Almost one in two families struggles to reach the emergency room and student residences are enough for just over two university students out of a hundred, compared to the European average of eighteen. These are two of the most critical values of the CNEL annual report on public services, presented in Rome.
In healthcare the first problem is distance. 48.2% of families declared difficulty in reaching the emergency room, a share which in municipalities with up to 2,000 inhabitants rises to 72.8%. Meanwhile, family doctors have decreased by 17.3% in ten years. One of the possible solutions are the "Community Houses", structures designed to bring care closer to home: even if all 1,038 financed by the Pnrr were built, another 297 would be needed to reach one for every 50 thousand inhabitants, with a cost of around 1.1 billion. On the other hand, home care is growing, reaching 1.7 million people, but those who give up treatment altogether are also increasing: in 2024, 9.9% missed visits or exams, compared to 6.4% before Covid. 6.8% of residents did so due to waiting lists, 5.3% for economic reasons.
The other alarm concerns the students. In 2021, housing dedicated to students covered just 2.2% of those enrolled, around 41 thousand places. Despite the 60 thousand beds financed by the Pnrr, to reach the European average in 2030, 236 thousand beds would still be needed, for an estimated cost of 4.7 billion, with Lazio, Campania and Lombardy among the regions with the greatest shortage. An issue that weighs heavily just as universities reach the historical record of 2.05 million enrolments, driven above all by the growth of telematics, despite the fact that graduates aged between 25 and 34 remain only 31.6%, compared to 48.4% of the OECD average.
The housing issue does not only concern students. Social housing accounts for just 2.7% of homes in Italy, compared to 17% in France and 29% in the Netherlands. And not all of them are available: of the almost 824 thousand managed by the bodies associated with Federcasa, over 60 thousand cannot be assigned to those who are entitled to them because they need to be renovated.
Beyond the individual services, the report records a profound change in the way the public administration works, driven by the Pnrr. For the president of the CNEL, Renato Brunetta, the Plan brought "an innovative method" with measurable objectives and precise results to be reported. This is demonstrated by public competitions, the average duration of which has dropped from around two years to 180 days. "The public administration reform was carried out by the Pnrr", said Brunetta, speaking of "an epochal turning point". The challenge, he says, is to move "from outputs to outcomes": not just what the State does, but what actually changes for citizens and businesses. For councilor Marcella Mallen, coordinator of the report, reforms and investments have given results, but without being able to "completely bridge the territorial and social gaps": for this reason the report "photographs a two-speed PA", with "undoubted progress" but "many asymmetries" between territories.
