[Forumlucca] I: informazioninrete

Szerző: Eugenio
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Tárgy: [Forumlucca] I: informazioninrete

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=20
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INFORMAZIONINRETE Notizie via email a cura di Rifondazione comunista=20
Lucca Piazza S. Romano 16 =96 fax e tel. 0583/316162 =96 la sede =E8 =
aperta
tutti i giorni dal luned=EC al venerd=EC dalle ore 15,30 alle ore 19,30, =
il
marted=EC dopo le 18,30 - www.rifondazione.it/lucca - email -
prclucca@???

Se non desideri ricevere le nostre informazioni, rispedisci questa email
e sarai immediatamente cancellato dall=92indirizzario
=20
=20
=20
=20

APPROVATO UN ORDINE DEL GIORNO SULLA SANITA=92 NEL CONSIGLIO COMUNALE DI
LUCCA PROPOSTO DALLA NOSTRA CAPOGRUPPO ROBERTA BIANCHI=20
=20
Rifondazione Comunista
 Sinistra Plurale antagonista
=20
Ordine del giorno
=20
Il Consiglio Comunale di Lucca riunito in data 04.03.2003 al termine
della discussione sul nuovo ospedale e sul futuro della sanit=E0 nella
nostra citt=E0, avendo rilevato
1)    la necessit=E0 di garantire un servizio pi=F9 puntuale all'interno
dell'ospedale Campo di Marte, aggiornando le attrezzature, adeguando gli
ambienti alle nuove tecnologie e superando la carenza di personale
tecnico e infermieristico
2)    la necessit=E0 di garantire la presenza di adeguati servizi e
strutture sul territorio per far fronte alle reali necessit=E0 dei
cittadini
1)   la consapevolezza che tali strutture di supporto saranno ancora =
pi=F9
necessarie a seguito della costruzione del nuovo ospedale, per effetto
della politica di deospedalizzazione che ne ispira la costruzione
2)   l'inadeguatezza di finanziamenti per la copertura di queste
necessit=E0
=20
invita il sindaco
a richiedere alla Regione toscana e al Governo finanziamenti
straordinari a copertura delle necessit=E0 evidenziate, in assenza dei
quali il problema sanitario, che gi=E0 oggi riveste caratteri di
emergenza, diventer=E0 drammatico per molte famiglie.
=20
Lucca 04.03.2003
Gruppo consiliare
Rifondazione Comunista
Sin.Plu.Ant.
=20
=20
DI SEGUITO PER CHI HA VOGLIA DI LEGGERE L=92INTERVENTO DI ROBERTA =
BIANCHI
IN CONSIGLIO
=20
=20
Voglio iniziare il mio intervento partendo da un'affermazione: il
diritto alla salute =E8 un diritto primario e in quanto tale va =
garantito
a tutti i cittadini. Io condivido fino in fondo questa affermazione
fatta dal consigliere Sonnenfeld, vorrei per=F2 cercare di capire se il
modo in cui viene affrontato oggi il problema della sanit=E0 =E8 tale da
garantire effettivamente  a tutti l'esercizio di questo diritto.=20
Per stabilire se un nuovo ospedale nella nostra citt=E0 era veramente
necessario si sarebbe dovuti partire dall'analisi della situazione
esistente, evidenziare i problemi e capire come tale costruzione
intervenisse in modo positivo per risolverli.
Partiamo dall'ospedale Campo di Marte. Quali sono i problemi di questo
ospedale?
Vi sono problemi strutturali, legati al fatto che questo ospedale =E8
diviso in padiglioni che rendono difficile un collegamento tra le varie
unit=E0; vi =E8 poi il padiglione centrale che, a detta del direttore
generale, presenta problemi di sicurezza e non =E8 a norma rispetto alle
leggi antisismiche. Per questo erano stati previsti dei finanziamenti
per interventi di straordinaria manutenzione. Questi soldi ovviamente
sono stati stornati sul nuovo ospedale e gli interventi che si andranno
a fare sul vecchio ospedale saranno solo di ordinaria manutenzione. Ma i
problemi sono anche altri. Alcuni sono stati evidenziati anche dal
sindaco in un suo intervento sulla stampa: l'aggiornamento delle unit=E0
operative alle nuove tecnologie, l'emodinamica in cardiologia,
l'angiografo non utilizzato in chirurgia generale, il potenziamento
della chirurgia endoscopica e laparoscopica, l'adeguamento degli
ambienti degli ambienti e della diagnostica per quanto riguarda
l'oncologia, l'aggiornamento delle attrezzature in nefrologia cos=EC =
come
in oculistica, l'aggiornamento della diagnostica operativa in
radiologia. A questi problemi io aggiungerei la carenza di personale che
fa s=EC che tutti i lavoratori ma in particolare tecnici e infermieri
siano sottoposti a carichi di lavoro molto pesanti; gli straordinari, i
rientri per progetti o per sostituire il collega in malattia o in ferie
sono all'ordine del giorno. Questa condizione lavorativa pu=F2 portare =
ad
uno stress psicofisico non indifferente e rende possibile una maggiore
percentuale d'errore sanitario. Negli ultimi anni inoltre si =E8 fatto
sempre pi=F9 ricorso a personale delle cooperative o in taluni casi =
anche
a personale chiamato solo per coprire l'emergenza. Tale personale, senza
nulla togliere alla professionalit=E0 dei singoli, non sempre pu=F2 =
fornire
un servizio adeguato e soprattutto continuativo. Sono inoltre aumentati
gli adempimenti burocratici per cui molto spesso si impiega il tempo a
riempire le carte piuttosto che ad occuparsi degli ammalati.
Sarebbe necessario intervenire  per superare le situazioni di
precariato, sia del personale infermieristico che medico, aumentando gli
organici.=20
Quali sono gli interventi previsti per sanare questa situazione?=20
Il direttore generale ha previsto una serie di spostamenti logistici di
alcune unit=E0 per rendere maggiormente funzionale il servizio, quali ad
esempio le due medicine nello stesso padiglione insieme alla
pneumologia; la pediatria insieme alla ginecologia, lo spostamento di
psichiatria e neurologia. Inoltre =E8 stata indetta la gara per la
radioterapia e sembra che l'emodinamica ci sar=E0, nient'altro e
soprattutto non ci sono finanziamenti. In attesa del nuovo ospedale
queste sono le condizioni in cui operer=E0 il vecchio e ci=F2 =
comporter=E0
un'ulteriore perdita di affidabilit=E0 della nostra struttura =
ospedaliera.
Ma tutti quanti hanno riconosciuto nei loro interventi che il problema
della sanit=E0 non si limita all'ospedale. La sanit=E0 comprende anche i
servizi sul territorio. Qual =E8 l'analisi a questo livello. Il =
direttore
generale dice, cito testualmente le sue parole in commissione sociale:
sul territorio non ci siamo. Non ci sono parametri per stabilire di
quanto personale c'=E8 necessit=E0.. e ancora "per quanto riguarda i
problemi degli anziani non siamo in grado di fare molto di pi=F9 di =
quello
che facciamo oggi. Il problema va risolto con risorse aggiuntive. Con
quelle che abbiamo non ce la facciamo. Inoltre =E8 necessario ricorrere =
al
contributo, alla compartecipazione del mondo del volontariato che deve
essere disposto a darci una mano".
Lo stesso sindaco sempre nell'articolo di cui parlavo prima denuncia la
mancanza sul territorio di strutture di supporto. Attualmente vi sono
infatti 5 strutture RSA (residenze sanitarie assistenziali) non adatte
ad accogliere pazienti subacuti o convalescenti, dislocate in modo
disordinato e carenti come posti e un solo ospedale di comunit=E0 per la
cura di patologie acute di lieve entit=E0 decentrato a Gallicano. Si
sconta inoltre una cronica mancanza di paramedici e di specialit=E0 =
nelle
strutture distrettuali. Questa analisi =E8 condivisa anche
dall'associazione dei medici di medicina generale.   Gi=E0 ora dunque
siamo in emergenza sanitaria e anche in questo caso sarebbero necessari
finanziamenti ulteriori, che per=F2 non sono previsti.
In questo contesto si inserisce la decisione di costruire un nuovo
ospedale. Risolver=E0 i problemi? Io credo di no, credo anzi che li
acutizzer=E0.
Il nuovo ospedale =E8 concepito in maniera funzionale ad un concetto di
sanit=E0. E' un ospedale per acuti, perch=E8 il principio =E8 che si =
deve
limitare l'intervento ospedaliero al minimo indispensabile dopodich=E8 i
pazienti (meglio definiti nelle linee d'indirizzo della sanit=E0 =
regionale
2002-2004 come clienti/utenti) potranno tornare a casa o trovare
accoglienza in altre strutture presenti sul territorio.=20
Quali? Abbiamo gi=E0 visto che gi=E0 ora sono insufficienti o =
inesistenti.
Per avere garantito un adeguato servizio sul territorio sarebbe
necessario un aumento consistente della quota destinata alla spesa
sanitaria. Qualcuno pu=F2 dire che poich=E8 cambia l'idea di sanit=E0, =
si
prevederanno finanziamenti straordinari per creare le strutture e i
servizi che mancano. Purtroppo non sar=E0 cos=EC e crederlo significa
nascondersi dietro un dito. Nell'ultimo decennio infatti vi =E8 stata =
una
sistematica riduzione delle risorse disponibili per il finanziamento al
sistema sanitario nazionale. Secondo un'indagine dell'INPDAP la spesa
sanitaria in Italia =E8 oggi inferiore al 5%, (nel '92 era l'8%). Questo
dato la colloca ad uno degli ultimi posti in Europa per il rapporto
spesa sanitaria /PIL. La media europea =E8 superiore di circa due punti.
Il governo Berlusconi ha ulteriormente accentuato la tendenza prevedendo
il finanziamento statale soltanto per la gestione corrente del sistema
senza alcun intervento in materia di investimenti sanitari e tagliando
le cure per le malattie croniche. D'altra parte il taglio delle cure per
le malattie croniche =E8 portata avanti da anni sia a livello nazionale
che a livello regionale. L'ultimo governo Amato ha trasferito per
decreto il costo delle cure a lungo termine per le persone con malattie
croniche e mentali (anziani e disabili) a carico dei bilanci dei Comuni,
che a loro volta chiedono una partecipazione delle famiglie alla spesa.=20
Il governo Berlusconi ha portato questo processo alle estreme
conseguenze.=20
L=92accordo del governo con i Presidenti delle Regioni e i =
rappresentanti
di Province e Comuni, pubblicato sulla Gazzetta Ufficiale e poi recepito
in un decreto firmato da Berlusconi, Tremonti e Sirchia, ha confermato
il trasferimento a carico dei Comuni e delle famiglie di una quota del
costo, che arriva fino al 60%, di alcune prestazioni sanitarie
considerate =93accessorie=94 rispetto =93ai livelli essenziali di =
assistenza
sanitaria=94. Si tratta in realt=E0 di prestazioni sanitarie relative
all=92assistenza domiciliare e alla diagnosi, riabilitazione e terapia =
di
persone con disabilit=E0 grave e malate di Aids.
La regione Toscana nel documento di programmazione economica e
finanziaria dice chiaramente che vi saranno problemi di sostenibilit=E0
economica del sistema sanitario, in una realt=E0 regionale in cui cresce
il bisogno e quindi la domanda sanitaria. Nella nostra regione il 25%
della popolazione =E8 anziana e si sa che gli anziani sono i pi=F9 =
grandi
fruitori di prestazioni sanitarie. E come pensa la Regione di risolvere
il problema? Ricorrendo alla sussidiariet=E0 orizzontale come elemento
portante del sistema stesso e da qui le sperimentazioni gestionali
miste, la sanit=E0 integrativa, i buoni servizio (tutte questioni =
presenti
nel nuovo piano sanitario regionale e nelle linee guida del piano
sociale). Questo accanto ad un ulteriore giro di vite sulla
razionalizzazione e riorganizzazione del sistema (taglio di posti letto,
chiusura dei presidi ospedalieri, blocco del turn over del personale,
incentivi ai medici che risparmiano sui farmaci) Ulteriore perch=E8 =
questa
razionalizzazione =E8 in atto da anni. La regione Toscana =E8 stata =
infatti
una delle prime a realizzare, dal punto di vista normativo, la riforma
De Lorenzo, (legge 502/92) dal nome dell'allora ministro della sanit=E0.
Questa riforma ha introdotto l'aziendalizzazione della sanit=E0, e di
fatto =E8 servita a negare il bene salute come diritto per tutti e per
tutte, riducendolo alla semplice aspettativa di ottenere servizi
compatibili con i finanziamenti stanziati. L'importante era per
l'azienda ospedaliera o sanitaria raggiungere il pareggio di bilancio
anche se per raggiungere questo obiettivo non si riusciva a soddisfare i
bisogni di salute della popolazione. La regione toscana  si =E8 dotata =
di
una propria legge regionale (legge 49/94) che ha recepito l'obiettivo
dell'aziendalizzazione della sanit=E0 attraverso appunto la dismissione =
di
presidi ospedalieri (in dieci anni da 93 a 40) i tagli dei posti letto,
(da 7,5 a 4,5 ogni mille abitanti), la riduzione del numero degli
addetti ( secondo l'organizzazione mondiale della sanit=E0 il rapporto
dovrebbe essere di 6,9 infermieri ogni 1000 abitanti: in Toscana ne
mancherebbero grosso modo 6.000)  la riduzione della degenza ospedaliera
senza peraltro dotarsi di strutture alternative sul territorio. Gli
ospedali di comunit=E0 per lungodegenti o malati cronici realizzati =
nella
regione a tutt'oggi sono 3: uno a S. Giovanni Valdarno, uno a Foiano
della Chiana e un altro nella zona fiorentina...La regione toscana
garantisce l'assistenza solo a un quarto dei quasi 28.000 anziani non
autosufficienti gravissimi o gravi ( e mi limito agli anziani ma il dato
dovrebbe comprendere i servizi revisti per gli altri ammalati cronici).
L'Osservatorio di epidemiologia dell'agenzia regionale della sanit=E0 a
proposito dell'assistenza agli anziani ha affermato che molta parte dei
bisogni sono a carico delle famiglie e che questo bisogno non
soddisfatto penalizza i gruppi sociali pi=F9 disagiati.
E' questa politica che ha permesso alla regione toscana di risparmiare e
di avere finanziamenti per la costruzione del nuovo ospedale.=20
Tutto ci=F2 =E8 avvenuto sulla pelle dei cittadini e saranno i cittadini =
che
continueranno a pagare le conseguenze di certe scelte se non si inverte
la rotta.
La salute non =E8 di destra n=E8 di sinistra, consigliere Ravenni,  ma =
certo
hanno connotazioni specifiche le scelte politiche in materia di salute.
Per quanto ci riguarda perch=E8 sia garantito effettivamente il diritto
alla salute a tutti i cittadini noi diciamo che la sanit=E0 deve essere
pubblica, lo stato deve investire, non ci possono essere tagli in nome
della compatibilit=E0 di bilancio. Questo significa che si devono
sperperare i soldi dei cittadini, non =E8 certo questo il punto. Ma
dobbiamo invertire la logica. Attualmente si stabilisce un budget e
all'interno di questo si realizzano gli interventi. Per avere interventi
adeguati =E8 necessario individuare i bisogni e in base ai bisogni
stabilire gli interventi. I soldi per la salute dei cittadini si devono
trovare. Perch=E8 non pensare ad esempio di diminuire i finanziamenti =
alle
spese militari? L'Italia spende per le spese militari 412 euro per ogni
cittadino, un terzo di quanto mette a disposizione per la sanit=E0 per
ogni abitante (1129 euro).=20
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<st1:PersonName>INFORMAZIONINRETE</st1=
:PersonName> =
Notizie via email a cura di Rifondazione =
comunista <o:p></o:p>

Lucca Piazza S. =
Romano
16 – fax e tel. 0583/316162 – la sede =E8
aperta tutti i giorni dal luned=EC al venerd=EC dalle ore 15,30 alle ore =
19,30, il
marted=EC dopo le 18,30 - <a =
href=3D"http://www.rifondazione.it/lucca">www.rifondazione.it/lucca</a>
- email - <st1:PersonName>prclucca@???</st1:PersonName><o:p></o:p>

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APPROVATO UN ORDINE DEL GIORNO SULLA SANITA’ NEL =
CONSIGLIO
COMUNALE DI LUCCA PROPOSTO DALLA NOSTRA CAPOGRUPPO ROBERTA BIANCHI =
<o:p></o:p>

<o:p> </o:p></s=
pan>

Rifondazione
Comunista<o:p></o:p>

=A0Sinistra Plurale =
antagonista<o:p></o:p>

<o:p> </o:p></s=
pan>

Ordine
del giorno<o:p></o:p>

<o:p> </o:p></s=
pan>

Il
Consiglio Comunale di Lucca riunito in data 04.03.2003 al termine della
discussione sul nuovo ospedale e sul futuro della sanit=E0 nella nostra =
citt=E0,
avendo rilevato<o:p></o:p>

<![if =
!supportLists]>1)    =
<![endif]>la</sp=
an> =
necessit=E0 di
garantire un servizio pi=F9 puntuale all'interno dell'ospedale Campo di =
Marte,
aggiornando le attrezzature, adeguando gli ambienti alle nuove =
tecnologie e
superando la carenza di personale tecnico e =
infermieristico<o:p></o:p>

<![if =
!supportLists]>2)    =
<![endif]>la</sp=
an> =
necessit=E0 di
garantire la presenza di adeguati servizi e strutture sul territorio per =
far
fronte alle reali necessit=E0 dei cittadini<o:p></o:p>

<![if =
!supportLists]>1)   =
<![endif]>la</sp=
an> =
consapevolezza
che tali strutture di supporto saranno ancora pi=F9 necessarie a seguito =
della
costruzione del nuovo ospedale, per effetto della politica di deospedalizzazione che ne ispira la =
costruzione<o:p></o:p>

<![if =
!supportLists]>2)   =
<![endif]>l'</sp=
an>inadeguatezza
di finanziamenti per la copertura di queste =
necessit=E0<o:p></o:p>

<o:p> </o:p></s=
pan>

invita il sindaco<o:p></o:p>

a</spa=
n> =
richiedere
alla Regione toscana e al Governo finanziamenti straordinari a copertura =
delle
necessit=E0 evidenziate, in assenza dei quali il problema sanitario, che =
gi=E0 oggi
riveste caratteri di emergenza, diventer=E0 drammatico per molte =
famiglie.<o:p></o:p>

<o:p> </o:p></s=
pan>

Lucca =
04.03.2003<o:p></o:p></=
font>

Gruppo
consiliare<o:p></o:p>

Rifondazione
Comunista<o:p></o:p>

Sin.Plu.Ant.<o:p></o:p>

<o:p> </o:p>

<o:p> </o:p=
>

DI SEGUITO PER =
CHI HA
VOGLIA DI LEGGERE L’INTERVENTO DI ROBERTA BIANCHI IN =
CONSIGLIO<o:p></o:p>

<o:p> </o:p=
>

<o:p> </o:p>

Voglio iniziare il mio intervento partendo da
un'affermazione: il diritto alla salute =E8 un diritto primario e in quanto tale va garantito a tutti i cittadini. Io =
condivido
fino in fondo questa affermazione fatta dal
consigliere Sonnenfeld, vorrei per=F2 =
cercare di capire
se il modo in cui viene affrontato oggi il problema della sanit=E0 =E8 =
tale da
garantire effettivamente=A0 a =
tutti
l'esercizio di questo diritto. <o:p></o:p>

Per stabilire se un nuovo ospedale nella nostra =
citt=E0 era veramente necessario si sarebbe dovuti partire
dall'analisi della situazione esistente, evidenziare i problemi e capire =
come
tale costruzione intervenisse in modo positivo per =
risolverli.<o:p></o:p>

Partiamo dall'ospedale Campo di Marte. Quali sono =
i
problemi di questo =
ospedale?<o:p></o:p>

Vi sono problemi strutturali, legati al fatto che =
questo ospedale =E8=A0
diviso in padiglioni che rendono difficile un collegamento tra le =
varie
unit=E0; vi =E8 poi il padiglione centrale che, a detta del direttore =
generale,
presenta problemi di sicurezza e non =E8 a norma rispetto alle leggi
antisismiche. Per questo erano stati previsti dei finanziamenti per =
interventi
di straordinaria manutenzione. Questi soldi ovviamente sono stati =
stornati sul
nuovo ospedale e gli interventi che si andranno a fare sul vecchio =
ospedale
saranno solo di ordinaria manutenzione. Ma i problemi sono anche altri. Alcuni sono stati
evidenziati anche dal sindaco in un suo intervento sulla stampa:
l'aggiornamento delle unit=E0 operative alle nuove tecnologie, l'emodinamica in cardiologia, l'angiografo
non utilizzato in chirurgia generale, il potenziamento della chirurgia
endoscopica e laparoscopica, l'adeguamento =
degli
ambienti degli ambienti e della diagnostica per quanto riguarda =
l'oncologia,
l'aggiornamento delle attrezzature in nefrologia cos=EC
come in oculistica, l'aggiornamento della diagnostica operativa in =
radiologia.
A questi problemi io aggiungerei la carenza =
di
personale che fa s=EC che tutti i lavoratori ma in particolare tecnici e
infermieri siano sottoposti a carichi di lavoro molto pesanti; gli
straordinari, i rientri per progetti o per sostituire il collega in =
malattia o
in ferie sono all'ordine del giorno. Questa condizione lavorativa pu=F2 =
portare
ad uno stress psicofisico non indifferente e rende possibile una =
maggiore
percentuale d'errore sanitario. Negli ultimi anni inoltre si =E8 fatto =
sempre pi=F9
ricorso a personale delle cooperative o in taluni casi anche a personale
chiamato solo per coprire l'emergenza. Tale personale, senza nulla =
togliere
alla professionalit=E0 dei singoli, non sempre pu=F2 fornire un servizio =
adeguato e
soprattutto continuativo. Sono inoltre =
aumentati gli
adempimenti burocratici per cui molto spesso =
si
impiega il tempo a riempire le carte piuttosto che ad occuparsi degli =
ammalati.<o:p></o:p>

Sarebbe necessario intervenire=A0 per superare le situazioni di =
precariato, sia
del personale infermieristico che medico, aumentando gli organici. =
<o:p></o:p>

Quali
sono gli interventi previsti per sanare questa situazione? =
<o:p></o:p>

Il direttore generale ha previsto una serie di
spostamenti logistici di alcune unit=E0 per =
rendere
maggiormente funzionale il servizio, quali ad esempio le due medicine =
nello
stesso padiglione insieme alla pneumologia; =
la
pediatria insieme alla ginecologia, lo spostamento di psichiatria e =
neurologia.
Inoltre =E8 stata indetta la gara per la =
radioterapia e
sembra che l'emodinamica ci sar=E0, =
nient'altro e
soprattutto non ci sono finanziamenti. In =
attesa del
nuovo ospedale queste sono le condizioni in cui operer=E0 il vecchio e =
ci=F2 comporter=E0
un'ulteriore perdita di affidabilit=E0 della nostra struttura =
ospedaliera.<o:p></o:p>

Ma tutti quanti hanno riconosciuto nei loro =
interventi
che il problema della sanit=E0 non si limita =
all'ospedale. La sanit=E0 comprende anche i servizi sul territorio. Qual =E8 =
l'analisi a
questo livello. Il direttore generale dice, cito testualmente le sue =
parole in
commissione sociale: sul territorio non ci siamo. Non ci sono parametri =
per
stabilire di quanto personale c'=E8 necessit=E0.. e ancora
"per quanto riguarda i problemi degli anziani non siamo in grado di =
fare
molto di pi=F9 di quello che facciamo oggi. Il problema va risolto con =
risorse
aggiuntive. Con quelle che abbiamo non ce la facciamo. Inoltre
=E8 necessario ricorrere al contributo, alla compartecipazione del mondo =
del
volontariato che deve essere disposto a darci una =
mano".<o:p></o:p>

Lo stesso sindaco sempre nell'articolo di cui =
parlavo prima denuncia la mancanza sul territorio =
di
strutture di supporto. Attualmente vi sono =
infatti 5
strutture RSA (residenze sanitarie assistenziali) non adatte ad =
accogliere
pazienti subacuti o convalescenti, dislocate =
in modo
disordinato e carenti come posti e un solo ospedale di comunit=E0 per la =
cura di
patologie acute di lieve entit=E0 decentrato a Gallicano.
Si sconta inoltre una cronica mancanza di paramedici e di specialit=E0 =
nelle
strutture distrettuali. Questa analisi =E8 condivisa anche =
dall'associazione dei
medici di medicina generale.=A0=A0 =
Gi=E0 ora
dunque siamo in emergenza sanitaria e anche in questo caso sarebbero =
necessari finanziamenti ulteriori, che per=F2 non sono =
previsti.<o:p></o:p>

In questo contesto si =
inserisce
la decisione di costruire un nuovo ospedale. Risolver=E0 i problemi? Io =
credo di
no, credo anzi che li acutizzer=E0.<o:p></o:p>

Il nuovo ospedale =E8 concepito in maniera =
funzionale ad
un concetto di sanit=E0. E' un ospedale per acuti, perch=E8
il principio =E8 che si deve limitare l'intervento ospedaliero al minimo
indispensabile dopodich=E8 i pazienti =
(meglio
definiti nelle linee d'indirizzo della sanit=E0 regionale 2002-2004 come
clienti/utenti) potranno tornare a casa o trovare accoglienza in altre
strutture presenti sul territorio. <o:p></o:p>

Quali? Abbiamo gi=E0 visto che gi=E0 ora sono =
insufficienti
o inesistenti. Per avere garantito un adeguato servizio sul
territorio sarebbe necessario un aumento consistente della quota =
destinata alla
spesa sanitaria. Qualcuno pu=F2 =
dire che poich=E8 cambia l'idea di sanit=E0, si prevederanno
finanziamenti straordinari per creare le strutture e i servizi che =
mancano.
Purtroppo non sar=E0 cos=EC =
e crederlo significa nascondersi dietro un dito. Nell'ultimo =
decennio infatti vi =E8 stata una sistematica riduzione =
delle risorse
disponibili per il finanziamento al sistema sanitario nazionale. Secondo
un'indagine dell'INPDAP la spesa sanitaria in Italia =E8 oggi inferiore =
al 5%,
(nel '92 era l'8%). Questo dato la colloca ad =
uno
degli ultimi posti in Europa per il rapporto spesa sanitaria /PIL. La =
media
europea =E8 superiore di circa due punti. Il governo Berlusconi
ha ulteriormente accentuato la tendenza prevedendo il finanziamento =
statale
soltanto per la gestione corrente del sistema senza alcun intervento in =
materia
di investimenti sanitari e tagliando le cure =
per le
malattie croniche. D'altra parte il taglio delle =
cure per le
malattie croniche =E8 portata avanti da anni sia a livello =
nazionale che a
livello regionale. L'ultimo governo Amato ha trasferito per decreto il costo delle =
cure a
lungo termine per le persone con malattie croniche e mentali (anziani e
disabili) a carico dei bilanci dei Comuni, che a loro volta chiedono una
partecipazione delle famiglie alla spesa. =
<o:p></o:p>

Il governo Berlusconi
ha portato questo processo alle estreme conseguenze. =
<o:p></o:p>

L’accordo del governo con i =
Presidenti
delle Regioni e i rappresentanti di Province e Comuni, pubblicato sulla
Gazzetta Ufficiale e poi recepito in un =
decreto
firmato da Berlusconi, Tremonti
e Sirchia, ha confermato il trasferimento a =
carico
dei Comuni e delle famiglie di una quota del costo, che arriva fino al =
60%, di
alcune prestazioni sanitarie considerate “accessorie” =
rispetto
“ai livelli essenziali di assistenza =
sanitaria”.
Si tratta in realt=E0 di prestazioni sanitarie relative
all’assistenza domiciliare e alla diagnosi, riabilitazione =
e
terapia di persone con disabilit=E0 grave e =
malate di
Aids.<o:p></o:p>

La regione Toscana nel documento di =
programmazione
economica e finanziaria dice chiaramente che vi saranno problemi di
sostenibilit=E0 economica del sistema sanitario, in una realt=E0 =
regionale in cui
cresce il bisogno e quindi la domanda sanitaria. Nella nostra regione il =
25%
della popolazione =E8 anziana e si sa che gli anziani sono i pi=F9 =
grandi fruitori di prestazioni sanitarie. E
come pensa la Regione di risolvere il problema? Ricorrendo alla sussidiariet=E0 orizzontale come elemento portante =
del
sistema stesso e da qui le sperimentazioni gestionali
miste, la sanit=E0 integrativa, i buoni servizio (tutte questioni =
presenti nel
nuovo piano sanitario regionale e nelle linee guida del piano sociale). =
Questo
accanto ad un ulteriore giro di vite sulla
razionalizzazione e riorganizzazione del sistema (taglio di posti letto,
chiusura dei presidi ospedalieri, blocco del turn over del personale, =
incentivi
ai medici che risparmiano sui farmaci) Ulteriore perch=E8
questa razionalizzazione =E8 in atto da anni. La regione Toscana =E8 =
stata infatti una delle prime a realizzare, dal punto di =
vista
normativo, la riforma De Lorenzo, (legge 502/92) dal nome dell'allora =
ministro
della sanit=E0. Questa riforma ha introdotto l'aziendalizzazione
della sanit=E0, e di fatto =E8 servita a =
negare il bene
salute come diritto per tutti e per tutte, riducendolo alla semplice
aspettativa di ottenere servizi compatibili con i finanziamenti =
stanziati.
L'importante era per l'azienda ospedaliera o sanitaria raggiungere il =
pareggio
di bilancio anche se per raggiungere questo =
obiettivo
non si riusciva a soddisfare i bisogni di salute della popolazione. La =
regione
toscana=A0 si =E8 dotata di una =
propria legge
regionale (legge 49/94) che ha recepito =
l'obiettivo
dell'aziendalizzazione della sanit=E0 =
attraverso
appunto la dismissione di presidi ospedalieri (in dieci anni da 93 a 40) =
i
tagli dei posti letto, (da 7,5 a 4,5 ogni mille abitanti), la riduzione =
del
numero degli addetti ( secondo l'organizzazione mondiale della sanit=E0 =
il
rapporto dovrebbe essere di 6,9 infermieri ogni 1000 abitanti: in =
Toscana ne
mancherebbero grosso modo 6.000)=A0 =
la
riduzione della degenza ospedaliera senza peraltro dotarsi di strutture
alternative sul territorio. Gli ospedali di comunit=E0 per lungodegenti =
o malati
cronici realizzati nella regione a tutt'oggi sono 3: uno a S. Giovanni Valdarno,
uno a Foiano della Chiana e un altro nella =
zona
fiorentina...La regione toscana garantisce l'assistenza solo a un quarto =
dei
quasi 28.000 anziani non autosufficienti gravissimi o gravi ( e mi =
limito agli
anziani ma il dato dovrebbe comprendere i servizi revisti
per gli altri ammalati cronici). L'Osservatorio di =
epidemiologia
dell'agenzia regionale della sanit=E0 a proposito dell'assistenza agli =
anziani ha
affermato che molta parte dei bisogni sono a carico delle famiglie e che =
questo
bisogno non soddisfatto penalizza i gruppi sociali pi=F9 =
disagiati.<o:p></o:p>

E' questa politica che ha permesso alla regione =
toscana
di risparmiare e di avere finanziamenti per la costruzione del nuovo =
ospedale. <o:p></o:p>

Tutto ci=F2 =E8 avvenuto sulla pelle dei =
cittadini e saranno
i cittadini che continueranno a pagare le conseguenze di certe scelte se =
non si inverte la rotta.<o:p></o:p>

La salute non =E8 di destra n=E8
di sinistra, consigliere Ravenni,=A0 ma certo hanno connotazioni =
specifiche le
scelte politiche in materia di salute. Per quanto ci riguarda perch=E8 sia garantito effettivamente il diritto =
alla salute a
tutti i cittadini noi diciamo che la sanit=E0 =
deve
essere pubblica, lo stato deve investire, non ci possono essere tagli in =
nome
della compatibilit=E0 di bilancio. Questo significa che si devono =
sperperare i
soldi dei cittadini, non =E8 certo questo il punto. Ma
dobbiamo invertire la logica. Attualmente si
stabilisce un budget e all'interno di questo si realizzano gli =
interventi. Per
avere interventi adeguati =E8 necessario individuare i bisogni e in base =
ai bisogni stabilire gli interventi. I soldi per la =
salute dei
cittadini si devono trovare. Perch=E8 non =
pensare ad
esempio di diminuire i finanziamenti alle spese militari? L'Italia =
spende per
le spese militari 412 euro per ogni cittadino, un terzo di quanto mette =
a
disposizione per la sanit=E0 per ogni abitante (1129 euro). =
<o:p></o:p>

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------=_NextPart_000_0007_01C2E693.9C9533C0--

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