Issue link: https://maltatoday.uberflip.com/i/219723
13 maltatoday, SUNDAY, 1 DECEMBER 2013 Martin Balzan, the secretary general of the Medical Association of Malta, believes that the government must clarify who is in charge at Mater Dei and what its health policies are PHOTOGRAPHY BY RAY ATTARD "I personally believe Dalli is trying to rehabilitate himself by doing something positive" - Martin Balzan primary health care." The Dalli report includes a recommendation to refuse self-referrals at the Mater Dei emergency department. However, Balzan believes that the people will oppose it, as did the minister. Moreover, it might create medical-legal problems. "Who is responsible? Is it the doctor or hospital if anything goes wrong? In principle we agree but it needs to be explored further." Balzan also notes that the country does not afford to invest in new hospitals so the government must to maximise the current infrastructure and offer health services for longer hours. In the past few years, Balzan explains, the association agreed that medical professionals should be encouraged to work longer hours and have operating theatres functioning till 8pm. "The tools are there but this administration has not implemented these measures. It will cost money, because it would require more doctors, more nurses and more beds." Asked if the country has the human resources to implement such a measure, Balzan says that the amount of new nurses provides the necessary personnel. He adds that similarly, doctors are committed to work for longer hours at the outpatients department, however the management "needs to act. It's either a problem of a lack of political direction or they are simply failing to act, or both". The tools to resolve these problems exist but they will come at a cost, he adds, explaining that incentivising doctors to work between 4pm and 8pm would require improved working conditions. Balzan puts the problem of out of stock medicines down to financial restrictions. "It's a financial problem, especially after October, the hospital runs out of money. It's a matter of financial sustainability. The blame is shifted to the management but it's mostly a budget problem. They never own up to it but they unfairly blame it on the management." Yet, he does admit that there is room for improvement in the procurement process and floats a recommendation to have a unit set up to determine the real market price of medicines and medical equipment. "Local bidders bid high and opting for the lowest offer will also land you a bad deal. There must be mechanism in the form of a network with other hospitals abroad to establish the real value of medicines and equipment." He also argues that the country is facing a demographic crisis with growing number of foreigners residing in Malta and an ageing population set to increase the pressure on the healthcare services. "We need a modelling system in which a scientific study would show how many doctors, nurses and beds will be needed in the coming years. The problem in the sector is that we have no adequate planning in place. Under (former PN health minister) Louis Deguara no planning was done at all. Long term planning only started under former ministers John Dalli and Joe Cassar and we're still trying to catch up." Doctors in Malta are widely regarded as one of the most powerful lobbies, and while admitting that doctors have enough muscle to defend their interests, Balzan points out that over the last 15 years there has been no major industrial dispute or strike involving doctors. Often doctors are accused of creating a backlog of appointments at Mater Dei to encourage patients to seek their services at private hospitals which would yield a bigger return in monetary terms. "In recent years we have introduced what is known as the 'A contract', which bars doctors from holding a private practice. Out of the 130 or so consultants at Mater Dei around 60 doctors are on the A contract. Older doctors will find it hard to change their ways but more and more young doctors are taking up the contract." He adds that MAM envisages a situation where up to half of the consultants practice exclusively at Mater Dei in the coming years and insists that the private sector plays an important role as it alleviates pressure on the state run services and grants patients an alternative choice. MAM is ready to cooperate in any drive to reform the sector, Balzan says, citing the doctors' commitment to work longer hours as an example. "When measures are implemented we will give our input to make sure they are successful and result in a better service for the patients. Once we are offered the right conditions to work in, the service will improve and the turnover will increase. However, as soon as confrontation sneaks in and antagonism raises its head, it's a lose-lose situation for all."