The world of research is mobilizing to save the National Health Service

The world of research is mobilizing to save the National Health Service


From 1978, the date of its foundation, to 2019, the NHS in Italy has contributed to producing the most marked increase in life expectancy (from 73.8 to 83.6 years) among high-income countries.

But today the data shows that the system is in crisis: decline in some health indicators, growing difficulty in accessing diagnosis and treatment paths, increase in regional and social inequalities.

This happens because the costs of technological evolution, the radical epidemiological and demographic changes and the difficulties of public finance have made the NHS highly underfunded, to which 6.2% of GDP will be allocated in 2025 (less than twenty years ago ).

The public still guarantees everyone a share of activities (emergency, acute hospitalizations), while for the rest (specialist visits, diagnostics, minor surgery) the public falls back, and citizens are forced to postpone operations or induced to resort to private services. Progress on this slope, as well as being in conflict with Article 32 of the Constitution, pushes us towards the US model, terribly more onerous (overall expenditure more than triple compared to Italy) and less effective (life expectancy six years lower ). Health spending in Italy is not able to fully ensure compliance with the Essential Levels of Assistance (LEA) and the differentiated autonomy risks widening the gap between the North and South of Italy in terms of the right to health.

An extraordinary financing plan for the NHS is therefore necessary and specific resources must be allocated to remove territorial imbalances. The allocation of resources must be accompanied by efficiency in their use and appropriateness in their use at a diagnostic and therapeutic level, as they are fundamental for the sustainability of the system. Furthermore, the NHS must recover its role as a place of research and innovation at the service of health.

Part of the new resources must be used to intervene in depth on healthcare construction, in a country where two out of three hospitals are more than 50 years old, and one in three was built before 1940.

But the great asset of the NHS is its staff: sophisticated equipment can be installed in a couple of years, but many more are needed to have competent healthcare professionals, who continue to train and update themselves throughout their working lives. In the current system crisis scenario, and in the face of increasingly dissatisfied citizens/patients, it is inevitable that operators are subjected to unsustainable pressure which translates into a flight from the public, especially from places of greatest tension, such as the emergency area. It is clear that wages must be adequate, but it is essential to address issues such as the valorisation of operators, their protection and the guarantee of sustainable working conditions. Furthermore, the shortage of nurses is particularly serious (a number well below the European average).

For decades we have been talking about continuity of care (hospital-territory-home and vice versa), but progress in this direction is timid. Today the problem can no longer be postponed: in 25 years almost two out of five Italians will be over 65 (many of them suffering from at least one chronic pathology) and the system, already in serious difficulty today, will not be able to assist them.

Spending on prevention in Italy has always been below what was planned, which partly explains the insufficient rates of participation in cancer screening programs that are recorded in almost all of Italy. But even more evident is the gap regarding primary prevention; one fact suffices: we have one of the highest percentages of overweight or even obese children in Europe, and this is linked both to a – worrying – change in eating habits and to the lack of propensity of Italians towards physical activity. Much must be invested, in a strategic way, in the culture of prevention (individual and collective) and in awareness of the opportunities but also of the limits of modern medicine.

Much, therefore, can and must be done on an organizational level, but the real emergency is to adapt the financing of the NHS to the standards of advanced European countries (8% of GDP), and it is urgent and indispensable, because a functioning NHS not only it protects health but also contributes to social cohesion.

April 3, 2024

Ottavio Davini

Enrico Alleva

Luca De Fiore

Paola Di Giulio

Nerina Dirindin

Silvio Garattini

Franco Locatelli

Francesco Longo

Lucio Luzzatto

Alberto Mantovani

Giorgio Parisi

Carlo Patrono

Francesco Perrone

Paolo Vineis


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