So the healthcare system, in a crisis of credibility and safety, chooses to rely on NAS and Guardia di Finanza

The three collective labor agreements have expired for almost a year and a half and there is no sign of an imminent renewal. The premier time in the Chamber of Deputies on May 13th showed yet another dystopian diatribe on the levels of financing of the Health Service. Violence against health personnel seems unstoppable and now considered "normal". Anaao Assomed has launched a judicial offensive against 50 health companies that incorrectly apply the Ccnl of January 2024 or do not apply at all.

In this increasingly discouraging context, however, it seems that the solution to the critical issues of the NHS is emerging: the militarization of public health. The memorandum of understanding, signed on May 5th by the President of the Lombardy Region and the Welfare Councilor with the Carabinieri Command for Health Protection, is recent news. This is an operational collaboration between the region and the Carabinieri for the performance of control and monitoring activities at public and private providers (hospitals and clinics) with the aim of further reducing waiting times for outpatient specialist services and hospital admissions.

The news has caused quite a stir, yet it is not the first time that law enforcement has been called upon to deal with highly critical situations, and at least two previous cases have been particularly striking. The first in chronological order refers to the Commissioner ad acta of the Lazio Region who adopted a specific decree on 13 May 019 - later incorporated into the Guidelines referred to in Dgr n. 574 of 2.8.2019 - with which he authorised the 16 regional companies and bodies to carry out 106 selections to fill management positions in complex structures of various medical disciplines. The plan was challenging and put an end to a long period of stalemate due to the recovery plan and the consequent block on turnover. What caught the eye, however, was the provision of "adequate forms of institutional collaboration with the Guardia di Finanza and according to procedural methods that will be explained and made public with a separate act and to which the Companies and Bodies of the Regional Health Service are required to comply, all the necessary surveillance, control and verification activities, provided for by the legislation, relating to all the preliminary phases to the completion of the procedures authorised therein, in order to guarantee their successful outcome".

Well, the determination of the President/Commissioner appeared completely understandable and certainly had to be linked to the utmost search for transparency and impartiality. It was also to be assumed that it had been influenced to a considerable extent by the unfortunate events in the Lucanian and Umbrian health system that had concerned the conduct of competitions in the health companies (and the party of the commissioner himself who, incidentally, was the national secretary at the time). The decision therefore appears unexceptionable and commendable, but it does lend itself to some considerations. I mean that the DGs of Lazio certainly did not come out of the whole affair well and even less so the members of the drawing commissions who, it should be remembered, are three managers or administrative collaborators employed by the company. If one comes to think that only the physical presence of the financiers at the drawing operations or a subsequent control intervention is able to guarantee the transparency of the composition of the commissions, one can insinuate the doubt that the system alone is not able to provide such a guarantee.

The second case dates back to mid-November 2022 when an investigation by the NAS was carried out throughout Italy to verify the regularity of the contracts and methods of recruitment by the SSN structures of the so-called "tokenists", who are used to fill the shortages of doctors, nurses and other healthcare workers supplied by external companies, usually attributable to cooperatives. 637 private companies/cooperatives were monitored and the suitability of over 11,600 figures including doctors (13%), nurses (25%) and other healthcare professions (62%), such as Oss, laboratory technicians and similar figures was verified. Well, irregularities were found in 165 job positions and 205 individuals were reported to the competent authorities. The irregularities in this discouraging general picture were of the most varied types, but perhaps the most striking - and shameful - case is that of a cooperative active in Lazio that supplied a doctor who was already in service at another public hospital in an exclusive relationship.