The scientific societies of internal medicine Fadoi and Simi: “NHS risks disappearing. Policy to address staff shortages: compared to 10 years ago 30 thousand fewer “

“In view of the elections we ask the parties to seriously address the issue of health which, apart from some slogans or smoky proposals, is off the radar of the debate as if the Covid emergency were a distant memory, the waiting lists were not very long, the staff shortages were not a reality and the need for reforms was not urgent ”, write in a joint note the president of Fadoi, Dario Manfellotto and the president of Simi, Giorgio Sesti.


“Compared to 10 years ago, the National Health Service has 30,000 fewer personnel. Despite the investments made during the pandemic, the NHS still badly needs resources and reforms to stop its decline. For this it is necessary to increase the Health Fund, address the shortage of staff and beds, reform the governance of the NHS giving greater centrality to the Ministry of Health, reorganize hospital care with the updating of Ministerial Decree 70, recover waiting lists and enhance Internal Medicine “.

These are some of the requests that the two scientific societies of internal medicine Fadoi and Simi make to the parties in view of the elections on 25 September. There are about 10 thousand hospital internists and they are present in all Italian hospitals.

We are talking about 1,478 complex structures of Internal Medicine between public and private (of which 360 Covid departments), out of a total of 1004 hospitals. From the historical total of almost 30 thousand internal medicine beds, internists have managed, due to Covid, over 40 thousand beds. In 2020 alone, the first year of the pandemic, well over 218,000 Covid patients were treated, equal to a quarter of the total hospitalizations in internal medicine and 70% of all hospitalizations for Covid. However, this large influx of Covid patients has caused a drop in total hospitalizations in the wards.

“In view of the elections, we ask the parties to seriously address the issue of health which, apart from some slogans or smoky proposals, is off the radar of the debate as if the Covid emergency were a distant memory, the waiting lists were not very long, the staff shortages were not a reality and the need for reform was not urgent. The pandemic has put a strain on our National Health Service and despite the interventions put in place, the road to safety public health is still long and does not allow for delays “, say the president of the Federation of Associations of Fadoi Internist Hospital Managers. Dario Manfellotto and the president of the Italian Society of Internal Medicine Simi, Giorgio Sesti. For this reason, the two scientific societies have drawn up a list of the main actions to be taken:

Adequate funding. For 2023, an increase of 2 billion in the health fund is expected, which should reach 126 billion. However, with the surge in inflation and the extraordinary expenses due to the pandemic, these resources still appear insufficient to allow a revival of the NHS.

Shortage of staff. Compared to 10 years ago, as reported by the Ministry of Health in its latest statistical yearbook, there are 30,000 fewer personnel. Specifically, about 5,000 medical employees of the NHS are missing. Furthermore, if we consider the provisions of the PNRR, around 40,000 new staff will be needed in the future between doctors and nurses. Action is needed immediately to unblock the spending ceiling because the shortage of personnel is the main emergency for our health care.

Reorganization of hospitals. The hospital needs guidelines to make them modern, so it is essential to update the Ministerial Decree 70/2015 on hospital standards. The pandemic has taught us that our structures, which are very old or in any case dated in most cases, must be ‘accordion’, ductile, that is, able to shed skin in turn, we need clear and nationally established rules that link the entire health service chain. Today, the treatment pathways are fragmented and often bottlenecks form that clog hospitals. It makes noise and the crowding of the emergency wards seems sensational, but that is the tip of the iceberg. It is clear that the system is blocked if one or more gears slow down: if the territory does not filter the admissions, if the wards do not discharge because the rehabilitation facilities and post-acute wards do not receive those discharged from the hospital, if the home does not welcomes.

Continuity of care. This is a key topic, because it allows patients who deserve chronic long-term care and rehabilitation therapy to be sent to the right care setting. In order to keep the average hospitalization times within the recommended objectives, it is necessary to unequivocally clarify the modalities of transition to another setting.

Transforming Internal Medicine from a ‘low’ to ‘medium’ intensity of care discipline. During the pandemic, 70% of Covid patients were assisted in the Internal Medicine Operating Units, which during the first, terrible waves, turned into real sub-intensive wards. The levels of care provided today in hospital in internal medicine wards are nowhere near comparable to those that were provided more than 30 years ago. Today the assistance provided has a significantly higher intensity of care with an average weight of DRGs above 1.30 and in many cases even up to 1.45-1.50.

This means that patients admitted to internal medicine always have serious and difficult clinical conditions, with very complex care needs, require constant assistance and specific skills, with extensive use of sophisticated technologies, technical-diagnostic instruments and integrated therapies. All of this is a major challenge for healthcare workers.

Unfortunately, the departments of Internal Medicine, which guarantee a high intensity of care, are still defined by the Ministry with the code 26-General Medicine, with a staff and beds that is that of a low level of care. In this sense, the re-definition of code 26 General Medicine as Internal Medicine and the transformation of Internal Medicine from a ‘low’ to ‘medium intensity of care’ discipline is fundamental, redefining the standards for healthcare personnel still bound by the old DM. 109/1988 Donat Cattin.

Retrieval of waiting lists. During 2020, the internal medicine wards lost approximately 650,000 hospitalizations for complex patients. A fact that we have elaborated independently and that Agenas has then confirmed. In 2021 we had recovered in part, but the subsequent waves of Covid have again slowed and hindered hospitalizations for our patients, as well as for all other medical and surgical pathologies. And even as far as 2022 is concerned, the numbers are not encouraging due to the Omicron waves.

Waiting lists are a structural problem, pre-existing at Covid, which requires serious interventions. Hiring staff from the last few years of specialization, encouraging extra-contractual activities for the recovery of waiting lists more than is currently the case and organizing territorial assistance more efficiently.

09 September 2022
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