Community homes and hospitals? A slow-moving revolution.
One hundred and four pages packed with tables, numbers, and considerations that aren't entirely unexpected and herald a near future filled with uncertainty. The Court of Auditors' half-yearly report on the " state of implementation of the NRRP and PNC interventions " relating to community homes and hospitals shows a country that is largely significantly behind schedule with respect to the June 2026 deadline. The Central Control Section, chaired by magistrate Mauro Orefice and called upon to express an opinion on the management of State administrations, specifies in the report that "the action strategy envisaged by Mission 6 , whose resources to date amount to a total of 17.32 billion euros , consists of two lines of intervention, aimed at improving the infrastructural and technological resources for local healthcare (8.2 billion euros, ed. ), as well as promoting scientific research and the strengthening of professional skills, innovation and digitalisation of the National Health System (9.1 billion euros, ed .)", as illustrated in the following table.
Interestingly, the report does not list Mission 6 among the most critical areas. However, the situation appears decidedly alarming, and work, with a few exceptions, is on average significantly behind schedule with respect to the June 2026 target. Naturally, some areas are more virtuous than others. Central and Southern Italy appears far behind Northern Italy, partly due to chronic structural issues: this more localized system was already more present or efficient, before Covid, in Tuscany, Emilia-Romagna, and Lombardy. One year after the crucial milestone, work had begun on 1,168 community homes, compared to the target of 1,038 redefined by the government. However, only 58 facilities had been tested. A similar situation exists for community hospitals: only 17 of them had been tested as of June 20 , but work had begun on 307 facilities (the initial target was 357 hospitals).
«Our organization has been monitoring the progress of the works financed by the PNRR since the Plan "The National Recovery and Resilience Plan was conceived," explains Anna Lisa Mandorino , general secretary of Cittadinanzattiva . "Some time ago, along with other third sector organizations, we complained that we had noticed a lack of participation in the construction phase of the PNRR ( here is the dedicated issue of VITA , ed. ). At least as far as we are concerned, we were committed to monitoring the progress of the planned measures and the allocated funds. A few years ago, on the occasion of the Festival of Participation (a public initiative promoted by Cittadinanzattiva and ActionAid Italia, ed. ), we launched the " Follow the Money " initiative to track the flow of funds allocated to the PNRR. We foresaw what then, to a large extent, happened and what the Court of Auditors promptly noted, namely the slowness in the use of these resources. A large part of them concern Mission 6 but also involves a part of Mission 5, linked to health. With OpenPolis , over the years, we have reconstructed the progress of the interventions envisaged by Mission 6".
The Court describes an implementation that, limited to the first six months of 2025, is "substantially in line with European objectives." A paradox? "No, because it doesn't actually rule out the slowness I mentioned," comments the head of Cittadinanzattiva. "And this slowness concerns structural interventions, aimed at building or renovating community homes and hospitals that will be made available to a community care system that we also appreciate. The problem is that this type of intervention, in our country, requires a rather long time and often encounters obstacles or setbacks. This is why, from the beginning, we expressed some concern. There is a need to accelerate, and the Court of Auditors also emphasizes this. But, at the moment, there are no prospects for a successful conclusion to the entire process."
There's another issue that Cittadinanzattiva consistently emphasizes: " Territorial disparities . Some regions are ahead, others are significantly behind: the latter are the ones that have had to face the process from scratch. Sometimes there are external obstacles, like elections or sudden resignations, as happened a few days ago in Calabria." As often happens, the more structured regions move forward at a rapid pace while the others struggle. "But precisely for the latter, such an intervention is doubly important," Mandorino notes. "It seems extremely unlikely to me that all the community homes and hospitals will be built by June 30, 2026. Not only that, but by that date the staff to work on them will have to be identified, and that's an equally huge challenge."
A startling element has emerged in this affair for some time: a certain mistrust among some political parties (both nationally and locally) regarding this type of infrastructure, which will be part of a more complex healthcare reform. Not everyone believes this. In fact, many still think that community centers are a kind of outpatient clinic. It's primarily a cultural issue. "This issue has emerged from the beginning," acknowledges the general secretary of Cittadinanzattiva. "Among other things, the name was chosen precisely because we're talking about a facility that promotes the health of a community, through community care, prevention, and chronic disease management. It even goes beyond the concept of community healthcare. In short, we're talking about the most vulnerable sectors of the national healthcare system. It's one of the reasons why so many people go to the emergency room, even for minor problems. For the third sector, these are the aims that should allow for the protection of healthcare as a whole. It's not just a response to an immediate healthcare need, it involves a proactive role. It should also be noted that the 1,038 planned community homes do not allow for a territorial distribution that would solve the problems. One of our main challenges concerns the location of community homes: originally designed to cover the most marginal and sparsely populated areas, not covered by services, they will ultimately be built primarily in areas that are already covered . According to research we published some time ago, we're talking about a full 84% of the facilities located in central and northern Italy. It's almost as if it were raining on the wet.
It must be said that the Community Houses won't be able to solve all the problems that have multiplied, especially with the pandemic. "Of course not. But they would be a big step forward, provided they are connected to general practitioners' practices and not individual doctors, as well as to local pharmacies, especially rural ones. A reorganization of the entire network is needed, a change of pace. It's even difficult to predict how much will be achieved in less than a year: we're doing everything we can to monitor the situation, researching individual data, but the Court of Auditors itself has emphasized in its document that, in addition to the need to accelerate the process, there's also the need to make information transparent for citizens, the non-profit sector, and all organizations working on these issues, precisely to ensure timely monitoring . The critical issues are, however, well-known: the initial gap that historically penalizes Central and Southern Italy, and the problem of inland areas , for which this intervention should have been more effective."
Cittadinanzattiva will resume monitoring in the coming weeks, along with other organizations it collaborates with. " The co-planning system must grow ," warns Anna Lisa Mandorino. "The third sector must facilitate this process, otherwise we run the risk of having very traditional healthcare structures. And even very unambitious with respect to the objectives of this reform. Co-planning, by definition, should be shared with all stakeholders in the process of change; otherwise, we're talking about something else."
Credits: The opening photo of the Tradate Community Center is courtesy of the Lombardy Region; the photo of Anna Lisa Mandorino is courtesy of Cittadinanzattiva.
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