New technologies support, more than ever before, the health sector to counter the progressive ageing of the population. A Third Sector widespread throughout the territory. These elements were the starting point for the reflection of the Scientific Committee of Toscana 2050 to answer the question ‘How is the relationship between health and quality of life changing?’
The trends
Analysing the current state of the art of the regional health system and in the face of the most important pandemic crisis recently faced, the Scientific Committee was able to develop its work on the basis of these trends:
- rising costs and underfunding:
Per capita public health expenditure in Italy is lower than in other European countries. Italy spends slightly more than Spain, Portugal and Greece but much less than, for example, France and Germany. The drive for progress in the medical field clashes with the underfunding of the national health system, which makes the introduction of new drugs and innovative technologies more difficult - The ageing of the population and the growth of chronicity and frailty:
Tuscany, in line with what is happening in Italy, is affected by a progressive ageing of the population, a decrease in the birth rate and the natural growth rate. Deaths systematically exceed the number of live births, particularly in the pandemic period. This leads to an increase in the number of chronically ill people, of whom there are about 1.4 million in Tuscany (and about 6 out of 10 are over 65 years old). The progressive increase in problems related to chronicity has been matched, as part of a policy of cost containment, by a progressive reduction in the number of hospital beds - The shortage of healthcare personnel:
The most relevant factor in the current fragility of the national health system, accentuated during the pandemic, is the shortage of health personnel. It is estimated that by 2023 there will be a shortfall of between 10 and 24 thousand specialists, and the main causes are: the so-called ‘training funnel’, i.e. the gap between the number of admissions to the degree course in Medicine and the insufficient number of postgraduate grants for General Medicine (GPs) and specialist contracts; professional migration abroad; the block on turnover and the consequent increase in the average age of the medical population; the ‘pension hump’, together with the recent pension reforms (e.g. Quota 100). Moreover, in the health professions it is recorded that, in our country, the number of nurses is among the lowest in the western world, in relation to doctors and the general population. The trend, therefore, is that of an increasingly poor system in terms of human resources and professionalism; - The growing contribution of technology:
Technological innovations of various kinds are also increasingly being used in the health field: avatars, artificial intelligence, robotics (in some ways already outdated), etc. In 2050, it is assumed that great strides will have been made in this respect, because technology will increasingly be seen as a means to the achievement of well-being, rather than an end. In particular, the success of surgical operations will be facilitated by new precision instruments, and the pharmaceutical industries will be able to produce targeted drugs that are more and more decisive and increasingly directed towards the prevention of diseases rather than their treatment following a diagnosis; - The focus on quality of life:
The population has been showing an increasing focus on quality of life in recent years. In particular, the culture of km0 and short supply chains, the promotion of healthy lifestyle habits, prevention, the importance of sport and the enhancement of natural and less anthropised environments have opened up in a strong way; - The increasing demand for integrated skills and multidisciplinary knowledge:
In addition to the health professions that are already present and established, in the future it will be increasingly important to train personnel whose knowledge will have to be strongly multidisciplinary and whose skills are integrated and straddle two or more fields. One example is the growing emergence of the figure of the biomedical engineer. - The difficulty of finding data:
What has been hypothesised about the growth of technologies clashes with a major current criticality of the healthcare system and more specifically of research (the prime driver of innovation), namely the use of data. Today, researchers and scientists are almost always obliged to use synthetic and not real data for their studies, and this represents a major obstacle in the conduct of work and the development of ideas. From a legal and regulatory point of view, the issue seems to be moving in a direction of ever greater closure and, therefore, ever less availability of existing data already produced; - The crisis of the current governance model:
In the Tuscan regional territory, the recent renewal of the USL system has generated - and risks generating to an ever greater extent in the future - a competition of the hospital sector that has led to the duplication of certain structures, which is not conducive to an optimal distribution and offer of services. At the same time, precisely because of the type of services that it offers and the management that the health system needs to have, it does not seem possible to think of the NHS in non ‘corporate’ terms.
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Strategic lines
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The work of the Scientific Committee resulted in the identification of 7 strategic lines to be submitted to the Regional Council of Tuscany and on the basis of which, to orientate the work in the immediate future:
- Towards a new financial balance
In order for the critical issues encountered in the national health system to be addressed and resolved, it is necessary, first and foremost, to rethink public spending, which should include health care among the country's spending priorities and therefore reserve more adequate sums for the sector. - La medicina territoriale in risposta alle esigenze della nuova struttura sociale
La tendenza all’invecchiamento dovrebbe essere gestita attraverso un rinnovato sistema di cura dedicato alla popolazione over 65, attraverso il rafforzamento della medicina territoriale e, quindi, di un sistema infrastrutturale sanitario non polarizzato. In generale, i cambiamenti demografici che stanno interessando il territorio, quali l’invecchiamento, la diminuzione della natalità e gli importanti flussi migratori, rappresentano un fattore fondamentale nella definizione di una strategia che interessi il futuro della Toscana. - Verso un nuovo modello di formazione
Per quanto riguarda la sempre più ridotta presenza di personale sanitario, occorre intervenire sul modello della formazione delle professionalità del campo medico e, quindi, sul dibattito, tuttora acceso, riguardo meritocrazia, concorsi e imbuti informativi. Allo stesso tempo, per quegli indirizzi e quelle specializzazioni (come chirurgia) i cui problemi non riguardano principalmente la disponibilità di posti, è necessario inter venire sugli equilibri che li regolano, creando le condizioni più idonee affinché uno studente sia in grado di studiare, formarsi e crescere in un ambiente stimolante e sfidante ma che non porti ad un sovraccarico e ad un sentimento di costante sopraffazione. - Qualità della vita e sistema scolastico
La crescente attenzione verso la qualità della vita dovrebbe passare anche per il sistema scolastico e, quindi, merita una riflessione specifica nel campo dell’insegnamento e della formazione primaria e secondaria. Occorre pensare a programmi ad hoc, rivolti ai bambini e ai ragazzi, in grado di favorire la tendenza in atto di promozione di una vita più sana. - Figure professionali e competenze integrate
Relativamente alla formazione, un’attenzione particolare andrà posta in maniera più specifica al tipo di figure professionali richieste nel futuro dal sistema sanitario. Professionalità quali l’ingegnere biomedico dovranno essere promosse e, pertanto, dovranno essere ripensate alcune tipologie di insegnamento universitario. - La norma e la disponibilità dei dati
Sul tema del difficile reperimento dei dati, la strategia individuata è quella di agire sul piano della normativa, che oggi risulta troppo restrittiva, così che si possa procedere alla creazione di registri e database implementabili, in grado di dialogare su più livelli, da quello locale a quello europeo. Inoltre, occorre favorire l’affermazione della figura del data scientist, sia nel pubblico che nel privato, la cui presenza, negli altri Paesi, è spesso quasi scontata sia nelle istituzioni sia nelle aziende, mentre in Italia fa ancora fatica a trovare il proprio spazio. - Un nuovo modello di governance
Affinché lo sviluppo regionale sul piano sanitario possa essere programmato in base alle reali esigenze dei suoi abitanti occorre ripensare il modello di governance attuale e definire un nuovo metodo di gestione del sistema sanitario nazionale che tenga conto della “Toscana diffusa” del 2050.