MAM president answers Times Editorial - 23/12/2004

The national health service
Stephen Fava, president, The Medical Association of Malta.

I thank The Times for the constructive editorial comments (December 7) regarding "reforms" in the health sector.

One must emphasise that the WHO has ranked our health service as the second most efficient in the world. Hence "cut and paste" arguments, presently being put forward by the government, that reforms in work practices are needed in order to improve our efficiency do not make much sense when applied to the health sector. What is needed is fine tuning rather than radical changes. In the words of Dr Appelyard, then president of the World Medical Association, radical changes to a system that is performing well has an 80 per cent chance of producing a deterioration in the service.

As the document was given to MAM confidentially, I am not in a position to disclose the details of what MAM is objecting to. However, the proposals would certainly not make the service more patient-centred but rather more management-centred. It is pertinent to note that surveys have repeatedly shown very good patient satisfaction rates. This again shows that radical changes are unwarranted. After all, it is doctors and not armchair managers who know best what patients' needs are.

WHO data, patient satisfaction surveys, outcome measures and vital statistics all show that doctors are doing a very fine job. Our results are better than those of much richer countries and we achieve this at a fraction of the cost. The number of surgical operations and patients seen at out-patients are also truly remarkable. So why does the government want to change work practices?

The major threat to our national health service is its failure to remain attractive to its medical personnel. It is an undisputable fact that doctors' pay is ridiculously low. For example, a consultant gets Lm5-10 for a major operation! MAM has repeatedly warned that unless remuneration and conditions improve substantially, a mass exodus will be inevitable. Unfortunately, this has fallen on deaf ears. Instead MAM received a document that doctors unanimously considered to be unacceptable and disrespectful to them.

Unfortunately, we are already witnessing that the number of doctors seeking greener pastures overseas is starting to increase. Do we need to wait for the collapse of our health service before we address the problem? By shortsightedly offering doctors ridiculously low salaries, the government is already wasting tens of thousands of liri in producing doctors who then leave the country. Furthermore, as the top medical brains are encouraged to leave our shores, the government will again need to start dishing out great sums of money in referring patients for treatment overseas.

When will the government get its priorities right? Does it make sense to spend almost Lm180 million for the new hospital and then be unwilling to invest a tiny fraction of this amount in order to have the necessary medical manpower to run it?

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