Case Study 1 – Tumour boards: collaboration as a tool to promote better care and

territorial assistance being more ready to face the pandemic’s challenges. The modernisation of all regional health systems towards a model capable of facing the environmental complexity and challenges of modern medicine will be key to ensuring sustainability and resilience.

§ Hospital-centred system: despite the already-mentioned regional variations, the pandemic has highlighted the need to invest in territorial assistance, which is often neglected. The absence of a primary care gatekeeping function and more generally of a ‘filter’ has caused a large number of patients, even with minor symptoms, to crowd the hospitals. Similarly, the lack of intermediate structures has slowed the discharge of frail and chronically ill patients, forcing regions to find quick-fix solutions. Continuity of care is essential for the future of our healthcare system, and will contribute to both its sustainability and resilience.

§ Workforce: The NHS suffers from chronic workforce shortages across a wide range of professional groups (physicians, nurses, administrators and other healthcare professionals), which was intensified during the pandemic. The latter has undoubtedly intensified workforce attrition rates, and has emphasised the need to review personnel planning, particularly for primary care. The workforce is fundamental to continue to adequately respond to COVID–19 and is the base upon which to build the sustainability and resilience of the system.

Recommendations

The following pages contain various recommendations on potential action to put in place to ensure the sustainability and resilience of the system. The final aim is to protect the healthcare system against possible future shocks. The recommendations cannot be considered exhaustive, and further work and mechanisms to ensure that lessons are learnt from the pandemic are paramount.

Table 2: Recommendations across the five domains and case studies

Domain Recommendations

Governance § Recommendation 1A: to improve the healthcare planning function to be based on timely, consistent and comprehensive data sets, at both national and regional levels, and to systematically measure the level of achievement of planning objectives. In this sense, the interconnectivity between databases should be improved in order to develop indicators to create incentives for the regions to reach specific and measurable healthcare goals. § Recommendation 1B: to conduct a public and participatory review into Italy’s response to the COVID-19 pandemic in order to strengthen the preparedness of the systems to health care crises. In addition, pandemic response plans should be regularly updated. § Recommendation 1C: to work on the coordination mechanism between central healthcare bodies and regional/local levels providing new national organisational standards for primary care services and non-hospital care. The pandemic has highlighted a slow regional response to governmental guidance, and unclear rules between of engagement between institutional levels. § Recommmendation 1D: to accelerate the process of introducing new healthcare services within the core benefit package of services (so called LEA) to be covered by the National Health Fund § Recommendation 1E: To reduce the administrative burden in order to increase the structural, organisational and operational flexibility of healthcare organisations with the aim of accelerating appropriate transformations.