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Medicina Democratica : Conclusioni del convegno nazionale di MD "Salute e Partecipazione"
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oggi è il: 29|05|2017
Comunicato Stampa conclusivo

Conclusioni del convegno nazionale di MD "Salute e Partecipazione"
image1

DOBBIAMO ESSERE IN GRADO DI CAMBIARE: basta con l’azienda, con i DRG, con il potere assoluto dei direttori generali, con le sperimentazioni pubblico-privato, con le trasformazioni degli IRCCS e degli ospedali in fondazioni, con l’esclusione di migliaia di malati dalla sanità (verso l’assistenza).

UN NUOVO GOVERNO DEL PAESE PER UN NUOVO GOVERNO DELLA SANITA’ L’Aziendalizzazione, la privatizzazione e le esternalizzazioni nel servizio sanitario hanno solo determinato la precarizzazione, la negazione del diritto alla salute, ad un lavoro dignitoso e rispettoso dei diritti dei lavoratori.

Il Convegno , organizzato da Medicina Democratica, ha visto la partecipazione di circa duecento persone, tra esponenti politici, sindacali, operatori, componenti di comitati di lotta contro gli inceneritori , le centrali termoelettriche.

In particolare il Convegno ha inteso ribadire che:
-  Il programma dell’Unione deve prevedere una forte discontinuità rispetto al tema del diritto alla salute , che rappresenta una priorità assoluta, così come lo è stata nelle ultime elezioni regionali, in Puglia come in altre Regioni;
-  il programma - e questa è la novità - va costruito con l’apporto di tutti i soggetti coinvolti: forze politiche, sindacali, associative, di movimento. In tal senso Medicina Democratica ha dato e dà il suo contributo: lo ha fatto a Napoli, in una città simbolo di tutto il sud, dove in non poche occasione la sanità è stata oggetto di affare, dove la salute è messa in discussione da vecchie e nuove nocività, nei luoghi di lavoro e sul territorio, dove i problemi di emarginazione, separazione e abbandono sono fra i più gravi e pesanti. Il Convegno, introdotto da Paolo Fierro, responsabile di Medicina Democratica di Napoli e da Tonino d’Angelo, Presidente Nazionale, è stato concluso fa Fulvio Aurora, vice Presidente nazionale di M.D.

Nel corso del Convegno si sono svolti quattro gruppi di lavoro, sui seguenti temi:

1.SALUTE E SERVIZIO SANITARIO. Si è convenuto che un nuovo quadro istituzionale non può prescindere dalla storia e dalle lotte che hanno portato alla promulgazione della legge di riforma sanitaria n. 833del 1978. Medicina Democratica fa propria l’attuale proposta della CGIL che riprende un’idea del suo fondatore, il prof. Giulio Maccacaro, di costruzione della CASA DELLA SALUTE, che nasce in un contesto di sanità pienamente pubblica, in cui la parola azienda sparisca, dove la dirigenza USL venga eletta dai cittadini, dove finalmente i cittadini possano essere coinvolti nella realizzazione e rinnovo dei servizi e delle strutture, nonché nella verifica del loro funzionamento.

2.SALUTE E ORGANIZZAZIONE DEI SERVIZI SOCIALI E SANITARI. Si ritiene che le risposte ai bisogni di salute devono nascere dalla conoscenza epidemiologica del territorio. I piani sanitari invece di essere volumi di centinaia di pagine senza garanzia di realizzazione devono stabilire: quali sono le priorità di intervento, quali le iniziative conseguenti, quali i servizi e le strutture con cui farvi fronte. Particolarmente si deve affermare la globalità dell’intervento sanitario. Le Istituzioni totali devono essere, sull’esempio dei manicomi, abolite: I CPT (Centri di Permanenza Temporanea per i migranti), ma non solo, anche gli OPG (Ospedali Psichiatrici Giudiziari), non ultimo i cronicari per anziani malati non autosufficienti.

3.SALUTE E AMBIENTE. Appare impossibile garantire il diritto alla salute senza un ambiente di lavoro e di vita salubre. MD nasce con le lotte della fine degli anni 60 contro la nocività nei luoghi di lavoro. Mai questa lotta è stata separata da quella contro il conseguente inquinamento ambientale e per il lavoro. Salute e occupazione non possono essere contrapposti. I processi in cui MD è stata ed è impegnata (primo fra tutti quello di Marghera) richiamano alla necessità di un riconoscimento di giustizia per milioni di lavoratori esposti nel mondo che si sono ammalati a causa dell’organizzazione del lavoro e per l’uso di sostanze tossiche e cancerogene. Cloruro di Vinile Monomero, arsenico, benzene, amianto rappresentano altrettanti simboli di questi processi: da Marghera a Manfredonia, Da Mantova a Brindisi. E non basta, grandi lotte si sono susseguite e si susseguono contro l’incedere delle forme più distorte di smaltimento dei rifiuti, come gli inceneritori: Acerra insegna. Vi è il problema delle scelte energetiche: da Ferrara a S. Severo sono decine e pressoché immotivate le proposte di costruzione di nuove centrali a turbogas. Quali interessi economici vi stanno dietro e come la salute viene salvaguardata? E qui dove la mettiamo la legalità?

4.GLI INFERMIERI E I SERVIZI INFERMIERISTICI. I Cittadini sembrano assuefatti alla emergenza infermieristica, gli stessi infermieri appaiono rassegnati: Fanno del loro meglio, ma i turni e i carichi di lavoro divengono sempre più pesanti; i servizi e le strutture si dequalificano. E’ comune nelle strutture per anziani cronici e in via di diffusione anche negli ospedali la sostituzione degli infermieri con altri operatori con minore formazione e meno adeguata professionalità. OSA, OTA, ASS, ASSS ; le sigle si sprecano, ma la realtà e pure i rischi sia per il personale che per i cittadini utenti restano. MD ha collaborato con un’associazione di infermieri generici (il MIGEP) e un sindacato la RDB per costruire una proposta di legge che si pone l’obiettivo di contribuire alla soluzione del problema. La proposta è stata già presentata al Senato da alcuni senatori dell’UNIONE ed è stata appoggiata da una petizione nazionale corredata da 23.000 firme.

Occorre infine riformare le facoltà e le specializzazioni inerenti sia la Medicina che ogni altra disciplina e settore coinvolto nella tutela della Salute, per riportare i lavoratori tra la gente, nei territori, nella prossimità dei luoghi ove nascono le patologie, nell’analisi e contrasto ai modi di produzione “patogena”, in modo che si rompa l’autoreferenzialità e inadeguatezza di operatori che in primo luogo deveno sentirsi cittadini, lavoratori impegnati, come diceva Maccacaro, fondatore di Medicina Democratica, per “la lotta per la salute che è in definitiva una lotta per la diminuzione dei ritmi, per la diminuzione della produttività e , quindi, contro lo sfruttamento”

UN NUOVO GOVERNO DEL PAESE PER UN NUOVO GOVERNO DELLA SANITA’ PER IL DIRITTO ALLA SALUTE Per dire
-  No all’Aziendalizzazione
-  No alla Privatizzazione e all’esternalizzazione
-  No alla precarizzazione
-  Si al Servizio socio-sanitario pubblico
-  Si alla Casa della Salute
-  Si alla Prevenzione
-  Si alla Partecipazione Si alla gestione sociale

-  1.Il fondo sanitario nazionale deve essere adeguatamente finanziato. Il diritto alla salute è diritto assoluto, libero da compatibilità economiche di qualsiasi tipo. E’ presumibile allo stato attuale che un finanziamento del fondo pari all’8% del PIL (corrispondente all’attuale finanziamento pubblico più le spese private dei cittadini) sia l’obiettivo da perseguire considerando che occorre intervenire prima di tutto al sud perché siano abolite le differenze in termini di strutture ed organizzazione sanitaria rispetto al nord, non ultimo contro la migrazione sanitaria di migliaia di cittadini. All’8% di finanziamento per la sanità si può giungere progressivamente agendo da un lato con nuovi investimenti e dall’altro sul fronte dei risparmi.
-  2.L’ideologia e la pratica dell’azienda deve essere abbandonata. E’ difficile individuare una formula precisa e magica sostitutiva del sistema aziendalistico fondato sul direttore generale. Possiamo stabilire però dei principi. a)Il primo è il principio degli obiettivi di salute. Chi dirige deve essere oltre che capace a che indirizzato a migliorare le condizioni di salute della popolazione che si trova nel suo territorio. In altri termini si tratta del principio dell’epidemiologia e della prevenzione. Occorre sapere dove si è e dove si vuole andare. b)Il secondo è il principio della democrazia che non è solo quello della partecipazione (ovvero della possibilità dei cittadini organizzati di verificare e fare proposte sul funzionamento delle strutture e dei servizi sanitari), ma è anche quello della gestione sociale. Non vogliamo eliminare il direttore generale, ma sottoporlo ad un controllo e sceglierlo con criteri diversi rispetto a quelli seguiti fino ad oggi. Il finanziamento delle strutture (e degli operatori) cosiddetto a prestazione deve cessare. E’ stato dimostrato che il sistema di pagamento a prestazione (i famosi DRG) ha fallito gli stessi obiettivi che si era posto. La spesa sanitaria si è ridotta nei primi anni dopo l’adozione del decreto legislativo 502/92 per effetto del blocco del personale e della progressiva riduzione dei servizi, successivamente verso la fine degli anni 90, in connessione con la piena applicazione dei DRG, la spesa ha ripreso a crescere, pur rimanendo costante il blocco del personale .
-  3.La centralità della prevenzione deve essere fermamente voluta: migliore condizione di vita nel suo insieme (lavoro, ambiente, trasporti, abitazione, cultura, relazioni sociali ed altro)=migliore condizione di salute ; adeguato sistema sanitario= capacità di conoscere e rilevare, oltre che di denunciare, le fonti di rischio . Fondamentalmente un sistema preventivo deve essere indipendente dai soggetti che producono o possono produrre rischi e danni.
-  4.IL Servizio sanitario Nazionale deve comprendere al suo interno per le attività di prevenzione cura e riabilitazione tutti i soggetti “qualunque siano le cause, la fenomenologia e la durata della malattia” (articolo 2 legge 833/78). Non è più accettabile l’emarginazione dal SSN e dalle sue strutture di persone malate croniche non autosufficienti, di malati di AIDS, di persone affette da gravi disabilità, di persone con disagi e malattie mentali, di immigrati malati (siano essi regolari o no).
-  5.La relazione medico-paziente, struttura sanitaria-cittadino utente, deve essere ripristinata. All’origine, molte volte, della cosiddetta malasanità vi è la non personalizzazione degli interventi, la non considerazione della condizione umana, lavorativa, famigliare, sociale, culturale delle persone. Chi è più povero e più disagiato ha bisogno di maggiore attenzione, non viceversa.
-  6.Il testo unico delle leggi sulla salute nei luoghi di lavoro (previsto dalla riforma sanitaria) deve essere approvato, con la messa al bando delle produzioni di morte e definito anche in via legislativa il rischio zero per i cancerogeni, per le nuove tecnologie, contro la precarietà del lavoro (che va combattuta in ogni caso), e leviolenze morali (mobbing). Non ultimo occorre realizzare quanto stabilito ancora dalla legge 833 in termini di riconoscimento degli infortuni e delle malattie professionali, e cioè il loro passaggio dall’INAIL alle USL.
-  7.I cittadini devono essere sollevati dal pagamento dei ticket e di altre contribuzioni che si configurano come tassa sulla malattia. In ciò va compresa la pratica della libera professione intramoenia che deve essere abbandonata chiarendo una volte per tutte che chi lavora nel pubblico non può lavorare anche nel privato. Certamente le retribuzioni dei dipendenti pubblici sanitari devono essere adeguate, come deve essere eliminata la precarizzazione del lavoro in sanità.
-  8.La ricerca scientifica deve essere parte integrante del servizio sanitario nazionale.Tutte le forme di privatizzazione dirette o indirette della ricerca scientifica a partire dall’ultima che stabilisce il passaggio a fondazioni degli Istituti di Ricerca e Cura a Carattere Scientifico (IRCCS), devono essere abbandonate. Allo scopo la politica farmaceutica deve essere ricondotta al pubblico nelle varie forme che si sono rivelate utili, come il ricorso ai farmaci generici, comunque all’educazione sanitaria e all’utilizzo dell’uso dei farmaci da parte dei medici di medicina generale. Infine è necessario che venga ripristinato il Fondo Sanitario Nazionale indirizzato a battere le differenze territoriali e di classe sociale, e perché ciascun settore di intervento possa contare su un finanziamento certo, relativamente alla sua importanza quantitativa e qualitativa.

Tonino D’angelo - Presidente nazionale MD




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