National Recovery and Resilience Plan (“NRRP”) – Mission 6: Health

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  1. Introduction

The pandemic has made some critical aspects of a structural nature even more evident in the health sector, which in the future could be aggravated by the increased demand for care resulting from the ongoing demographic, epidemiological and social trends; in particular:

(i)   significant territorial disparities in the provision of services;

(ii)  inadequate synchronisation between hospital services, local services and social services;

(iii) long waiting times for the provision of some services;

(iv) lack of synergy in defining strategic responses to environmental, climate, and health risks.

The strategy of the NRRP, aimed at addressing the critical aspects above in a synergistic way, is divided into two components:

  • proximity networks, intermediate structures and telemedicine for territorial health care;
  • innovation, research and digitalization of the national health service (“NHS”).
  1. Proximity networks and intermediate telematic structures for territorial health care

General Objectives

  • Strengthening the NHS by aligning services to the needs of communities and patients;
  • Strengthening of institutions, local health care and home services;
  • Overcoming the fragmentation and lack of homogeneity of health services offered in the territory, through the development of telemedicine, and specifically, using advanced solutions to support home care.

Areas of Intervention and Investments

  1. a) Proximity networks, structures and telemedicine for territorial and national health care, environment and climate network

 The new health reform envisages two main activities:

  • definition of (i) homogeneous structural, organizational and technological standards for health care services across the territory, (ii) measures to be adopted by health care providers, and the approval of a specific ministerial decree relating to the foregoing;
  • the definition, by mid-2022, of a new institutional framework for prevention in the healthcare environmental and climate sectors, in line with the “One-Health” approach.

The 7 billion euro investment plan includes the:

  • activation of 1,288 Community Houses (“Case della Comunità”) (both existing and new structures) by mid- 2026 (for 2 billion Euros). The Community House will be a physical, single point of access to health services to be provided by a multidisciplinary team of general practitioners, pediatricians, specialists, community nurses, and other health care professionals having also the possibility of accommodating social workers;
  • increase in the volume of home-care telematic services (tele-assistance, tele-consultation, tele-monitoring and tele-reporting), for up to 10 percent of the population over the age of 65 by mid-2026 (for 4 billion Euros). To obtain funding, telemedicine projects must be able to integrate with the Electronic Health Record, achieve quantitative performance targets linked to the main objectives of telemedicine and the NHS, as well as ensure that their development translates into an effective harmonization of health services (favoring projects that link several Regions, and exploit existing successful experiences, and aim to build real, easily accessible “telemedicine platforms”);
  • enhancement of intermediate assistance on a territorial level through the activation of Community Hospitals – e., healthcare structures within a territorial network for patients who require medical medium to low intensity clinical  treatment and for short-term hospitalization; this structure (having between 20 and 40 beds and mainly managed by nurses) will facilitate more suitable care by reducing inappropriate access to health facilities (such as the Emergency Room, other hospitalization establishments, and other specialized services) and assist with the transition of patients from acute care facilities to their home. The investment (for 1 billion Euros) will result in the construction of 381 Community Hospitals by mid-2026.
  1. Innovation, research and digitalization of the National Health Service

General Objectives

  • Reinforcement of scientific research in the biomedical and health fields;
  • Strengthening and innovation of the NHS’ technological and digital structure at central and regional levels.

Areas of Intervention and Investments

Technological and digital updating

  1. a) Reorganization of the Scientific Hospitalization and Care Institutes (“Istituti di Recovero e Cura a Carattere Scientifico” or “IRCCS”) Network

The reform (to be implemented with a legislative decree by the end of 2022) will entail, first of all, the revision and updating of the regulatory structure, the legal and governance regimes of the IRCCS and the research policies of the Ministry of Health.  It is aimed at strengthening the relationship between research, innovation and health care, thereby creating an integrated network between the institutions and facilitating the exchange of specialist skills between the IRCCS and other structures of the NHS.

  1. b) Modernization of the Hospital Technology – Digital Park

 The investment (for a total of EUR 4.05 billion) involves the:

  • purchase of 3,133 new large equipment with high technological content (CAT, MRI, Linear Accelerators, Fixed X-ray Systems, Angiographs, Gamma Cameras, Gamma Camera/CAT, Mammography, Echotomography) for € 1.19 billion, by the end of 2024;
  • enhancement of the level of digitization of 280 health facilities with level I and II ER Departments (for 1.45 billion Euros, by the end of 2025);
  • renewal of existing intensive and semi-intensive care equipment and beds,  modernization of emergency rooms, and increasing the number of secondary medical transport vehicles (project already underway) for 1.41 billion Euros, by the second half of 2026.
  1. c) Towards a Safe and Sustainable Hospital

The investment aims to carve a path for the structural improvement and safety of hospital buildings by ensuring compliance with current regulations on construction in seismic areas. A survey conducted by the Ministry of Health in 2020 identified the need to carry out 116 interventions to comply with said regulations. The total investment amounts to 1.64 billion (1.0 billion of which relates to projects already in progress); these interventions should be complete by the second quarter of 2026.

  1. d) Strengthening the Technological Infrastructure and Tools for Data Collection, Processing, Analysis and Simulation of data.

Two distinct actions are envisaged:

  • Electronic Health Record (“EHR” or “Fascicolo Sanitario Elettronico – “FSE”)

The objective is to strengthen the EHR in order to guarantee its diffusion, homogeneity and accessibility throughout the national territory for patients and health workers. The EHR will perform three key functions: (i) provide an and information and access point for individuals and patients regarding the essential services provided by the NHS; (ii) provide a database for healthcare professionals which contains homogeneous clinical information including a patient’s entire medical history; (iii) permit the local health authority to use the EHRs clinical information to analyze clinical data and improve the health services provided.

The project involves:

  • the full integration of all healthcare documents and data typology, creation and implementation of a central archive, an interoperable platform of services, design of a standardized user interface, and the definition of services that the EHR will provide; and
  • integration of documents in the EHR by the different Regions,
  • financial support for (i) health service providers to update their technological infrastructure and data compatibility, and (ii) the regions that adopt the EHR platform,
  • support in terms of human capital and skills to carry out the changes (in terms of infrastructure and data) necessary to adopt the EHR.

It is estimated that 1.38 billion Euros in resources will be dedicated to the project (0.57 billion of which is allocated to projects already underway for the creation of the Electronic Health Card System) will be dedicated to the project.

  • The Ministry of Health’s Technological Infrastructure; Data Analysis and Predictive Model to Guarantee the Italian Essential Levels of Assistance (“LEA”), Health Surveillance and Supervision

The aim of the project is to strengthen the NSIS (“Nuova Sistema Informativo Sanitario” or “New Health Information System” – ie, the infrastructure and analytical tools the Ministry of Health uses to monitor the LEA  (“Livelli Essenziali di Assistenza”) and program the health care services for the population in line with the needs, evolution of the demographic structure, trends and epidemiological framework.

The project envisages: i) strengthening the Ministry of Health’s technological and application infrastructure, (ii) improving the collection, processing and production of NSIS data at the local level, (iii) developing advanced analytical tools to study complex phenomena and predictive scenarios in order to improve the ability to plan health services and detect emerging diseases; iv) creating a national platform where the demand and offer of accredited telemedicine service providers can meet. The project will absorb resources for a total of 0.29 billion Euros.

Training, Scientific Research and Technology Transfer

 a) Strengthening and enhancing the NHS’ Biomedical Research

The investment aims to (i) strengthen the biomedical research system in Italy, increasing the response capacity of its centers of excellence in the sector of rare diseases and (ii) promote technology transfer between research and businesses. In pursuit of these objectives, three types of intervention are envisaged:

  • financing Proof of Concept (PoC) projects aimed at reducing the gap between the scientific research sector’s results and their application for industrial purposes, by preparing prototypes for commercialization and mitigating potential risks – arising from patents, licenses or other entry barriers – that could discourage market investors (0.10 billion Euros, to be awarded by the end of 2023 and the end of 2025);
  • funding of research programs or projects in the field of rare diseases and rare cancers (a total of € 0.10 billion to be disbursed respectively by the end of 2023 and the end of 2025);
  • funding for research programs on highly disabling diseases (a total of € 0.32 billion to be awarded by 2023 and 2025)
  1. b) Developing the technical, professional, digital, and managerial skills of NHS personnel

 The investment aims to strengthen (i) basic medical training, introduce an extraordinary training plan for hospital infections, and (ii) the managerial and digital skills of healthcare personnel; in particular, it will include:

  • an increase in scholarships for general medicine;
  • the launch of an extraordinary training plan for all healthcare and non-healthcare personnel in hospitals regarding hospital infections;
  • the activation of a management skills acquisition path for, and to prepare, NHS healthcare professionals to face current and future challenges in an integrated, sustainable, innovative, flexible and consistently result-oriented perspective;
  • an increase in specialist training contracts to address the “training funnel” – ie the difference between the number of medical graduates versus the number of post-graduate specialization positions available – and ensure an adequate turnover of specialist doctors in the NHS.

The total cost of these initiatives, to be carried out by mid-2026, is estimated at 0.74 billion Euros.

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