Policlinico and Niguarda: the healthcare battle causes collateral damage

All-out war over healthcare in Lombardy. At the end of September, the latest clash in the regional executive took place between Councillor Romano La Russa – the all-powerful representative of Fratelli d’Italia at the Pirellone – and the hard-nosed Welfare Councillor Guido Bertolaso. The issue was the change of leadership at Niguarda Hospital: the outgoing Director-General, Alberto Zoli, was due to retire in October, paving the way for Mario Melazzini (nominated by Bertolaso), who boasts an impressive CV (former president and Director-General of AIFA, and a frequent collaborator with the Ministry of Health). La Russa put up a fierce fight in an attempt to block the appointment, but Bertolaso prevailed, granting Zoli a three-month transition period as acting director. The most recent move, chronologically speaking, originated at the Policlinico, where the Director-General Matteo Stocco (strongly backed by FdI) resigned to take up a post running a private healthcare facility in Rome. Perhaps he was disappointed that the path to the top at Niguarda had become impassable. “It wasn’t an easy decision,” commented Stocco, “I am leaving an institution to which I have dedicated three intense and extraordinary years, proud of the results achieved together with President Marco Giachetti and the whole team.” Now, the Policlinico will also need a commissioner.

Is the constant conflict damaging the healthcare system? Il Foglio put this question to Lisa Noja, regional councillor for Italia Viva – Renew Europe and member of the Health Committee. “All this creates a sense of precariousness that is difficult to manage,” explains Noja. “The uncertainty surrounding appointments, coupled with constant clashes even within the Council, does not help. Fanning the flames of conflict between the majority and the regional councillor, even in the press, leads to a loss of direction and does not help the search for competent figures to lead the healthcare facilities. It’s chaos.” Not everyone in the majority likes Bertolaso’s gruff manner. But healthcare facilities have a life of their own, and these rifts do not help cohesion. Moreover, within FdI there are those already thinking about the leadership of the Region in the next legislative term. “The Lombardy healthcare system,” explains Noja, “is built on a foundation of undoubted hospital excellence, even if in recent years a few alarm bells have rung (the San Raffaele affair), particularly regarding staffing, starting with nursing staff. What remains a black hole in Lombardy is the interconnection between the local area and hospital facilities. A prime example is the rare diseases sector – very similar to that of the very elderly – where patients are left to fend for themselves.” There is also the problem of staff preferring the private sector or even commuting to Switzerland. “Yes, the chronic shortage of frontline staff, from doctors to nurses, also risks undermining the role of community care homes, which are multiplying. We are also lagging behind in telemedicine and struggling with integrated home care. Furthermore, the management of waiting lists is being tackled in a simplistic manner. It is not a question of increasing services; rather, we need to manage demand and ensure appropriate care.” But is there a way out? “Cross-referencing data is essential, but it now seems that the whole task will be entrusted to Poste Italiane. The CUP (appointment booking system, ed.) should be complemented by the use of artificial intelligence to make it more effective and to facilitate automated processes that enable doctors to map out complex care pathways,” concludes Noja.

Giulio Gallera, former Regional Councillor for Welfare, now Chair of the Special Regional Committee for Health and Safety in the Workplace, and a leading figure in Forza Italia, also has some points to raise. “The Regulatory Agency recently presented an overview of the healthcare system, analysing macro-data and patient pathways. Overall, it highlighted a number of critical issues. Indeed, the data stream provided by Aria (the Regional Agency for Innovation and Procurement) is slow to arrive. What is certain is that the issue of Aria’s functionality has been a long-standing one; its inefficiencies were already evident during the Covid pandemic. It must be said that there has been a long-running standoff between Bertolaso and Aria; in fact, as soon as he arrived in the Regional Government, he set out the organisation’s limitations in writing. Clearly, a more detailed business plan is needed; otherwise, the merger that created Aria (three organisations into one) risks failing to meet the Region’s needs. Today we should be asking ourselves what to do with Aria: is it a reliable organisation? Because then there is also the issue of incomplete, difficult-to-use health records and data. With a whole host of technological issues, such as telemedicine, to manage, is Aria capable of coping? Or would it be better to outsource this via a tender process?’ And indeed, the idea of entrusting the health database to Poste Italiane is gaining ground. The facilities are performing well, but the staff are also under strain – what is needed? “It’s not easy; patients’ legitimate demands are increasing whilst our employment prospects are becoming less attractive. Then there is the challenge of the local area: the tools, such as community care homes, are there, even if there is currently little clarity on how to use them.” The undoubted excellence of Lombardy’s hospitals – both public and private – as attested by international rankings, is a guarantee; yet, according to some observers, it is far more closely linked to current results than to the future. There is a risk of a decline driven by the limited resources available and the lure from across the border that is drawing doctors and nurses away. It is up to politicians to play their part.