The cuts to the health service have even infuriated the usually mild-mannered Bertolaso

When, on 14 October, the Council of Ministers gave the final go-ahead to the agreements on ‘differentiated autonomy’ – the Lega’s flagship policy, as agreed by the regional governors – for the regions of Lombardy, Veneto, Piedmont and Liguria – covering areas such as healthcare – President Attilio Fontana certainly did not expect to find himself, just a few days later, having to contend with a diametrically opposed political decision: namely, the healthcare cuts decided upon in the Budget Bill by a government ally. Just as Rome was slashing funding for Lombardy’s healthcare system, Fontana and Guido Bertolaso were pushing hard to open new community care homes in many of Lombardy’s provinces, to open the new Sforza wing of the Policlinico (800 beds, 26 operating theatres) and the new healthcare facilities at Niguarda (Eye Bank, Centre for Advanced Surgical Training), and working on drafting the new regulations for waiting lists (the bane of every regional administration, and of the Lombardy administration in particular, given the chronic inefficiency of Aria). It is notable that the most measured figure in the Fontana administration—free from Lega-style excesses—namely Guido Bertolaso, Councillor for Welfare, was the one who voiced the grievances: “The attitude of the other regions is truly embarrassing. Nowhere in the world – whether within a family, in the business world or in institutions – does it happen that, at the end of October, someone comes up with a cut and asks us to leave 250 million from the 2026 budget on the table to meet the needs of other regions. An unconstitutional and embarrassing decision that penalises the regions that have managed their finances responsibly at the expense of the others.”

A criticism of the government but, above all, of the southern regions. “We have a financial year to manage, we have commitments that must be honoured, we have to pay the healthcare staff who are working day and night, we are tackling the waiting lists – in short, are we supposed to shirk our responsibilities just because someone claims to be paid less than the Lombardy Region?”, Bertolaso snapped. He then delivered a strong message on the national health service: “Every day, we help our fellow citizens who come to Lombardy from other regions to receive treatment and find the care to which they are entitled, as the Constitution states. It is one thing to reason, quite another to be faced with blackmail that puts us in a difficult position.” Bertolaso is not giving up: “I believe that the planned cuts to healthcare, at this stage, are truly unsustainable for all regions, including us. Compared with last year, Lombardy would face a cut of half a billion euros, and this means we would be unable to complete the work on waiting lists, finish the care homes and community hospitals, or incentivise healthcare staff to work in the public sector as we are trying to do.”

So the Treasury would cut 250 million from Lombardy’s 2026 budget and a further 500 from the 2027 budget. What can be done? “On the one hand, we are preparing to manage the figures released by the Council of Ministers; on the other, we will do everything we can to ensure this allocation is increased. We hope that during the debate on the Finance Bill there will be changes that will allow us to plan for 2027 as well,” concludes the Welfare Councillor. “I’m pleased with Bertolaso’s good faith and confidence,” replies Carmela Rozza, a regional councillor for the PD who knows the healthcare sector very well, “but I’m convinced that the government will secure a vote of confidence and so the budget drafted by Palazzo Chigi will be passed. The Meloni government has continued to cut healthcare funding because it has never linked this funding to a virtuous cycle with GDP, and so we haven’t even kept pace with inflation. Then there’s the issue that if you don’t increase the healthcare fund, salaries don’t rise, and so you’re telling workers: sort it out yourselves. Many choose to work on a casual basis because they pay less tax and have fewer responsibilities.” Others, on the other hand, go to work in Switzerland to earn much more. On the dispute with the southern regions, Rozza has a different view: “It’s not as though, if I – a southern region – ask for more money, the north has to give it to me. Indeed, the increase in the national fund requested by the regions was 5 billion. So increased funding for the south isn’t being demanded at the expense of the north; it’s the government that has chosen to penalise the north. By dealing a blow to ‘differentiated autonomy’, which always makes the south (and not only the south, ed.) break out in hives,” concludes Rozza.

In about ten days’ time, the text of the Budget Bill will reach the Chamber of Deputies’ committee, where the frantic rush to amend it will resume. Attilio Fontana is banking on his moral suasion with the Minister of Finance, Giancarlo Giorgetti, with whom he shares a deep political rapport. But he is not shy about having his say: “This Budget Bill is the result of cuts made by past governments – the governments from 2011 to 2019; let me just point out, for the record, that they were all centre-left.”