A new year also begins for the national health service which sees, in the 2025 budget law, various innovations to try to solve the numerous problems that afflict it. For the needs necessary for the correct financing of Italian healthcare we are left, once again, with a sock full of coal. We start from the assumption that using the word “cuts”, often in the mouths of the opposition, is wrong since the national health fund with the new budget law will see an increase over the years. The point is that this is an inconsistent increase compared to the real needs of the NHS as it is conceived today. So do you invest? Yes. But little and bad.

Healthcare personnel are expendable

According to Eurispes-Enpam data, from 2014 to 2017, the incidence of spending on NHS employees on total healthcare spending fell from 31.4% to 30.1%. In 2018, 45% of annual fixed-term units of the entire PA were used in the healthcare sector (35,481 out of 79,620). As of 31 December 2022, the NHS staff amounted to 625,282 units, an increase of 1.3% compared to the previous year of +8,083 units. At the same time, precarious employment and the use of fixed-term staff are also increasing.

The policy of saving on human resources is not, over time, the right path to pursue. Chilling data today presents us with the fact that approximately one doctor and one nurse in two are in burnout, that is, they suffer from chronic stress syndrome. These are not data to be underestimated because protecting those who take care of citizens becomes self-protection for one’s own health.

Does the 2025 budget law economically value healthcare personnel?

Increases in the salaries of doctors and nurses in the national health service are a necessary action, after years of sacrifices and unfulfilled promises. But is it really a turning point or are they just crumbs? I answer you frankly that this maneuver will not resolve the discontent of Italian healthcare professionals. For nurses, an increase in the specific nursing allowance is expected of approximately 7 euros net in 2025 and 80 euros from 2026. For doctors, from 2025 the increase in the specific allowance is 17 euros net per month and 115 euros from 2026. These increases will not bring about major changes to the structure of the NHS or instil increased motivation in staff or encourage, for example, a graduating student to choose a nursing career.

To try to make some areas more attractive, such as emergency and urgency which is in serious trouble, the measure provides for an increase in the allowance for healthcare personnel working in emergency rooms. This with 50 million euros gross allocated starting from 2025, divided into 35 million for the healthcare sector and 15 million for medical management. Investments which, however, do not go hand in hand with company attitudes towards healthcare personnel. To make a place attractive, increasing compensation is not enough but protection policies for staff are needed.

The mistake of focusing on overtime rather than ordinary work

The 2025 budget also provides, for nursing staff, that overtime will be subject to preferential taxation in order to increase the net income received. Mind you, these are additional hours, therefore additional time to be taken away from the worker’s psychophysical recovery and free time. Why must the NHS continue to rely on overtime to function? I often wonder if those who legislate have ever worked a shift in an intensive care unit or an emergency room and know what it means to work overtime in those contexts.

The main concern of healthcare personnel, both women and men, is to find a balance between private and work life. Women have more difficulty and it is they who have to adapt to the healthcare sector, often choosing between career and family. It is not the sector that has pursued greater equality through real cultural, organizational and supportive policy change. For this reason, economic sops or tax relief on overtime work will lead to nothing without a serious reorganization that has the human being as its unit of measurement.

Is it possible to practice a helping profession up to the age of 70?

Another controversial aspect of the maneuver is the raising of the retirement age to 70 for doctors and healthcare personnel. The goal is to combat staff shortages, but the question that arises is: at what cost? Healthcare work requires physical and mental energy and thinking that a healthcare professional, also in light of the recent data on burnout indicated above, will continue to work with the same effectiveness up to the age of 70 appears unrealistic to say the least.

For waiting lists the solution lies in the accredited private sector.

In order to reduce waiting times, it increases the spending limit for the Regions in purchasing services from accredited private individuals by 0.5% for the year 2025 (61.5 million euros) and by 1% starting from from the year 2026 (123 million euros per year). Furthermore, rewards will be established for the regions that comply with the reduction of waiting lists: 50 million euros for the year 2025 and 100 million euros per year starting from the year 2026. Diverting public funds towards the private sector, in my opinion, continues to delegitimize an already underfunded public health system. The figures, if looked at in the general context, are resources that end up fueling the Regions’ dependence on the private sector, rather than investing in structural improvements to the public sector: new hires, diagnostic tools, reorganization of processes. This approach accelerates fragmentation between citizens who can afford care and those who will be trapped in a weakened public.

In a historical moment in which public health is at the center of the concerns of millions of Italians, it is legitimate to ask: is this the answer that the professionals who keep the system afloat every day deserve?