The enormous conflict of attributions and competences is the main cause of the inefficiencies with which the Calabrian health system is facing the second wave of the pandemic. Three institutional levels – national emergency commissioner, commissioners for the implementation of the repayment plan and the Region – have not worked together as they should have done in recent months and the result is there for all to see: the interventions imagined to strengthen the health care network were only minimally implemented.
Multi-level confusion
In March, the Government identified the Region as the implementing body of all the measures useful for the containment of Covid-19 infections. The chain of measures is therefore led by the governor Jole Santelli and her delegates for the management of the pandemic, Antonio Belcastro and Fortunato Varone. It is an arrangement destined to last a short time because with the decree law 34 of May 19, the national government also establishes that in the Regions with the health care commissioner – as is, precisely, Calabria – the reorganization interventions must be guided by the structure that supervises the Return plan.
The reorganization of the hospital network
On June 18, former commissioner Saverio Cotticelli and his deputy, Maria Crocco, presented the decree that reorganizes the hospital network. The act includes a series of interventions deemed indispensable to cope with the advance of the coronavirus, including the implementation of intensive and sub-intensive therapies. For the former, an increase of 134 beds is expected, for the latter a contingent increased by a further 136 seats. But it is along this line that the first conflicts of competence are generated. Yes, because if on the one hand the Calabrian commissioners prepare the Covid Plan, on the other hand it is up to the national delegate for the emergency, Domenico Arcuri, to implement the interventions to enhance intensive and semi-intensive therapies. All this while on 27 October the Ministry of Health, in agreement with the Mef, communicates to Cotticelli that the power-duty to prepare and adopt the Covid operational program rests exclusively with the commissioner. A perfect short circuit, basically.
Arcuri’s choices
It should be noted that the works banned by Arcuri for the activation of the new beds are additional to the standard pre-pandemic equipment of Calabrian hospitals. On the other hand, setting up an intensive care station is not easy. As more experts have explained, the simplification according to which a fan is enough to make a Ti station functional is wrong. Without adaptation work on structures and other equipment – including qualified personnel – it would be naïve to think of increasing intensive care tout court. To this must be added, in the Calabrian case, the impasse that occurred in the interlocutions between Arcuri, the Region and the commissioner structure. The government delegate communicated to the top management of the Citadel that it would have been difficult for him to entrust the delegation of interventions to the Region in a reality where the health service is commissioned. Hence the expectation of a response from the commissioners (Cotticelli and Crocco) that never arrived and the choice to appoint implementing subjects (we are already in October) for the strengthening of intensive care the managers of the individual health and hospital companies . Is it squaring the circle? Not exactly. The funds expected from Rome have not yet arrived and the scenes of the last few days, with patients waiting for treatment scattered in the corridors of hospitals, are the clearest example of a very inadequate strategy.
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