This portal will allow monitoring the progress of the PNRR projects in the area of Mission 6: Health, with particular reference to the progress in the construction of Community Houses, Community Hospitals and Territorial Operations Centres. Citizens and users will be able to directly verify the use of the investments planned for the improvement of services, for the benefit of the entire population throughout the country.
The reform of the territorial health care services in Italy, launched with Ministerial Decree 771, will make use of the investments of the National Recovery and Resilience Plan (PNRR), to create a new organizational model of the healthcare network, aimed at defining models and standards related to territorial assistance, as the basis of the interventions envisaged by Component 1 of Mission 6 of the PNRR: "Proximity networks, structures and telemedicine for territorial health assistance".
In such a new reference framework, the proximity of care achieved through a reorganization of the District level, which should cover on average of about 100,000 inhabitants (with some variability allowed according to population density criteria and orographic characteristics), will apply the following standards:
- n.1 "Hub" Community House for every 40,000-50,000 inhabitants, with a staffing standard of 7-11 Nurses, 1 social worker, 5-8 units of Support Personnel (social, health and administrative). The Community House is the physical place that will be easily identifiable by citizens to access health care and social needs, where all professionals willl work in an integrated and multidisciplinary way, to plan and provide health and social integration interventions. A network of "Spoke" community homes, and general practitioners' (GPs) and paediatricians are also envisaged, taking into account the orographic and demographic characteristics of the territory, to favour the decentralization of services and greater equity of access, particularly in inland and rural areas. All aggregations of General Practitioners and Pediatricians are included in Community Houses, whose physical headquarters will be functionally connected to them.
- n.1 Family or Community Nurse every 3,000 inhabitants, as a standard for the total number of Family or Community Nurses employed in the various care settings in which community care is divided. The Family or Community Nurse is the reference professional figure ensuring nursing care for the various levels of complexity, in collaboration with all the professionals present in the community in which they operate, pursuing interdisciplinary, health and social integration of services and professionals and placing the person at the centre.
- n.1 Continuity Care Unit (1 doctor and 1 nurse) for every 100,000 inhabitants, in which an average of 1 doctor and 1 nurse operate in the catchment area, also using telemedicine tools (e.g. televisit and teleassistance ) in collaboration with doctors and paediatricians. The Unit does not replace but supports for a defined time the professionals responsible for taking care of the patient and the community. It can be activated in the presence of particularly complex clinical-assistance conditions and proven operational difficulties.
- n.1 Territorial Operations Center (COT) every 100,000 inhabitants, in which 1 Nursing coordinator, 3-5 nurses, and 1-2 units of support staff operate . The COT fulfills its role as a link between the various services through distinct and specific functions, e.g.: a) coordination of taking charge of the person between services and professionals; b) coordination/optimization of interventions, activating subjects and resources of the healthcare network; c) tracking and monitoring of mobility from one place of care to another; d) information and logistic support to all professionals; e) collection, management and monitoring of health data, also through telemedicine tools.
- 1 Operations Center with the Harmonized European Number 116117 for every 1-2 million inhabitants or in any case of regional level, with the function of facilitating population's access to non-urgent medical care and other low-intensity local health services/ priority of care, also linking up with the continuity of care and urgent emergency service, with the Territorial Operations Centers and other services provided by each Region or Autonomous Province.no.
- 1 Community Hospital with 20 beds for every 100,000 inhabitants, equipped with 7-9 nurses (of which 1 Nursing Coordinator), 4-6 social and health workers, 1-2 units of other health personnel with rehabilitation functions and a doctor for 4.5 hours a day 6 days out of 7. These structures perform an intermediate function between home and hospitalization, with the aim of avoiding improper hospitalizations and promoting protected discharges in more suitable places given the prevalence of assistance needs, of clinical stabilization, functional recovery and autonomy closer to home.
- 1 Home Palliative Care Unit for every 100,000 inhabitants, with a hospice of 8/10 bed places for every 100,000 inhabitants.
- 1 counseling center for every 20,000 inhabitants with the possibility of 1 for every 10,000 in inland and rural areas, where an activity aimed at minors is carried out in the context of community care with direct access, guaranteeing services, including home, medical, specialist, diagnostic and therapeutic, obstetrics, psychological and psychotherapeutic, nursing, rehabilitative, preventive, for women, minors, couples and families.
- 1 Department of Prevention (DP) for every 500,000 inhabitants to promote actions aimed at identifying and eliminating the causes of harmfulness and disease of environmental, human and animal origin, through initiatives coordinated with the districts and with the departments of the local health authority and the hospitals, ensuring the involvement of operators from various disciplines.
Monitoring compliance with these standards can be complex, especially when projects are underway and some services can evolve quickly over time, without the citizen being adequately informed.
Therefore, it becomes essential for the citizen to verify directly that these standards are met equally throughout the country, so that he/she can directly ascertain how proximity care is evenly implemented for everyone.
For such reason, the Transparency Portal will constantly update the cartographic representation, drawing upon all official information available regarding the progress of the implementation of PNRR projects in this area.
In this way, we plan to directly involve all the public, as well as professionals, in the continuous monitoring of planned investments - towards a new public health service built together, closer to home.
REFERENCES
- DECREE 23 May 2022, n. 77 Regulation containing the definition of models and standards for the development of territorial assistance in the National Health Service. (22G00085) (GU General Series n.144 of 22-06-2022),
https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2022-06-22&atto.codiceRedazionale=22G00085&elenco30giorni=false
