Health estimates - Minister acknowledges need for structured training - 3/11/2006

link to The Times

Health Minister Louis Deguara said next year presented a number of challenges, prominent among them being the migration from St Luke's to Mater Dei Hospital. The migration process started a year ago when workers started being taken to the new hospital to get acquainted with the new systems. Unfortunately not enough doctors had visited the new hospital, but they would be taken in the concluding stages of the process when the wards were being completed.

Some had complained that consultations on the migration process had not been held, but, Dr Deguara said, talks on migration should not be defined as meaning only working conditions. The budget, the minister said, including Lm1.3 million in extra funding to add staff for the new hospital because the leap of quality would not come from the building or its equipment, but from the people who ran it.

There was also additional funding to cover recurrent expenses while both hospitals were run in parallel.

Reacting to comments by Dr Farrugia, Dr Deguara said the acute admissions ward had just opened at St Luke's.

As for the brain drain, he said the outflow was not any higher than before. Doctors were leaving Malta for the same reasons as doctors were leaving Canada for the US or Germans were going to the UK. There was no brain drain of nurses from Malta, and only three had left for the UK. It had been claimed that 96 of 103 doctors who graduated between 1997-2001 had left Malta. But those figures were taken when the Medical Course started every two years. Now doctors were graduating every year.

Since 1996 there were 408 doctors who graduated and there was a net gain of 162 doctors.

Dr Deguara said that while some doctors had left Malta for purposes of career progression, others had done so for better remuneration. Unfortunately Malta could never hope to match the kind of salaries given in countries such as the UK, but there was a need for an improved training structure to enable more doctors to continue their studies here.

Turning to waiting lists, Dr Deguara said one should first examine the extent of the waiting lists. Unfortunately some consultants were not producing detailed lists. There was no doubt that demand would continue to rise for certain conditions as people lived longer, and one, therefore, needed innovative methods to tackle this problem.

In all cases, there was no waiting list for urgent cases.

The government had tried to launch an afternoon outpatients scheme to cut the waiting list for cataract operations within 18 months based on 10 operations per day four times a week, but pandemonium broke out when the suggestion was made.

Introducing new systems needed everybody's cooperation. One could not have a situation where, for example, some wanted to boycott outpatient sessions in the afternoon in the new hospital.

The majority of people in the medical service worked hard and deserved to be compensated adequately, but no one was being paid Lm12 per hour.

Dr Deguara said the government had acknowledged that medicine prices had gone up for various reasons, not all of which were local. The price of medicines on average rose by between 8 and 12 per cent annually abroad.

The purpose behind medicine registration was the maintenance of high standards. Long negotiations had been held with the stakeholders with different interests, but agreement was finally reached and a new unit had been formed under the competitiveness ministry which would issue a reference price beyond which a medicinal product may not be sold. That median would be calculated on the basis of the lowest and highest prices abroad.

The government had been criticised over a shortage of medicines in government pharmacies, yet the budget for purchases was being raised by Lm1.5 million.

Furthermore, payments to importers were being made within five months.

Dr Deguara said anti-cholesterol pills would again start being given to all those who needed them as from next week, benefiting 36,000 new patients, including those aged over 75.

Turning to the transfer of the Oncology Department, Dr Deguara said this was demanded by the fact that 1,700 new cancer cases were being reported and 700 died every year. Boffa Hospital was far too small for the increase in cases and the space needed to treat them, and operations would, therefore, be transferred to Zammit Clapp which would have 280 beds. The transfer operation would cost Lm5 million.

It was not true that funds had been wasted on the re-siting of a unit within Boffa Hospital, and some change had been needed in the interests of the patients.

A pilot national breast screening programme would also be launched next year, when three specialists would be coming to Malta.

Dr Deguara said a masterplan on the Addolorata Cemetery had been approved and implementation would start next year. Restoration students would also be restoring the cemetery chapel.

On air quality, the minister pointed out that it was this government that had decided to close the Maghtab dump and it would be rehabilitated.

The government's vision was to improve hospital care in a way that was previously undreamed of, but there were other challenges the extent of which was not yet known, such as the impact of the Working Time Directive. He was pleased that the opposition was backing the government's stand to retain the opt-out clause to protect the heath service. Another big question was patient and services mobility from one country to another, the demands of longevity and greater financial sustainability of the health service.

He hoped the people would be united to face the challenges of the future.

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