(Finance) – “At 31 December 2024 the only European deadline of the PNRR health mission which conditions the payment of installments, or the realization of at least 480 territorial operational centers, has been respected”. This is what he declares Nino Cartabellotta, president of the Gimbe Foundation.
According to the data published on the portal of the Ministry of Health that monitors the state of implementation of the PNRR health mission – notes the Gimbe Foundation – The deadline relating to the entrance was reached according to at least 480 territorial operating centers (COT), essential structures for the coordination of taking charge of patients and the integration of health and social and health care. The resources assigned to this target amount to 280 million euros. The Minister for Relations with Parliament, Luca Ciriani, He confirmed to the Chamber that the reporting of this goal was sent to the European Commission, thus starting the procedure for paying the seventh installment of 18.3 billion euros. However, – underlines the Foundation – it is important to remember that, following the remodeling of the PNRR, the minimum target of Cot was reduced from at least 600 to at least 480 and the deadline was postponed from 30 June to 31 December 2024.
Milestone and national targets – “Even if they do not condition the provision of PNRR funds – he explains Cartabellotta -These intermediate steps require careful monitoring because they could compromise the related European deadlines. “All the targets scheduled for the period 2021-2024 were reached. In detail, in the last quarter the following results were achieved: publication of a procedure for The assignment of voucher for POC projects (proof of concept) and research on tumors and rare diseases.
Interoperability of the electronic health file (FSE) – The necessary architectural components have been made. The expiry of this target had been extended from 30 June to 31 December 2024.
Completion of interventions for business interconnection – Milestone centered 6 months late compared to the original expiry of 30 June 2024.
Training on hospital infections – The registration procedure was reached with a delay of over 3 months compared to the original deadline of 30 September 2024.
Territorial operational centers
As part of the territorial assistance reform provided by the PNRR, the COTs have been designed as organizational hubs to improve the coordination between hospitals, family doctors, home care and social services. Think to ensure a continuous and personalized taking care of patients, they represent a key element to face the challenges related to the aging of the population and the growing prevalence of chronic diseases. “On the occasion of the achievement of the EU target on the COT – he explains Cartabellotta – it is appropriate to take stock of the overall status of implementation of these structures which, together with community houses, community hospitals, telemedicine and the enhancement of home assistance, configure that organizational revolution of the territorial assistance provided for by Ministerial Decree 77 and financed by the PNRR ” General of the Healthcare Company certifying the entry into function of the work and related services.
Target Cot Remoduction – According to the initial programming of the PNRR, a ratio of one Cot per 100 thousand inhabitants was foreseen, for a total of at least 600 structures distributed proportionally between the regions. However, for the increase in energy costs and raw materials, the remodeling of the PNRR approved on November 24, 2023 by the European Commission, reduced them by 20%, bringing the target to at least 480 cot. This remodeling, however, does not change the original number of COT to be activated, but prudentially reduces the EU target to ensure the delivery of the resources provided for by the PNRR: consequently, the additional 120 COTs must be made with other funds not yet well defined and Without constraints related to the deadlines of the PNRR, that is, without defined timing. “In this sense – comments the president – until all 611 COTs originally planned are fully functional, there will be an increase in the workload for the active ones, which will find themselves managing a wider catchment area, risking to compromise the quality of services “.
Activation and functioning of the COT – “Although it was reached – he highlights Cartabellotta – The European target of at least 480 fully functional cots, necessary to request the payment of the seventh installment, to date the relative regional distribution of COT fully functional at 31 December 2024 is not publicly available, indispensable for monitoring territorial equity “. According to the last figure made public by Agenas on September 18, 2024, 362 Cot was fully functional at 30 June, equal to 59% of the total expected before remodeling, or 611 cot. “Finally – continues the president – in a historical moment characterized serious lack of nurses by the NHS, the actual operations of the COTs risks being compromised, actually making it empty boxes”. In particular, according to Agenas estimates for operation Cot would serve from 2,400 to 3,600 units of family and community nurses (IFOC), or a nursing coordinator, as well as 3-5 IFOC for each Cot, staff for which 480 million euros have already been allocated by Legislative Decree 34/ 2020 , compared to the OECD average of 44.9), both with the poor attractiveness of the profession seen for the academic year 2023-2024 23,627 questions for 20,058 places available and for 2024-2025 21,250 questions for 20,435 seats were received.
“Inevitably – he concludes Cartabellotta – The crisis of health personnel, in particular the nursing one, affects cascade on the reform of territorial assistance scheduled by the PNRR which risks transforming itself on a missed opportunity. It is unacceptable that, while the objectives achieved are rightly celebrated, it is lost sight of that the indebtedness of the country risks having no benefit for the health of people. That is, the ultimate goal of the PNRR cannot be limited to respecting the deadlines to collect the installments: but it is crucial to ensure that these reforms leave a lasting legacy to protect the health of all people, reducing regional and territorial inequalities and ensuring a ‘ fair and universal health care. That’s why the success of the PNRR is closely linked to the relaunch of the National Health Service and in particular of the policies to make the career of all professionals in public health attractive again “.