Italy is at a pivotal moment for healthcare reform, particularly with its Case di Comunità (community homes) plan under the National Recovery and Resilience Plan (PNRR). These community homes are intended to serve as localized healthcare facilities, providing access to various medical and social services. Unfortunately, the current state of these facilities reveals significant challenges, particularly due to staffing shortages and regional disparities.
According to recent data, by June 30, 2024, out of the 1,419 planned Case di Comunità, only 413 were operational. This underwhelming figure highlights the slow progress made under the PNRR aimed at revamping Italy's healthcare system. Health Minister Orazio Schillaci recently assured, "Entro il 2026 saranno pronte le nuove strutture territoriali necessarie per il rafforzamento dell’assistenza sul territorio che proprio durante la pandemia ha mostrato il lato vulnerabile del servizio sanitario," indicating the urgency of building new medical infrastructures.
Fast forward to December 20, 2024, and Agenas, the National Agency for Regional Healthcare Services, reported only 485 of the 1,717 community homes had at least one active service. Alarmingly, only 3% of these planned structures are reported to have complete staffing, which poses serious questions about the effectiveness of the healthcare reforms underway.
One of the most pressing issues is the mandated staffing requirement. The PNRR outlines the need for 24/7 medical coverage at hub community homes and 12/6 coverage at spoke facilities, with nursing staff scheduled for 12/7 at hubs and 12/6 at spokes. Yet, the reality is starkly different. Currently, only 46 of the Case di Comunità are fully functional with both medical and nursing staff available. That means 118 facilities boast all required services but lack any medical personnel.
Such statistics are not limited to the national level; regional disparities are glaring. For example, Lombardy leads the way with 138 active Case di Comunità followed closely by Emilia-Romagna with 125. On the other hand, regions like Campania, Friuli-Venezia Giulia, Basilicata and others have seen no community homes activated. This uneven distribution is not just about numbers; it significantly affects healthcare access for citizens residing in underrepresented regions.
Taking Piemonte as a case study, the situation is particularly alarming. Despite having planned for 95 Case di Comunità, only 28 are operational as of late 2024. None of these provide complete services, and 3 have only experienced staffing shortages of medical professionals and nursing staff. It indicates not only ineffective administration but also highlights deep-rooted staffing issues faced by healthcare workers across Italy.
When analyzing community hospitals, the picture is equally dire. While the country planned for 568 community hospitals, only 124 have one active service. Piemonte’s situation is even more dire with no operational services among the 30 hospitals planned. This lack of functionality significantly hampers the region's ability to respond to community health needs and reinforces the issues surrounding healthcare disparities.
The inadequacies revealed by the Agenas data shine a light on the challenges Italy faces as it attempts to reform its healthcare system with the help of PNRR funding. Considering the announcement of 70% of the required structures' construction set to begin by 2026, there is tangible hope for improvement. Yet, without adequate staffing and support, the effectiveness of this reform remains uncertain.
Community homes and hospitals are meant to be the backbone of localized healthcare, particularly during crises such as the pandemic, which exposed vulnerabilities throughout the healthcare system. The responsibility now lies with regional governments and healthcare authorities to address these fundamental staffing issues, ensuring these facilities can deliver on their intended promise.
The question remains: can Italy bolster its community healthcare infrastructure effectively, or will it continue to fall short, leaving many Italians without access to necessary medical services? The coming years will be pivotal as the country works to realize the ambitious goals set forth by the PNRR, making sustained effort to recruit and retain healthcare professionals the linchpin of this effort.