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Changes Interviews

A new form of policy-making: starting again together from local support services and with children

From paediatrician to MP to defend equality and legality standards

Interview with Paolo Siani

Paediatrician and MP, XII Committee on Social Affairs and Healthcare, and Bicameral Committee on Children – Director of the Paediatric Department Unit 1 at the Santobono Hospital, Naples

By April 2021April 26th, 2022No Comments
Photo by Lorenzo De Simone

Paolo Siani is a paediatrician from Naples. His 26-year old brother Giancarlo, a journalist, was murdered by the camorra. He directed the Paediatric Department of the Cardarelli and the Santobono Hospitals in Naples. He was the president of the Cultural Association of Paediatricians and of the Polis Foundation, which supports initiatives against violence and crime. In 2018 he decided to bring his experiences and battles to the Parliament.

Doing better to change for the better. What do you think of your professional experience and civic participation?

In March I will have been in the Parliament for three years, a period during which I also progressively decreased my presence at the hospital and eventually stopped going there altogether due to the pandemic. I often wondered whether it was worth leaving a full time job that I love and am passionate about. All things considered I don’t regret my decision. Even though it is a new environment for me, as I have little experience with parliamentary dynamics, I managed to carve out my intervention niche and introduce changes that I strongly believe in. An example of these is the 2020 implementation of the law that, following the 2018 research on palliative care in Italy, introduced specialised training in palliative care in Italy. Another one is the draft bill, about to be discussed in Parliament, on child abuse and the research on bullying and cyberbullying, which is likely to result in a series of amendment and legislative proposals to safeguard children online. Last but not least, there is also the amendment of law n. 62/2011 for mothers who are incarcerated with their children. As an MP I visited both the Poggioreale prison and the Institute for Mothers on Remand (ICAM or the Prison’s Mother and Baby Unit) of Lauro, in the province of Avellino, and a protected community home in Rome. According to the law prisoners who are mothers should be detained inside ICAMs or in protected community homes but the Government is not responsible for their provision, which means that in Italy we just have five ICAMs and two protected community homes. For this reason I made an amendment proposal to this year’s Budget Law and suggested to create a fund dedicated to incarcerated mothers.

Let’s reverse our perception of things and put children first instead of seeing them as a marginal issue.

It was miraculously accepted (it wasn’t a given since I’m new to the Parliament). Now the Justice Committee of the Parliament is holding the initial hearings to discuss a bill proposal- that I’m the first signatory of- intended to enhance the experience of community homes, as these constitute the true solution to the issue of children living in prison. I discussed my views with the members of the Justice Committee and there seems to be a good predisposition around this, even from the other parliamentary groups. I am confident that there can be a fast legislative process to approve this bill. It was not easy to do but in my small way I managed to receive praises for being a politician that defends an ideal rather than a flag.

That was also the case for the law concerning children, which you defined as a “political project” and “an appeal for hope-inspiring policy-making”.

During the second Government led by Conte we asked to insert in the Recovery/Resilience Plan a chapter dedicated specifically to children- a plan centred on children support- intended to reduce the inequalities present in our country as these are intolerable when they concern children. President Conte mentioned our parliamentary work in one of the hearings and seemed quite open towards our plans. We made the proposal on the children bill and also discussed it in Parliament but when his government fell unfortunately the processed stopped. Nonetheless, we managed to put our proposals back on the table, starting with our bill concerning nurseries where we suggested a reallocation of the resources destined to them based on criteria that guarantee a greater provision, particularly in areas where this is lacking. Political forces perceive the nursery matter as a marginal issue but I think that explaining it better can give it a whole different meaning. Therefore I tried to reverse the perception of things: let’s put children first instead of seeing them as a marginal issue. The problem isn’t that moms have to go to work thus nurseries are needed, but that every child has the right to access a good quality nursery and as a result moms can go to work without any worry.

The healthcare context will change, for the better, only when everything we worked on will be implemented equally throughout Italy, from north to south.

What changes do we need to ensure a form of policy-making that is centred on children and young people? Is a bill proposal enough?

In January I presented the social “adoption” program in Montecitorio Palace (the Parliament). It is a support model for families that covers the period spanning from the children’s birth to their 6th birthday and it was piloted in the Secondigliano Quarter of Naples and afterwards in other areas of Italy. It is an integrated system intended to improve the health and wellbeing conditions in the medium to long term and to reduce social exclusion since the start. Identifying inequalities early on means being able to intervene today and not having to chase social risks in the future. That would create the type of change that is in line with what Prime Minister Conte wrote in the national Recovery/Resilience Plan, “We need to intervene now to avoid the crisis that results from being unable to prevent the risks linked with exclusion.” Thanks to the Recovery Fund this “social adoption” model could become reality all across Italy, just like the universal child benefit- families can claim child benefit for each child from the seventh month of pregnancy to the child’s 21st birthday- that the Senate plans to implement to simplify the support for families with children. However, projects and bonuses are not enough to create change, we also need to offer families services dedicated to children. Additionally we need reforms and improvements in the healthcare provision, as already described in the former Re-launch Plan and outlined in the Recovery Fund. The changes will impact community hospitals and community clinics (or health centres) where GPs and paediatricians (that families can pick) will work together with other professionals such as psychologists, neuropsychiatrists and paediatric nurses, and also the relationship between the local health service provision and hospitals and the relationship with schools and the community. It will then be up to the Regions, the paediatric associations and the healthcare trade unions to apply these guidelines in the most efficient way possible. The healthcare context will change, for the better, only when everything we worked on will be implemented equally throughout Italy, from north to south.

Where should we start again from to create a better healthcare system and, more broadly, even a greater Italy?

We should start from education and from local health services. I always fought to deliver the message that abolishing the student quotas rules of medical universities would not solve the issue of the shortage of doctors and that it was necessary to act on the educational funnel that stops many medical graduates from accessing specialisation training instead. The Covid-19 emergency accelerated a type of change that we could only dream of before: thanks to the Ministerial Decree n. 106 of 15 September 2020 there will be a 62% increase in available seats for specialisation training and that will be implemented based on local needs (which is important). However, the pandemic also highlighted the weaknesses of the primary care and social-healthcare services provided locally, which is an issue that we’ve known about for years. Today we are finally reviewing the organisation of local health services. We need a different distribution of work and competencies, and local health services equipped with multidisciplinary teams of physicians in order to avoid delegating all care to the hospital, which should be viewed more and more as a place for intensive care and planned interventions. This means greater efficiency for the entire system- less crowded hospitals, less patients travelling north when they can actually receive health services in the south and greater patient satisfaction as they can be treated at home, or close to it, and not necessarily in hospitals. It is a completely new approach that we’re currently working on assessing and designing. However, we need to see how it will be implemented in reality.

We must never stop; we must keep going day by day.

Civic values and the commitment towards a better society are constant elements of your battles, which you also fight in the name of your brother Giancarlo. Do you think that things could change one day?

I will answer by sharing two anecdotes with you. 21st March is Memory and Commitment Day, which is dedicated to the memory of all the innocent victims of organised crime. On that day citizens, students, MPs and institutions and police representatives march in an Italian city. I never missed a march before but on 21 March 2019 I had to work at the Chamber of Deputies. I was feeling really uncomfortable about that so I asked the President of the Chamber, Roberto Fico, whether we could remember the Day in the Parliament. We agreed that he would allow me to speak when the time came. I was on the fourth row, on seat n. 14. I got up and listed the names of some of the people that were murdered by the mafia, leaving Giancarlo’s name at the bottom. I said, “These are the names that I would have recited this morning in Padua, where people are marching for Memory and Commitment Day. I think that the members of this Chamber should commemorate the innocent victims of organised crime each year.” Every group present in the Chamber participated in a standing ovation; it was a really heartfelt moment. I received a lot of messages (not just from colleagues in my party). I think it is crucial that on 21 March the Chamber of Deputies observes a half-hour break, stop what they’re doing and commemorate the victims of crime. It never happened before and “perhaps” it would not have happened had I not made that request. I don’t know…but if I managed to make the Chamber stop and talk maybe it means that it’s possible to get results. Will things truly change? I hope so and I’m doing everything I can to make it happen.

The work we need to focus on concerns children and families, both in terms of local service provision and policies.

What about the second anecdote?

A mural was unveiled in the Neapolitan Spanish Quarter; it pictures Ugo Russo, the 15-year old who was tragically killed during a robbery attempt- his death sparked a lot of criticism. In another part of the city, instead, a panel exposed outside the Polis Foundation with Giancarlo’s Mehari, a symbol of the fight against criminality, was vandalised. Both episodes make me realise that there is still so much we need to do in order to increase people’s sense of legality and even their sense of belonging. We must never stop; we must keep going day by day. We’ll fix the panel dedicated to Giancarlo and start a conversation with the young boys who vandalised it to help them understand its symbolic meaning and raise awareness on legality. The work we need to focus on concerns children and families, both in terms of local service provision and policies; that is where we need to start from to help our country grow.

Edited by Laura Tonon