Budget parliamentary debate on health - The Times - 15/11/2005

link to The Times article

Waiting lists, brain drain dominate health debate

Emissions from St Luke's Hospital chimney remained a source of complaint, opposition health spokesman Michael Farrugia said yesterday.

Opposition health spokesman Michael Farrugia said yesterday that the medical service was steadily getting worse, with waiting lists for operations and medical investigations getting longer and a brain drain of doctors getting more serious.

Health Minister Louis Deguara said in reply that Malta could not compete with the sort of salaries being offered to Maltese doctors to work abroad, but the government was seeking "real talks" on how doctors' conditions and job satisfaction could be improved.

On waiting lists, he said that while the lists had grown, the number of operations and investigations which were being carried out had also risen substantially.

The comments were made during the budget debate on the Ministry of Health.

Dr Farrugia said that Mater Dei Hospital had already taken longer to build than the Valletta bastions. But God forbid that migration to the new hospital should be made before the existing problems were resolved.

Among them was the management structure, with far too many leaders and the resultant confusion.

Another was the brain drain affecting not just doctors but also many other specialised staff. The situation was getting more serious, exacerbating the waiting lists for operations and investigations.

In the anesthetics sector, for example, there was a serious lack of staff and foreigners were being brought in while the Maltese were leaving.

In pathology there was a serious staff shortage and no trainees. Was it true that biopsies were being sent to Gozo because there were not enough people to do them in Malta?

Doctors and nurses at the Emergency Department were under continuous stress, leading to burn-out, and patients were having to wait longer, sometimes only to be seen by inexperienced doctors. Although there should be educational campaigns on when people should call at this department, people often had nowhere to go when health centres were closed at night.

Unless primary care was extremely strong there would be a crisis as soon as Mater Dei, a hospital with fewer beds, was opened. The Gozo Hospital also lacked the required staff.

The same brain drain problems were also resulting in lack of staff at the Outpatients Department. It was taking months for so-called non-urgent investigations to be made. For mammograms, for example, one had to wait 15 months. What if serious problems were then discovered? Waiting for so long only meant that problems got worse before they were discovered.

Much the same applied for operations where waiting times were getting longer and longer.

But it was not just the brain drain which was causing the problems. Hospital departments and even operating theatres were suffering a shortage of basic equipment and medicinals, and maintenance of equipment was far from what it should be.

For example, there was a lack of plates and screws used for internal use in orthopaedics.

Correspondence from responsible staff on the state of equipment went unheeded for months. The minister had said the defective equipment would be replaced soon, but in the meantime waiting lists continued to grow.

Dr Farrugia insisted that there was no protocol which laid down that patients should be refused cholesterol-reducing medicines when they became 75, after years of taking them. The protocol said that no new patient over 75 should be given such medicines.

On the pandemic flu Dr Farrugia said the opposition did not agree with everything that the government was doing. Of course it was impossible to know what strain to fight until and unless the pandemic hit Malta. But the government seemed to decide on which WHO recommendations to adopt and which not to adopt.

What was the philosophy about the future of St Luke's Hospital? And what was the role of the Foundation for Medical Services? The commissioning teams of the new hospital were not being consulted, even when plans were changed.

While the hospital would ultimately cost much more than projected, if the hospital was to be inaugurated with the backdrop of the current crises in the health sector, the real crisis would explode in 2007 as soon as the migration started from St Luke's to Mater Dei. That would be like jumping from the frying pan into the fire.

Touching on other issues, Dr Farrugia said Malta still had one of the highest obesity rates, especially in children.

He said the Maghtab landfill was continuing to affect the health of many Maltese, and studies showed that people in the area suffered respiratory problems. The St Luke's Hospital chimney was still belching thick black smoke with the process for the replacement of the hospital incinerator not yet having been completed. At the beaches, seawater quality was such that while in 2004 four bays were closed, this year there had been eight. There were also 37 instances when seawater quality fell below the Barcelona Convention standards and 43 failed EU criteria.

Dr Farrugia said it was shameful that such architectural gems as the cemeteries were being allowed to deteriorate.

On mental health he complained that the process towards new legislation, which had been embarked upon in 1997, had still not yielded results.

In his reply Dr Deguara promised that with the migration from St Luke's to Mater Dei no employees would lose their jobs, and they would not have to reapply to work at Mater Dei.

He said that the government did not just want to ensure having medicines of the highest quality; it was also looking at a reform of the procurement system, more so because the shortage of 17 out of 24 medicines mentioned by the opposition was caused because agents failed to deliver.

Referring to the waiting lists for operations mentioned by Opposition leader Alfred Sant last week, Dr Deguara said that while he was not contesting the figures, Dr Sant forgot to mention that between December 2003 and May 2005, 10,416 heart operations and interventions were conducted. Dr Sant also did not say that in the same period over 11,000 gynaecological interventions were made as well as more than 2,000 surgical operations and more than 6,400 ophthalmological interventions.

There was a 32 per cent increase in the number of operations using the same facilities and people as before.

The number of laboratory tests had increased by 1.45 million in four years. The number of ECGs had increased from 58,000 in 1995 to 178,000 in 2004, a 205 per cent increase. CT scans increased from 5,274 in 1995 to 10,250 last year, a 94 per cent increase, and while 4,695 MRI scans were held last year, just 1,364 were made in 2000.

Dr Deguara said that while there were 3,300 people who in 2000 took cholesterol-reducing pills, in 2004 there were 10,350, increasing the cost from Lm130,000 to Lm1 million. This was not a situation unique to these pills as the consumption of medicine had increased by more than 1,000 per cent.

The number of people entitled to free medicine for chronic illnesses had also increased, and the expense on medicine had grown to Lm22 million from Lm5.8 million in 1995. Health services, the minister said, cost Lm45 million in 1995 and Lm93 million now, a 105 per cent increase not including the funds for the new hospital.

Dr Deguara said that Malta placed second in a survey on primary health care with 5.7 per cent of its health budget allocation being dedicated to primary care.

Turning to the poaching of Maltese doctors to work in the UK, Dr Deguara said that while a doctor at Maltese health centres was being paid an average of between Lm7,000 and Lm8,690, doctors there were being offered Lm90,000 to work in NHS group practices between 9 a.m and 5 p.m. At those rates, he could not blame them for considering work in the UK

Two newly graduated dentists who were paid a maximum Lm7,000 here had left Malta for a starting fee of 80,000 in the UK, and they could do private work.

The obvious solution would be introduce better conditions, especially salaries, but it was easier said than done. The ministry had a letter from a MAM official saying that Lm35,000 tax free would be a good starting point for discussions. He did not know if this would be for exclusive service with the public health sector. But could the Maltese people afford these sorts of salaries?

The government was endeavouring to sit down for "real talks" to improve conditions and make doctors proud to work for their own people, even with salaries inferior to those overseas.

There were other issues to be looked at. For example, was there the necessary flexibility that would allow a ward doctor to help out in the emergency department?

On pandemic flu Dr Deguara quoted a foreign expert who had visited Malta and said Malta was the second best-equipped country to tackle pandemic flu. In contrast, Dr Farrugia had been quoted in the media as saying that stocks of Tamiflu would be arriving in Malta too late in 2006 to be of any real help. Actually Malta would be one of the six first countries to have enough Tamiflu for more than 90 per cent of the population.

It was clear that in spite of the country's deficit targets, the government was not miserly when it came to the people's health, and Lm2 million were being allocated for the pandemic, Dr Deguara said.

Other speakers will be reported tomorrow.

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