Dr. Andrea Valdré, Director CHP Dr. LAURA ZECCHI Development and strategic planning CHP EUROSOCIALNETWORK THE NATIONAL HEALTH SERVICE The territorial Healthcare Unit of Florence The social services in the municipalities The interaction among services Project approved by the Tuscan District with Italian Decree No. 1975 of 22/04/2010 Regional Operational Programme ob. 2 Axis V “Transnationality and interregionality. Transnational projects submitted by Tuscan Provinces/Districts”. Implementing body: temporary association for a special purpose between the Province of Florence (leader) and Irecoop Toscana cooperative company (partner).
Italian Consitution - Article 32 The Republic of Italy safeguards health as a fundamental right of the individual and as a collective interest, and guarantees free medical care to the indigent. No one may be obliged to undergo a particular health treatment except under the provisions of the law. The law cannot under any circumstances violate the limits imposed by respect for the human person. Healthcare in Italy is based on Art. 32 of the Italian Constitution, which officially recognizes health as a fundamental right of the individual.
Principle of universality: according to which health benefits are guaranteed to every one without distinction of individual, social or income conditions; Principle of equality: according to which every one has the right to the same benefits, their needs being equal; Principle of globality: according to which it is not the disease which is taken into consideration, but the person in general, this necessarily infers a connection among all health services of prevention, treatment and rehabilitation. The health reform in 1978 (the same year of the WHO Conference in Alma-Ata )
Population Area Density Fiscal burden/GDP Over 65 60 millions 301,225 sq. km 163.1 43.2 % 21 % 9 millions 449,964 sq. km 21.9 47.8 % 17 %
Since 2011 regional districts administrate public health. Through the Local Health Units (Italian: ASL) the regional districts provide hospital services, healthcare in the districts and prevention. Every Local Health Unit organizes, provides and purchases services from the private sector and from voluntary associations in Tuscany. The National Health Service (NHS)
3,7 millions population
12 Local Health Units
Our territorial Health Unit 6.500 employees 5 hospitals 4 zones 33 municipalities
Area North-Western Florence Area Florence Population Over 65 Resident migrants Life expectancy at birth 217,000 48,201 (20.18) 20,208 (9.4 %) 80.49 - 85.33 365,000 94,664 (21.82) 46,268 (12.4%) 79.95 – 84.96
Healthcare services Area: North-Western Florence
Primary care 200 General Pratictioners.
Adult mental health
Child mental health
Addiction care centres (Addiction to drugs, alcohol, smoke, etc.)
Social services – (Law 328/2000)
The Italian Republic assures to people and to families an integrated system of social interventions and services, promotes interventions in order to guarantee the quality of life, equal opportunities, non-discrimination and rights to citizenship; it prevents, cancels or reduces the conditions of disability, need and individual or family deprivation rising from the inadequacy of income, social difficulties or non-autonomous situations.
The role of municipalities (Law 328/2000)
The municipalities are responsible for the administrative functions concerning the social interventions at local level and contribute to the regional planning .
The planning and carrying out of the local system of social services .
Areas of expertise of the municipalities
Information to the citizens for the access to the services.
Professional social services, counselling and contract of undertaking
Foster care and international adoption.
Cultural mediation and social integration.
Job placement .
Aid grants, meal tickets, tuition fees for day care centres…
Fees for adult day care centres and day carers for elderly people or disabled, etc.
Public healthcare – Local Healh Units Social area – municipalities The Community Health Partnership of the north-west zone of Florence is a public consortium that includes the eight municipalities of Calenzano, Campi Bisenzio, Fiesole, Lastra a Signa, Scandicci, Sesto Fiorentino, Signa and Vaglia. It was created in 2004, in response to the 2002 Tuscany Regional Health Plan, to better integrate social and health services and improve services for the disadvantaged population, including socially excluded immigrants. Since then, 17 other community health partnerships have been created within the Tuscany Region. Community Health Partnership
Plus Municipalities and the Territorial Health Unit join together in a single BODY and develop complex projects which involve different private entities in order to cope with the needs of a wide area. New feature : the project salvages the previous little plans and everything is carried out together. Community Health Partnership
ADVANTAGES The private entities share common working methods and good practices, rationalize the resources and reduce the managing costs The public body offers more opportunities to less wealthy citizens. It develops a role of strong coordinator of the territorial policies. Community Health Partnership WEAKNESSES: this system works only if the public body can wield a strong coordination also on the activities of common planning.
A few projects examples: Social exclusion (reception shelter for women with children, adult shelter, job search, housing search, Food Bank….) Disability (job placement, professional training workshops, recreational and free time workshops, holidays, school-home daycare, rehabilitation…) Minors (recovery programmes for failing students, day care centres, sport, school/work counselling, social hardship aid…)
Services with social purposes provided by single or joint municipalities : Interventions and services : (directly provided: interventions of professional social services, counselling, information, contracts of undertaking: home care, school or after school assistance, others...) Money transfers: (directly provided: low income grants, rental and aid grants, tax breaks, exemption from fees payment) Admission in residential or semi-residential care home managed directly or indirectly
Intervention areas: toward following subjects
Adult exclusion and hardship
But the interventions of the municipalities and the Local Health Units are not sufficient to cover the entire demand; this is why the role of volunteering and of the third sector becomes of great importance.
Exemples of interaction: DISABILITY Undertaking Social worker and neuropsychiatrist School and after-school care Rehabilitation therapy speech therapy, physiotherapy etc. Day care centres Socio-therapeutic placement Job placement Residential care Holidays, Free time, Sport, Theatre wksps, etc., Professional training wksps, Home-school centres, “ Dopo di Noi ” External actors 3 rd sector