From Community Homes to Telemedicine: Only 2.8 Billion of the 15.6 Planned by the PNRR Spent and It's a Personal Alarm

Construction sites that are late or not even open yet and a lot of funds still to be spent with the greatest difficulties in the South. And then the risk that as soon as the new health facilities, such as Community Houses and Community Hospitals, are opened, they will remain empty boxes due to the serious lack of staff: the risk is that there will be a lack of doctors and nurses to staff them, also because the health professions are less and less attractive. The risk of a flop of the PNRR programs to relaunch Healthcare - there are 15.6 billion allocated and only 2.8 billion spent so far - is the parliamentary budget office in a report dedicated specifically to the programs of the Health mission of the National Recovery and Resilience Plan: "The delays in the implementation of projects, particularly construction and especially in the South, and the serious lack of staff are the critical issues and the main challenges for the reorganization and strengthening of the NHS, with the risk - writes the Upb - of compromising the strengthening of the NHS and the provision of uniform assistance throughout the national territory".

With this Focus, the Parliamentary Budget Office takes stock of the progress of Mission 6, Health, of the National Recovery and Resilience Plan (PNRR), focusing mainly "on the concrete possibility of success in the challenge of reorganizing and strengthening the National Health Service". In addition to the progress of investments according to the most recent data available (official monitoring documents and ReGiS platform), the Focus assesses developments in terms of the actual entry into full operation and in a structural manner of the new services. At the latest available monitoring, the total public funding in this area detected in ReGiS was equal to 19.4 billion, of which 15.6 related to the PNRR. The scope of the interventions is broad, embracing territorial assistance, hospital assistance, research and training. The Upb analysis shows that the Health Mission deadlines agreed at European level have been respected so far, but the next stages will be the most difficult to complete (81.7 percent of the projects are in the executive or final phase, others are still to be started) and "would require significantly better performances compared to the traditional length of public works in Italy". At the moment, according to the latest available data, the expenditure made is equal to 2.8 billion, an amount slightly lower than that foreseen in the timetable (3.1 billion), but far from the total resources to be used.

Among the main issues reported by the Upb are the construction sites that are still open or even yet to be opened, especially in the South where the greatest delays are concentrated. "At present - explains the Parliamentary Budget Office - there is a discrepancy between the programming and the actual execution of the financed projects". The PNRR in fact provides for a constraint on the allocation of resources to the South (at least 40% of the total), "but the downward revision of the targets on construction interventions and the lack of new regional objectives consistent with the revision may not guarantee the expected infrastructural rebalancing even if the European goals were respected". The Upb gives the example of Community Houses and Community Hospitals: "The presence of construction sites in the executive or final phase is not homogeneous across the national territory; the proportions of the distribution and programming are not confirmed in the implementation, with a delay that is more accentuated in the South. If, once the European objectives have been achieved, attention is lost to the completion of the planned works, which should also be financed by other resources, the territorial rebalancing would not be achieved and compliance with the standards of territorial assistance would not be ensured across the entire national territory".

The UPB's examination of other interventions confirms that a strong commitment is still needed to complete the actions started, so that they generate a concrete strengthening of the NHS: the use of the electronic health record is still limited; for home care, the territorial operations centers (COT) are active, but the information on patients receiving home care still dates back to 2023, while telemedicine has slowed down, even if the target has become more ambitious; the digitalization of the emergency departments (DEA) is behind the end of the year deadline, especially in some regions of central and southern Italy; after a start slowed by various difficulties, the purchase of machinery is making rapid progress but some regions are behind in deliveries and testing; for the intervention relating to intensive and semi-intensive care places, developments are differentiated between the regions; in the field of training and research, progress is being made, with objectives achieved, calls for tenders published and funding started.

Finally, the UPB Focus notes that the implementation of investments will not guarantee the full operation of new or improved healthcare facilities if they are not populated with specially trained professionals. Currently, the services provided in community homes and hospitals are few, especially in the South, and it is not clear to what extent the new intensive and semi-intensive care beds are equipped with additional personnel to assist patients. If this also depends, in part, on the fact that construction sites are still underway, a recruitment plan appears essential, especially for nurses and some medical specialties, but also for general practitioners. Already at the time of the approval of the PNRR, this had appeared as one of the most serious gaps in the overall project to strengthen the NHS, for which additional resources were added to strengthen staff with the budget laws for 2022 and 2024. Therefore, concludes the UPB, it is necessary to evaluate whether these resources, which are quite substantial, are sufficient and to verify whether the Regions are making use of them, keeping in mind that regional difficulties could depend on deficiencies in management capacity or budget problems, or even on the low participation in recruitment procedures, due to the low attractiveness of the NHS.