Lacking” are the mental health, prevention, care and rehabilitation services of adulthood and developmental age, as well as a Rems, the Residence for the execution of safety measures intended for inmates with mental problems (on this last point , the Region has created a working group that will shortly present a project). In addition, a lack of homogeneity between the two Usl is underlined with regard to the services provided to drug addicts. Finally, there are shortcomings for other services such as rehabilitation or palliative care.