Beyond the Covid-19 emergency. The evolution of our National Health Service
Authors: Botta, A.  
Published: May 2021

The emergency created by the spread of COVID-19 has lead to a wide spread awareness of the central role of the health policies. Certainly it seems to be essential that the scientifically based monitoring of the health sector should persist and carried through the participation of Medical-Scientific Associations which are the real bearers of the experience lived daily, especially considering the forthcoming arrival of a conspicuous amount of European financial funds: the Italian health system, and the whole country, certainly cannot afford to miss the opportunity for a radical modernization of their infrastructures, according to the current Parliament debate. The Recovery Fund will be a great opportunity and responsability to reform our public machinery, planning how renovating our NHS. Looking at the next 10 years, taken for granted the Mission of our NHS is the Vision will need to adapt to future social needs. Healthcare must not be a sector which consumes a substantial proportion public expenditures but an investment for growth. Effective planning requires to be preceded by a strategic vision, in order to define the objectives to be pursued and therefore the key performance indicators to measure effectiveness. Bridging the health inequalities that still persist in the country: this must be the priority in the use of resources and make the universalism of the NHS effective for all Italians, in the same way throughout the country. The role of the “territory” is fundamental. A profound reflection is needed on the relationship between hospital and territory: it no longer makes sense to think of the two categories in alternative terms. The main obstacle to strengthening the “territory” is the lack of shared organizational models. The evolution and refinement of technological knowledge with the increasing spread of telematic “networks” and computer hardware, together with demographic and morbidity changes, require a rethinking of the methods of providing care. In some conditions - for example in chronic diseases such as diabetes mellitus - technological aid could be the solution to allow the adequacy and appropriateness of treatments in conditions of maximum safety. This is the time to define specific treatment paths that are the new references for the definition of tariffs by reviewing the tariff nomenclator (LEA Review), and to overcome the rigid logic of prescription and reimbursement of individual services (Essential Path Levels, LEP). This model would respond more precisely to the needs of a “patient-centered medicine”, recognized by both the National Diabetes Plan and the Chronicity Plan as the most effective care models for managing chronicity, capable of safeguarding and protecting the patient in the long term, preventing acute situations and ensuring real responsibility for the healthcare professionals concerned. The development of a new organic model of taking charge of the patient with Diabetes, also thanks to the introduction of telemedicine and tele-assistance, provides an all-in-clusive rate of the enteire path/process, including different services in different specific conditions – for example diabetic foot, diabetes in pregnancy, the implantation of insulin pumps –. We must un- doubtedly invest not to maintain the status quo, we cannot afford only about recovering the losses due to the pandemic COVID-19 crisis, we must move on from the past and create the conditions for a transition towards a health service model for the future. To do this, it is necessary to have a structured vision, which can only be built with a choral contribution of ideas: effective and efficient programming is that which starts from a vision of the system and from a long-term stabilization of the state financing. KEY WORDS COVID-19; national health service; flexibility; resilience; recovery fund.