The response of national healthcare to the COVID-19 pandemic. Reflections and proposals based on the case of Lombardy

The global epidemic of COVID-19, which broke out at the beginning of 2020, has focused the debate on several issues related to the health system: first of all, the unpreparedness of the Italian national health system (SSN) to deal with an event considered unlikely, given the epidemiological transition; but also the conviction that the cause of this unpreparedness is to be found in the fragmentation of the service into many subnational subsystems. The conviction therefore emerged that it is possible to respond better to crises by re-centralising the SSN or simply by increasing public funding in this area. On the basis of what has happened in Lombardy, however, it is possible to propose a less simplistic reflection that focuses on the crisis factors that have emerged in recent months and on their possible solutions, starting from some social cleavages that have not been sufficiently considered: the adequate development of the relationship between health and social services, between hospital and territory, between districts and local communities and between the health system and the social system as a whole. It is therefore not only a question of rethinking health governance, but also of placing social relations within communities at the centre of it.