Private practice preferred to Lm45,000 exclusive service contract -Health Minister - 12/12/2004

Medical services
Minister demands new practices to cut overtime bill
Private practice preferred to Lm45,000 exclusive service contract
The health minister yesterday insisted that work practices in public hospitals needed to be reviewed because it was unacceptable that even though staff levels rose, the overtime bill did not go down.

He told parliament during the budget debate that the government was paying Lm1 million in overtime at St Luke's Hospital every year, along with Lm14,000 at Boffa Hospital and Lm500,000 at Mount Carmel Hospital.

Recruitment, he said, had to be made in a way that ensured that the need for overtime decreased. For example in the recruitment of new staff in the medical laboratory, one should consider engaging people who would start work later, so that no overtime would be needed for late afternoon work.

Dr Deguara said talks would be started with the trade unions next month on a reform of the health sector, including separating the regulatory and operative roles and changing work practices.

The government's ideas had been indicated in a consultation document sent to the unions.

The minister said persons who had been offered a renewal of a Lm45,000 contract which does not allow them private practice had opted for a Lm8,000 government salary which would leave them the option to also have a private practice. That would mean they expected to earn more than Lm40,000 from private practice.

In his speech, during the budget debate, Dr Deguara said spending on the health sector was being raised by 7.2 per cent next year, reflecting the government's commitment to the social sector. But it was a major government challenge to ensure that the health sector, as well as pensions, remained sustainable in the future.

He said the increase in the price of kerosene, announced in the budget would not only serve to cut abuse, but also reduce the use of a cancer causing product.

But the biggest achievement, which was started last year and would be completed this year, was the ban on smoking in public places. The government, he said, increased excise duty on cigarettes, not to reduce consumption but to put off those who were considering starting to smoke. Yet the leader of the opposition had said such measures only served to encourage contraband and the government had lost Lm2 million in contraband. While the government cared for the people's health, others still worked according to the calculator.

Dr Deguara said he agreed with Labour health spokesman Michael Farrugia that health promotion campaigns should be held year round and not occasionally. The ban on smoking in, say, restaurants was an example of an all-year campaign.

The minister said it was important to ensure the sustainability of the health sector. Malta was proud to have one of the best services in the world and efforts had to continue to be made for further developments. He felt, however, that the system where everything was free for everyone, all the time was a recipe for failure.

The government was usually accused that health was not sustainable because of waste and theft. It was easy to say this, but even if waste and theft were controlled, sustainability would not be guaranteed since costs were rising alarmingly.

Speaking about the health service reform, Dr Deguara said he had passed a consultation document to trade unions on October 29 to give them an idea of the lines the government was thinking about.

They were asked to evaluate the report so that talks would start in earnest in January.

The government wanted separation of the role of regulator and service provider, it wanted shortcomings to be identified and it wanted to offer new practices for improvement in the quality of service.

Although the agreement was that this document would remain semi-confidential, Dr Deguara said he was willing to make it public so that it could be evaluated by all as soon as discussions started.

The doctors' union said it was insulted by what was being said in the document, without first asking for clarifications. But it requested an urgent meeting when it heard rumours of possible changes in the doctors' sleeping quarters at the new hospital.

Not all the comments were negative, however, because several trade unions had said that they agreed on separating the health service from the civil service. Indeed the setting up of agencies for the provision of several services had proved beneficial, doing away with civil service bureaucracy.

The unions, Dr Deguara said, had demanded adequate remuneration so that health care professionals would not be dependant on overtime or private practice. This was a situation which also had to be seen in the context of the EU's proposed Working Time Directive which was setting the maximum hours which doctors and paramedical staff should work.

Malta's view was that the people involved should be able to decide the number of hours they could work as long as this was not detrimental to their health. It was also worth pointing out that it was only Malta which paid full salaries even when staff were inactive on call.

The proposed health reform document discussed areas where certain categories of employees in top positions would work exclusively at the hospital.

The government had already indicated, though not in the document, salary packages for those in certain posts who worked exclusively in the health service - there were two persons who had been engaged for Lm35,000 tax free and Lm45,000 taxable. This indicated that the government was committed at ensuring that those who wished to commit themselves exclusively to the public health service would be able to do so.

Significantly, however, when those packages had come up for renewal, these persons preferred to revert to their Lm8,000 government salary without restrictions on private practice. That would mean they expected to earn more than Lm40,000 from private practice. One wondered, therefore, how one could justify the complaints being made when the Tax Compliance Unit investigated doctors' income.

Dr Deguara said the reform consultation document also discussed the issue of career progression, although it acknowledged problems that existed because Malta only had one hospital.

Turning to the new hospital, Dr Deguara said the cost and the opening date of the new hospital had now been established but other challenges remained and everyone needed to cooperate for solutions to be found.

Referring to other points raised by the opposition, he said one reason why waiting lists for operations had grown was that patients preferred to choose their surgeon. Should this option be removed, the lists for some surgeons would be considerably shorter.

Dr Deguara said four ambulances have been bought for St Luke's Hospital and another five were on order. Efforts were being made to instil greater discipline in this sector.

An inquiry was being held about a person who knowingly mislaid patients' files.

On the Casualty Department, Dr Deguara said the average waiting time was less than abroad, but many people went to this department needlessly.

As for the list of free medicines, one could not simply continue to add new medicines. A review of the whole list was needed. It was not right that free medicines were given for chronic diseases, irrespective of one's income while other medicines were not provided.

Concluding, Dr Deguara said the medical sector had many challenges ahead of it, but this was also a unique occasion for change in the interests of the patient, first and foremost.

Parliamentary Secretary Helen D'Amato said that the challenge facing the government was not just to provide a high standard of health service and services for the elderly, but also to sustain them in the future.

Pensioners formed 18 per cent of the population and this would eventually rise to 31 per cent.

This budget saw a three per cent increase in the social budget which was now 43 per cent of total expenditure.

Ms D'Amato said Labour MP Michael Farrugia, who had spoken earlier, seems not to have taken account of the Lm1 million for the elderly which had been transferred to the vote of another ministry.

She added that despite the increase in the contribution paid by St Vincent de Paul inmates through deductions of their pensions, patients were paying much less than those in church or private-run homes. This was social justice in practice.

Ms D'Amato defended the quality of catering services at the home, but said presentation was sometimes lacking. The Institute for Tourism Services will hold courses at the home next year on food presentation.

The government, she said, had continued investing in St Vincent de Paul. The new building would cost more than Lm2.5 million. More wards would be refurbished next year.

The biggest project insofar as homes were concerned, was the building of the Mellieha home. Attention would also be given to the one at Mosta.

Ms D'Amato said that 1,400 households were making use of the home help services. Last year alone more than 700 applications for the service were received.

She regretted that only two day centres were functioning properly; others were only being utilised on particular days. A pilot project was in hand where helpers would visit the aged on a regional basis.

Maltacom had made a considerable investment in the Telecare service and capacity was extended from 1,000 to 10,000 clients.

The Floriana sheltered housing scheme was ready and progress was registered on that in Valletta.

Discussions would also be held next year with local councils on the possibility of establishing night centres for the elderly. It had to be ensured there was real need for them.

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