Times of Malta, Talking point 'The future of the health sector'
The future of the health sector
Gordon Caruana Dingli
The public has been inundated with news about the health sector in recent weeks. It started with the granting of a permit to build a new private hospital in Bulebel and this was soon followed by news that the owner will be selling St James Hospital in Sliema to foreign investors.
Last week we were told that Barts will be opening a medical school in Gozo and that Karin Grech, St Luke’s and Gozo General hospitals will be refurbished. The private sector is being invited to invest in the provision of healthcare for foreign patients – medical tourism – which will subsidise some of the costs of refurbishing the state hospitals. Just as we began digesting all this news, it was announced that another new private hospital will be built at Smart City.
Before commenting on these developments it is important to consider the present state of healthcare provision in Malta.
The standards of health care are high. Malta’s health indices compare well with those of many European countries. We also score highly in assessments by the World Health Organisation and patient satisfaction surveys. The staff work hard and statistics reveal ever-growing numbers of admissions to hospital, outpatient visits and operations performed.
It is actually amazing that such a small country provides such high standards of healthcare and the dedication and the hard work of health care professionals should be acknowledged.
There is no doubt that more beds are needed at Mater Dei for the provision of acute services. There are patients being cared for in corridors and this is demeaning to them and to their relatives. It also decreases efficiency of work practices and may have impacts on patient safety. Although surgical interventions increase year after year by some 5%, demand also continues to increase and some departments have waiting lists.
New wards are presently being built at a fast pace but the extra beds might not be enough. Elderly patients who cannot continue to live at home are faced with a bottleneck, as not enough places for them are available and many remain at Mater Dei for longer than necessary. Government homes for the elderly are stretched to full capacity, and private care can be expensive.
Providing extra beds for the elderly is not the only solution, as a lot can be done through community services to help to keep the elderly in their own homes; this includes the provision of day centres and also night centres. The Government should consider financially supporting elderly people who enter private homes; this might actually be cheaper than looking after them in a state home.
Staff shortages are also a problem. While the number of medical students is increasing rapidly, the medical school struggles to cope with the large numbers and to find enough patients for teaching. There is a marked shortage of nurses and the Faculty of Healthcare will have to expand as the hospital currently relies on the recruitment of nurses from abroad. The expansion in beds, both private and state, will need large numbers of new doctors, nurses and paramedics.
Primary care needs to be modernised and strengthened to decrease the load on the hospital. General practitioners provide a very good service to patients but private GPs may become a rare species as younger doctors are opting for employment in health centres where there are difficulties in providing continuity of care to patients.
The recent announcements promise extra beds, refurbishment of the hospitals, and investment in the health sector, which are all positive steps.
However, the devil is in the detail and we know very little about the details so far. Healthcare workers as well as the man in the street are struggling to understand how these complex changes will be implemented and funded. Many are concerned about how the changes will affect them. Uncertainty leads to anxiety and speculation, and should be avoided. Once these announcements about new health care facilities and services have now been made, all available information should be provided.
These radical changes must be fully explained and discussed, rather than presented as a fait accompli. The proposals are blurring the interfaces between public and private healthcare and financing. They have implications on the teaching of medical students and the management of hospitals, working practices and career progression for doctors and nurses and the sustainability of healthcare today and for future generations.
It appears that the details of the proposals still have to be worked out. These decisions are far too important to be rushed and the Medical Association of Malta would like to be presented with more information and recommends wide consultation before any firm decisions are made.
While it is important to increase the capacity of health services in Malta we must also always strive to maintain the highest standards of patient care to all, irrespective of soci0-economic status. There should be a comprehensive national health policy which should be determined by patient and social needs and not by business priorities.