Pnrr, Puglia’s paradox: closed hospitals reopen, big cars arrive but staff are missing

A cascade of money. Nearly 650 million euros to improve the health care of citizens of Puglia after the years of pandemic and the weight of increasingly unaffordable waiting lists. A program that should be ambitious, but which gives a lot of stomach ache. Starting with the decision of the Puglia region to push on the technological equipment, with investment in new diagnostic equipment, given the obsolescence rate of 5 years as a parameter. In some cases, the risk will actually be to replace still-functioning machines or to over-equip structures with unnecessary equipment. And then the system of communal houses, in areas where hospitals have been closed precisely because of the reorganization plan created by the reference government (Raffaele Fitto between 2000 and 2005) by the current health councilor, Rocco Palese. A true paradox. Then the territorial operations centers (COT), “control towers” for home services. A whole stream of infrastructures and intermediate services, therefore almost without reference to human resources. Yet doctors, nurses and assistants are the real emergency situation where emergency rooms and wards risk bursting. The knots of the pandemic emergency have emerged now. Without targeted and sharp interventions, there is a risk of no longer being able to guarantee services.

Doubt about the quality of the purchases

Covid was the watershed: on the one hand, the fragility of the social health system was revealed, on the other hand, the crisis of doctors and assistants on the ward widened. A very complex picture that Bari wants to solve with the creation of communal hospitals “mainly run by nursing”. In the province of Foggia, 9 are planned (San Nicandro Garganico, San Marco i Lamis, Volturino, Vico del Gargano, Panni, Vieste, Torremaggiore, Monte Sant’Angelo og Foggia). The strategy is “proximity care” (what was done before with the first aid points: closed), using telemedicine, community centers (26 in Capitanata) and the many instruments to guarantee “an improvement in diagnostics”. But what diagnoses can be made without doctors? A particularly interesting chapter in this sense is the one dedicated to technological and digital updating.

The reference point in the regional law is the Ministry of Health’s study, which assessed the total need for new large sanitary equipment in 273 units, “Purchased to replace obsolete technologies or technologies that have been out of use for over 5 years”. Over the years, however, millionaire investments have been made with a lot of waste, as in the case of tac and resonances that have been crammed for many years in the basement of healthcare companies. So what are you doing? Others are purchased, not less than 64 only in Foggia between the “Riuniti” outpatient clinic and the ASL. To give some examples, 7 tacs (which have been added to the ultra-technological equipment already available on Deu), 8 radiodiagnostic systems and as many as 35 ultrasound scanners. Going into detail with the maps, the investment of 13 million euros for the “supply for digitization of Level II Dea hospitals” is striking, an area where a project of around 3 million euros already existed.

Wards without doctors and collapsing emergency room

The current scenario is unsustainable. The few doctors are at risk of burnout and assault. Some 118 stations do not stand still and close. General practitioners are no longer able to cope with the growing demand. The reason is always the same: white coats are few, nurses and social workers are often poorly organized. To complicate matters, there is the high number of inappropriate performances and the increasingly long waiting times. To the point that the number of citizens abandoning treatment is increasing. Some believe they can “guarantee Lea”, the essential levels of assistance (almost always neglected), through “prediction models”: to determine in advance what patients’ health needs may be. Fanta Sanità, if you think about the error in the ‘electronic health record’.

The only reference to staff in Puglia Region 688 is the chapter dedicated to the “development of technical, professional, digital and managerial skills of health professionals”. Pnrr has stipulated that for each year of the three-year period 2021-2023, a government decree on the allocation of financial resources to the regions will be published to finance 900 additional scholarships per year for specific training courses in general medicine (f. A total of 2,700 additional scholarships). After all, there are only concrete, innovative machines and virtuality. The rest does not seem to be a priority. Maybe because, as an old mantra says, “the resources are there, it would be a shame not to use them”.

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