That link between healthcare, corruption and mafias. And the mistakes not to be repeated

Alberto Vannucci: «The fear is that in this emergency phase corruptors and mafias could make room. Among the experts involved there were no anti-corruption figures"

"Corruption seriously harms health." Word of the International Monetary Fund and of Alberto Vannucci, political scientist and coordinator of the master's degree in Analysis, prevention and fight against organized crime and corruption at the University of Pisa, interviewed here by Valori.

«Even bribes have their effects on the sick», he wrote a month ago in La via libera, just at the moment in which the Lombardy region had appointed Guido Bertolaso ​​as extraordinary commissioner for the Covid-19 emergency. «A disheartening appointment – ​​comments Alberto Vannucci – The past commissioner management of the emergency in our country, of which the former national head of Civil Protection remains a symbol, turned out to be a mass of waste and delays, let's not forget that».

The time will come to trace the death toll, but as of now we can state with certainty that the spread of corrupt practices is responsible for a portion of those victims – by Alberto Vannucci https://t.co/6bIIy0iaiP

mdash; Lavialibera (@Lavialibera) March 17, 2020

Without transparency and controls we fall back into medical malpractice

Meanwhile, the news confirms that, in addition to the health workers themselves, the elderly and disabled have paid the price for inefficiency and cuts in healthcare. That most fragile and exposed part of the population, for example, hospitalized in nursing homes (RSAs) or in RSDs, which have become deadly hotbeds of coronavirus. It will be the judiciary that will ascertain the responsibilities, but what emerges is a dramatic picture. In which heartfelt denunciations alternate, as in Bergamo, with "obedient" silences to the directives given by the Lombardy region, as in the Ats of Varese, Insubria, at the Pio Albergo Trivulzio in Milan or at the Bassano Cremonesini Institute in Pontevico.

The privatization of the healthcare system is revealing all its limits. «The fear is that corruptors and mafias could still make room – underlines Vannucci – And it amazes me that, among the many experts called to the ministerial task force for the use of data against Covid-19, there are no anti-corruption figures».

A problem which, once again, is not perceived - despite all the alarms from the DNA, from the Ministry of the Interior itself and from Public Notice - as an looming danger. «What is certain – adds Vannucci – is that this dramatic “stress test” is highlighting the regional health systems where there is more public, such as in Veneto. And all the shadows of the Lombard model."

Corruption in healthcare costs us between 5 and 7 billion

According to the map, drawn up by Transparency Italia, of corruption in Italy (reported in the media), in the last year alone there have been 141 cases of corruption in healthcare throughout the Peninsula. From Lombardy to Calabria, no regional healthcare system is without blemish and citizens have understood this well.

According to the current Deputy Minister of Health, Pierpaolo Sileri, corruption affects at least 5% of the National Health Fund and costs us between 5 and 7 billion every year.

All Italians are well aware of the corruption phenomena in our country: at least 44% have identified healthcare as one of the most affected sectors, as documented by the latest Eurobarometer survey. «But it is tolerated, as if it were the price to pay for having a good health service – reiterates Vannucci – Yet, without transparency and an adequate system of controls, it is precisely the quality of care that declines. With certain repercussions on the health of patients."

Commissioner management: over 22 billion euros of contracts to monitor

At a national level there are at least 22 billion euros on the plate, out of the 30 total of public spending for the national health service. Funds that are managed through Consip, a company of the Ministry of Finance. «It is an implementing body», explains Vannucci, who supervises all purchasing tenders for «standard» goods and services. But also to spending on diagnostic equipment, medical devices and drugs.

In the chain of command, outlined by the Conte government, the extraordinary budget for the Covid-19 emergency is managed by the Department of Civil Protection and by the Extraordinary Commissioner, Domenico Arcuri, former CEO of Invitalia, one of the most important contracting authorities that operates for the Italian Public Administration. Thus, as a result of the government appointment, he found himself on the other side of the barricade.

Refined controls are needed

Are emergency funds once again at risk of being managed without controls? «The situation is such that we cannot do otherwise – recognizes Alberto Vannucci – But in phase two, we will have to pay more attention again. It's true, the rule isn't perfect, it's still cumbersome."

Despite the entry into force of anti-corruption legislation and the reform of the procurement code, too little has still changed, Vannucci underlines:

«The process requires more refined control mechanisms, different from the past. Some tools are already there and have been put in place. But we also need greater transparency in the administrative machinery."

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Contracting out care services encourages corruption

Where should we make an impact, then? «Behind the word "efficiency", we often find the outsourcing of care services. It is also an effect of the cuts made by the regions on the local health authorities, but it can become the object of the interference of corporate and organized crime", reiterates Vannucci. The tip of the iceberg is the total lack of personal protective equipment, on which corporate crime immediately pounced, as demonstrated by the first arrest of a Roman entrepreneur for the disruption of a Consip tender for 24 million euros, blocked by the Guardia di Finanza.

This is also remembered in the latest report of the Anti-Mafia Commission of the XVII legislature led by Rosy Bindi, with an entire chapter dedicated to mafias and corruption in healthcare. «The outsourcing of services is in itself a simple risk factor, like that connected to the purchase of goods. It is not a cause of illegality", underlined the commission in 2018. "But it is undeniable that many of the agreements to the detriment of public health, implemented by criminal organisations, with the direct or implicit collaboration of politics and health administration, concerned outsourced services".

#Rome at the presentation of the final report of the #Anti-Mafia Commission Don Luigi #Ciotti thanks Rosy #Bindi for the work done: you have built dignity and #hope, but we all need to do more #together to build a more just society free from #mafia and #corruption pic.twitter.com/FWeziIxAPr

mdash; Lorenzo Frigerio (@lorenz_frigerio) February 21, 2018

Pushed liberalization opens structural gaps to corruption

Also the Organized Crime Observatory, led by prof. Nando Dalla Chiesa, already in 2015, in the six-monthly report to the Anti-Mafia Commission, had confirmed that «Lombardy was the Northern region in which the main cases of mafia penetration in the healthcare sector were found». According to the Cross researchers, the Lombardy healthcare system is "a gold mine in which to launder money deriving from illicit proceeds or to win, through appropriate intermediation strategies, important contracts from which to obtain further profits".

The so-called "grey zone" has advanced, outlining some new features: «such as the system of political loyalty, which regulates the appointments of medical and healthcare personnel - underlines the Observatory on organized crime - but also the opening of structural gaps to corruption, through a process of extensive liberalization of the regional healthcare system. With an insufficient control mechanism to guarantee a strategic balance between public (declining) and private (growing)".

From Transparency to Openpolis: transparency on emergency funds

«The measures adopted in the event of a health emergency must remain exceptional, strictly proportionate and limited in time. Furthermore, Parliament must be informed in real time and exercise its powers of control over public action", the managers of Transparency Italia remind decision makers, who, on the occasion of World Health Day (6 April), launched the Health Integrity Forum (HIF). An initiative born under the patronage of the Italian Association for Health Integrity, which aims to promote and disseminate good practices of transparency, ethics and integrity in all public healthcare facilities.

On the other hand, the Openpolis foundation has asked for all documents related to the emergency to be made available in open data. «We ask Arcuri, Borrelli and Cannarsa to make public the contracts stipulated to deal with the Covid-19 emergency. Transparency is not an obstacle, but a prerequisite for good administration."

It is not our job to comment on the management of the crisis, but we must prevent the principles of responsibility, transparency and ethics from being overshadowed by the "urgency to act". #COVID19 #Covid_19 https://t.co/B6frzs6eqc

mdash; Transparency Italia (@transparency_it) April 7, 2020

The alarm from the DNA and the Anti-Mafia Commission

"We must prevent the clans from eating up the economy." This is the other risk of the pandemic, recalled the national anti-mafia prosecutor, Federico Cafiero de Raho. Italy is doubly exposed to corruption and infiltration, as the latest DNA report had revealed in recent months.

Cafiero De Raho at Half an hour more: "With a liquidity crisis we risk a #mafia assault on the economy" https://t.co/0G8g7YiHMo pic.twitter.com/ZwVXTjVFlh

mdash; Antimafia Concentration (@concentrazione) April 5, 2020

Meanwhile, last January the president of the current Anti-Mafia Commission, Nicola Morra, appointed Raffaele Cantone, the former president of the Anti-Corruption Authority, as his collaborator. «An experience that will help the commission's work in its legislative proposal phase». A hope, after the Canton itself had been forced to abandon the management of the Authority before the end of its mandate, also following the lack of changes to the procurement code.

Corruption: «Local authorities under the thumb of the mafia»

The National Anti-Mafia Directorate: 40% of contracts are at risk of infiltration. And the new public contracts code signed by Lega-M5S has made things worse