“Dm 71”. In Gazzetta the reasons behind the government’s decision to move forward even without the agreement in the state regions

by Luciano Fassari

The CDM resolution has been published, which gives the green light for the adoption of the decree of the Minister of Health, in agreement with Mef, containing “Models and standards for the development of territorial assistance in the national health service”. From the imminent expiry of the Pnrr milestone to the need to supplement Ministerial Decree 70/2015 with the reform of the territory to the Court’s findings on the weakness of territorial assistance and all the attempts made to convince the Campania Region here agree on all the reasons why the government has decided that Ministerial Decree 71 should be continued. THE RESOLUTION

“Dm 71”.  In Gazzetta the reasons behind the government’s decision to move forward even without the agreement in the state regions

03 MAY

“Taking into account that the entry into force of the aforementioned provision constitutes a necessary step, in accordance with the provisions of the Community Plan to be reached by 30 June 2022 and in view of the urgency of authorizing the adoption, from the entry into force of The aforementioned decree “The Council of Ministers gives the green light to the substitute resolution of the agreement of the State-Regional Conference on ‘models and standards for the development of territorial assistance in the national health service’.

Thus we read in the resolution of the Cdm of 21 April, which has just been published in the Official Gazette (of which Quotidiano Sanità was the first to report), which gave the political ok to the so-called Dm 71, which in the last month has experienced a hard tug of war between the government and the Campania region (which was opposed, motivated the lack of resources to hire staff to work in the new structures such as Community Homes and Hospitals) and did not allow the state regions to reach an agreement. Remember now that the decree is being examined by the Council of State, then it must be evaluated by the Court of Auditors, and then it will be finally published in the Official Journal.

But the government’s decision is not bad. The reason why the government has decided to go direct is not only the deadline of 30 June 2022 set by the NRP, which, if not complied with, would cause Italy to lose around 7 billion. There are numerous reasons for this in the decision. First of all, reference is made to the need for Ministerial Decree 70/2015 on hospital standards to be accompanied “by the strengthening of territorial services in a uniform manner throughout the national territory by defining specific standards”.

The Government then refers to the Court of Auditors’ report on the coordination of public finances in 2020, which reiterates that: “despite the increase in activity in recent years, a significant weakness and limitation of the territorial network in terms of being able to to meet the needs of the population in conditions without self-sufficiency and those where the severity of the conditions or chronic illnesses would require help outside the hospitalization facilities.

“The need and urgency, once the crisis is over, to accompany a more correct use of hospitalization facilities with the strengthening of the territorial structures (health homes, …) that may provide a continuous response to the health needs that are not so serious and reorganization of the general practitioners’ activities, interdisciplinary specialist networks as well as further strengthening of the ADI and housing care represent a mandatory choice, which he has also approached with the national chronicity plan that proposes new organizational models centered on territorial care and home care, integrated and delegates to hospital treatment management of acute / complex cases that can not be handled by primary health care professionals.

But not only. the government also traces the whole history from the first dispatch of the provision on 23 February, passing through all the amendments to the technical annex requested by the regions, to the niet of the Campania region (the last on 21 April) despite that they have “been found by the regions themselves, as well as to the government’s obligation to find resources, which the latter draft is an improvement over the former”.

In fact, the Executive Board recalls how “the text of the decree submitted for review of the conference was updated and reworded following discussions with the regions” and that the “Stats-Regions Conference reached a unanimous position on the progressiveness of the implementation of the Conference”. standards and organizational models in relation to the availability of financial resources available under current legislation; that the Ministries of Health, Economy and Finance ensured a constant dialogue, including the establishment of a specific working table composed of all the institutional actors for assessment of any organizational, regulatory and staffing requirements, and that the Government has also committed itself, following the results of the work in the aforementioned table, to gradually and in accordance with the constraints of public finances, find the resources necessary to enable a complete implementation of the decree.

These are the reasons why the government went ahead. It is very likely that Ministerial Decree 71 will enter into force, but it is clear that the doubt that what has happened may represent a false start to the most important health reform of the new millennium for our country is difficult to erase.

Luciano Fassari

May 3, 2022
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