Lavia, CISL Cosenza: per una Sanità normale serve ripartire dalla rete territoriale

Lavia, CISL Cosenza: per una Sanità normale serve ripartire dalla rete territoriale

Uno dei problemi più importanti della Sanità calabrese – afferma Giuseppe Lavia, Segretario generale della Cisl di Cosenza – è l’assenza del territorio, le troppe disfunzioni di una rete della medicina territoriale tropo spesso rimasta sulla carta.

Anche durante questa emergenza Covid-19 alcune fra le criticità maggiori sono proprio sul territorio, dalla mancata attivazione delle USCA (Unità Speciali di Continuità Assistenziale) e dell’assistenza domiciliare Covid alle disfunzioni sul tracciamento. Una lezione che dovremmo apprendere.

La rete ospedaliera è certamente fondamentale, ma serve ri-costruire la rete territoriale.

In queste ore i Sindaci chiedono a gran voce la riapertura dei 18 ospedali chiusi dal 2010. Sull’altare del piano di un rientro mai realizzato, sono stati tagliati troppi ospedali e troppi servizi.  Alcune di quelle strutture devono essere riaperte: ci sono sentenze che vanno applicate e ospedali di montagna che vanno salvaguardati. Ma pensare di riproporre la situazione del 2010, la fotografia dei troppi ospedali fotocopia, è una soluzione non realizzabile e crediamo potrà rappresentare più che altro un tema per cercare consenso da qui alle imminenti elezioni regionali.

Ripartire dal territorio è la grande priorità per ricostruire una Sanità di prossimità e di comunità. Nel piano di riorganizzazione della rete territoriale dell’ASP di Cosenza vediamo troppi progetti rimasti sulla carta. Con le risorse disponibili che si perdono fra contenzioso e cattive gestioni, senza un piano straordinario di assunzioni che da tempo invochiamo, anche questa riorganizzazione resterà sulla carta.

La Cisl – prosegue Lavia – ha espresso a più riprese le sue forti perplessità sul Decreto del Commissario ad Acta 65/2020 e sulla delibera 646 del 3 agosto relativa al Piano di Riorganizzazione della Rete Territoriale dell’ASP di Cosenza. Al nuovo Commissario ad acta Longo e al Commissario dell’ASP il compito di organizzare finalmente la rete di medicina territoriale che manca.

Ad oggi i Punti Unici di Accesso e le Unità di Valutazioni Multidimensionali non funzionano. Così come nulla è stato fatto per la creazione delle Aggregazioni Funzionali Territoriali (AFT) e delle Unità di Cure Complesse Primarie (UCCP) che, per come previsto nel Patto per la salute, dovrebbero essere la prima linea del sistema di cure sul territorio. Crediamo che questa sia una sfida importante e fondamentale. Quello che manca davvero è il sistema Distretto-UCCP-AFT.

Da troppo tempo denunciamo i ritardi nella realizzazione delle Case della Salute/CAPT da attivare negli ex presidi ospedalieri di Cariati, Lungro, Mormanno, San Marco Argentano e presso il poliambulatorio di Amantea, che restano sulla carta e che, invece, avrebbero dovuto essere luogo di integrazione fra cure primarie ed attività distrettuali.

Per la Casa della Salute di San Marco Argentano sono disponibili 8 milioni, per quella di Cariati 9 milioni. Ora, dopo anni di ritardi, la realizzazione degli interventi è affidata da maggio ad Invitalia, ma non ci risultano passi in avanti.

Sul versante del Piano di riorganizzazione, riqualificazione ed implementazione dell’Assistenza Territoriale registriamo troppe criticità. Non comprendiamo come, in assenza di personale e risorse, possa essere attivata, per esempio, l’offerta dei servizi di assistenziale residenziale e semi residenziale.

Nella nostra provincia le disfunzioni della rete territoriale sono croniche. E tutto questo molto prima che la pandemia si abbattesse su un sistema sanitario depredato, smantellato in tanti anni di un Commissariamento che non ha risolto nessuno problema.

Le strutture ospedaliere dell’ASP, specialmente alcune che tra l’altro sono in buone condizioni, potrebbero essere utilizzate per ospitare ambulatori polispecialistici di base, alcuni anche con day hospital e possibilità di offrire ottime risposte alle esigenze dell’utenza.

Ma in questi anni abbiamo perso tantissime ore di specialistica ambulatoriale che non sono state rimpiazzate per ragioni di bilancio, così come da anni non sono state bandite le postazioni di continuità assistenziale perse e tante aree della provincia sono carenti di medicina generale.

Una particolare attenzione in questa fase, anche in vista della campagna di vaccinazione congtro il Covid-19, deve essere prestata ai centri vaccinali, nei quali manca personale medico ed infermieristico.

Molto semplicemente, se c’è un Piano di riorganizzazione della rete territoriale, bisogna fare qualcosa di concreto per realizzarlo.

Nelle RSA Medicalizzate, rispetto al fabbisogno di 156 posti letto, ne risultano attivati 80, con la vicenda grottesca dei 20 posti letto della struttura RSA di Caloveto non operativi, nonostante siano accreditati.

Per le RSA Anziani, in base al fabbisogno servirebbero 749 posti letto.  Ne sono accreditati 659 in strutture private, ma è un numero non veritiero, con i 40 posti letto della RSA di Caloveto, per esempio, non contrattualizzati.

Sulle Case Protette per Anziani, rispetto al fabbisogno di 656 posti letto, la metà circa è da attivare. Peggiore ancora la situazione sulla semiresidenzialità Anziani e Demenza, con un fabbisogno di 218 posti letto complessivi e nessuno attivato.

Sulla residenzialità disabili, non c’è alcun posto letto attivato per sla-gravi malattie degenerative, rispetto ai 13 previsti. Per la residenzialità sanitaria disabili, su 116 posti letto previsti in base al fabbisogno, ne sono stati attivati solo 80. Sulla residenzialità dipendenze patologiche sono 42 i posti letto da attivare. Sulla semiresidenzialità dipendenze, c’è un fabbisogno di 43 posti letto e nessuno attivato. In questi numeri sui posti letto previsti e non attivati c’è la chiave per restituire alla fruibilità dei cittadini alcune strutture ospedaliere dismesse.

E poi ci sono i ritardi nelle cure domiciliari. Rispetto al fabbisogno totale di ADI (Assistenza Domiciliare Integrata) per gli anziani fissato a 6.243 casi, la presa in carico non supera i 4533.

Solo in queste settimane, sull’onda dell’emergenza Covid, l’ASP di Cosenza ha inteso avviare le procedure per l’assunzione di alcuni infermieri professionali. Una goccia in un oceano, perché negli ultimi mesi sull’albo pretorio sono state pubblicate decine di provvedimenti di collocamento a riposo di personale sanitario. Sul tappeto restano sempre le due questioni cruciali: risorse e personale.  Serve, per l’ASP di Cosenza e per la Sanità calabrese in generale, rompere incrostazioni e interessi consolidati; serve tagliare gli sprechi e governare un contenzioso fuori controllo. Un lavoro certamente necessario, ma non ancora sufficiente: perché senza una sterilizzazione del debito della Sanità calabrese, senza una sua riduzione sostanziale, senza un piano straordinario di assunzioni che non si areni sui tavoli di verifica ministeriali, il percorso verso una Sanità normale, verso una vera riorganizzazione della rete ospedaliera e della rete territoriale sarà lungo e pieno di ostacoli.

Barbara Santelli

Giornalista

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