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Learning lessons from Italy

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I have just returned from a very relaxing holiday in Tuscany. In between eating and drinking (and trying to persuade myself that walking in the hills was counteracting both) I noticed a few things about local government and health.

It was a relief to be somewhere which wasn’t in the thrall of swine flu. Unlike the UK, the Italians are not busy establishing Tamiflu stockpiles and opening up antiviral collection points.

They have had only 320 confirmed cases of febbre suina compared with the UK, which had more than 100,000 new cases for the week ending 19 July.

Certainly when I returned to work I saw the pressure on primary care becoming marked.

The out-of-hours service run by my primary care trust reported 100% more enquiries over the weekend compared with the similar period last year. All GPs were experiencing a very high volume of calls, especially from patients who wanted advice.

The National Flu Helpline seems to be working well in the first few days, with flu friends (rather than those with flu) correctly coming to the three antiviral collection points we have established locally. The numbers arriving for their supply of Tamiflu are, however, surprisingly high, leading to suspicion that some are laying in a supply in case they become ill.

I didn’t see Italy’s flu planning, but I did see it embracing the public behaviour changes being adopted across Europe. Recycling is well organised in Tuscany, with both doorstep collections and drop-off depots.

Even in rural areas there are recycling bins by the roadside.

A smoking ban in public places was introduced in January 2005 (having been delayed by the health minister to permit
smokers to enjoy themselves properly over Christmas and New Year), 18 months before a similar ban was introduced in England.

And allowing for some creative interpretation of what constitutes an outdoor smoking area, the results have been impressive, with the Rome Health Authority reporting an 11% drop in heart attacks in high-risk groups since the ban was introduced.

I spent a very hot late afternoon and early evening in Siena. During that time the sound of ambulances moving round the city was a constant feature. I saw two tourists who looked as though they were overcome with heat stroke being taken to the local hospital.

In a city of only 48,000, but with more than one million visitors a year, planning capacity in hospitals must pose a particular challenge to Siena’s health authority.

This is only an Italian example of the problems faced by some primary care trusts in tourist centres here, such as the Isle of Wight, an island that is home to 130,000 people but host to more than two million visitors every year, some of whom will become ill and need treatment in the local hospital.

Finally, I was at an event near Pisa when there was an announcement. In the previous month there was a terrible train crash in Viareggio in Tuscany in which 28 people had died and some of the town’s ambulance fleet was destroyed. The announcer was asking for funds to replace some of the lost ambulances.

However widespread the flu pandemic becomes, and however much we observe the same problems in public services being tackled in other countries, the NHS would at least not be dependent on donations to replace lost ambulances destroyed by a fire.

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