We tried to obtain a reflection from Minister Roberto Speranza to enrich this in-depth issue of Forward. We did not manage but we decided not to leave those who follow our project without Speranza (hope). We included different quotes by the Minister and took the liberty to suggest some potential additions taken from the notes collected during the work of these past months.
“When I talked about local care provision and proximity-based healthcare I wanted to emphasise the need to design a National Healthcare Service that focuses on proximity, closeness and the immediate needs of citizens”.
Closeness to people, citizens and operators is essential to understand their needs, worries and challenges. As Nerina Dirindin told us, we need to think about a type of policymaking that is closer to people because of its ability to listen to them.
“What we need is not an emergency plan but rather a project for the coming decade. We have a great opportunity to keep reforms and investments together. We are facing an unprecedented challenge: we have the chance to reform the National Healthcare Service in such an expansive season”.
The PNRR (National Recovery and Resilience Plan) aims to create and implement, with the help of the European funds, a widespread network of local services comprised of 1,200 community homes, 600 community hospitals and 602 local coordination hubs. As Francesco Enrichens specified, it is becoming increasingly clear that taking care of the health and social needs of people requires a global approach that is closer to families and communities.
“Proximity-based healthcare means two seemingly different things but these should actually go hand in hand. It means having a doctor and a nurse that come to your home and are therefore physically close to you. However, the concept of proximity-based healthcare should also correspond to a National Healthcare Service that takes care of patients and communicates with people and individuals via new technologies. If the National Healthcare Service managed to get onto people’s phones it would achieve a very significant level of proximity so we will use all the available resources to invest in the digital sector, in telesupport and in telemedicine”.
As Gianpaolo Collecchia and Riccardo De Gobbi explained, the hope is not so much that technology could change medicine but that medicine could “shape” technology based on its principles: equality, real needs, accessibility and continuity of care. This should constitute a true “technological” innovation, with high added value; it should be flexible, powerful and cheap, and centred on the real needs of people.
“To be concrete, I think about a healthcare system that does not require citizens to search for services provided the National Healthcare Service but one where it’s the other way around and the National Healthcare Service goes to people- those living in small towns, in neighbourhoods, in communities, in suburban areas or in inner areas”.
As Francesco Monaco wrote, it is necessary to look at the work done by the 72 pilot areas of the National Strategy for Inner Areas in the healthcare sector- one of the three sectors that the plan focused on, together with education and mobility. It might be a way to understand how to better implement such strategies, particularly the missions of the PNRR that focus- directly or indirectly- on this topic.
“We can redesign and define the role that rural pharmacies could play; they are an important factor for our ability to deliver local support. They are an example of proximity-based service provision and a space one turns to in order to get answers or advice. Pharmacies should therefore be imagined as places that go beyond the simple administration of drugs; obviously we should protect them as they are essential to our society and redesign them so that they can provide other services as well. The concept of pharmacies as healthcare service providers was actually based on this idea”.
Pharmacists too play an important role in the treatment and follow-up of patients with chronic conditions and the implementation of pharmacies that provide healthcare services greatly enhanced this function. However, as Viviana Ruggieri told Forward, patients’ engagement is as essential. Nonetheless, as Paolo Zanini pointed out, experts need proximity as well because if you really view your job as a lifelong learning and development process then everyone needs proximity as a learning space.
“Essentially there is a dual challenge. A major challenge today is undoubtedly the need to overcome this pandemic, but we shouldn’t forget the need to design and create the healthcare of the future as its foundations are being laid. Local healthcare services represent a helpful tool to guarantee the actual delivery of basic levels of support and to reduce inequalities- the integrated and multidisciplinary provision of social and healthcare services”.
Echoing the words of Filippo Anelli, we are about to witness a significant shift in the provision of local healthcare services and the real challenge lies in guaranteeing a system where multidisciplinary teams of professionals work and collaborate together. Today this challenge proves difficult and facing it requires everyone’s wisdom so that a way to put together various professionals, without damaging their individual legitimate expectations, can be identified.
Nonetheless, as Serena Donati said, organisational models should be revisited with a more wide-ranging approach in order to promote the development of professional communities that could integrate different expertise, ranging from healthcare to social figures.
“You should also consider the need to take care of the mental health needs of people and the more vulnerable groups in order to protect and include those who risk being cut out from the support provision. This can be achieved through the full coordination between State and Regions among other things”.
Let’s be reminded of the fact that, as Chiara Badaloni and Matteo Renzi explained, the concept of environmental justice should develop alongside the notion of social justice in order to guarantee the end of inequalities and the right to health of each individual.
“Finally, proximity should also be viewed as an essential principle in decision-making processes as institutions should be closer to the experts and the social parties working in the healthcare sector, which we need to know are fully engaged with the decisions that are being made”.
Luisa Saiani warned that it is not possible to suddenly create a context of proximity-based support when the entire academic and education system is centred on hospital-based services and the treatment of acute conditions. First of all you need a change in curricula and also a cultural shift.
“In order to improve the relationship with citizens the focus will be placed more and more on transparency and communication, through their engagement in inclusive opportunities to participate”.
The hope for greater proximity should not be satisfied with the citizens’ availability to help. As Tommaso Giagni observed, self-organisation and the fact that people join forces despite being at the bottom should be praised but the issue is that this becomes an alibi for those who are actually responsible for those tasks, as they then claim that, “People can manage on their own anyway”. It triggers a perverse mechanism whereby people swipe the road in front of their home because they assume that those who should do it won’t. This should only be a temporary scenario; if it becomes permanent it means that there is a problem.