Issue link: https://maltatoday.uberflip.com/i/248536
23 Opinion maltatoday, SUNDAY, 26 JANUARY 2014 Claudine Cassar Bridging the health divide O ur national health service is a dichotomous being. On the one hand it is extremely successful, with 65-year-old Maltese having a longer healthy life expectancy than their Italian or UK counterparts. On the other hand, however, serious cracks have become painfully evident, with our general hospital showing an occupancy above a 100% in winter and close to that even in summer. Another serious problem is the availability of life-saving medications which are often out of stock, both in the government and in private pharmacies. Unfortunately successive governments have been patting themselves on the back, buoyed by WHO reports and high customer satisfaction results, for too long. It is irritating when politicians cannot see the root of the problem, but it is even more exasperating when they do see the problem but fail to act and find a solution. The top-heaviness of our government health service is obvious – millions in recurrent and capital expenditure are spent each year on secondary and tertiary health services, with only a pittance being invested in primary health care. The irony is that election after election, budget after budget, minister after minister, we keep hearing the same 'kantaliena': our government will invest more/emphasise more/ reorganise the primary health care system. Clearly they are all talking the talk, but nobody is putting their money where their mouth is. The problem with primary healthcare reform can be summed up in three issues. The first is that secondary/tertiary care and the pharmaceutical services are hardly coping, therefore all energy and resources available are being used to prop up Mater Dei and procure medicines. Casualty waiting times, beds in corridors, cancelled operations and out-of-stock medicine are constantly in the news. Other things get only secondary attention, since they do not have an immediate effect and are not as headlinegrabbing. The second problem is that the country's coffers are not exactly overflowing. Changing the current system of primary health care, which is mainly based on private practice, would require a considerable amount of money – money that quite frankly the government does not have. The third problem is the proverbial lack of political commitment. The two political parties' sole aim seems to be to criticise and score political points against their opponents. Any change will be resisted by a section of doctors and the opposition will surely ride the wave. PN shied away from a reform process at the discussion stage in the last legislature when it was deemed politically too dangerous. "Screw doing the right thing and reforming primary health, we want to try getting re-elected," I imagine they said in Pieta. "Mela x'naghmlu? U nispiccaw bhal Alfred Sant u il-50c li mar jivvinta," they are saying across the road in Hamrun. I sincerely hope I am wrong, but I think that despite the appointment of a GP as Minister of Health a meaningful reform of primary health services is still not on the cards. In the first year of this legislature we are only seeing a continuation of the half-baked and poorly funded initiatives started by their predecessors. Two-thirds of "It is irritating when politicians cannot see the root of the problem, but it is even more exasperating when they do see the problem but fail to act and find a solution" primary health care is private and this is where the government has to intervene, improving the integration of GPs with the public health system and empowering GPs to extend the range of services they offer in the community. Dr Farrugia should spend a lot of his energy dealing with his fellow private GPs. If private family medicine practitioners want to continue referring patients for government run services then they must integrate their practice with the public service. The government needs to invest in a nationwide medical records system. Despite the appointment of a GP, Godfrey Farrugia, as Minister of Health, a meaningful reform of primary health services is still not on the cards A GP visit (and prescription) should be accessible from hospital, just like a GP can see your hospital records, thus ensuring a seamless communication and continuity of care. Many hospital visits are avoided in the UK because GPs continue the patient's management in the community, e.g. a post-op visit can be done by the GP as per hospital instructions. We have been hearing about public-private initiatives for ages and primary health care is ideally set for this. It is cheap and within the reach of most people (cheaper than the €35 I recently paid a technician who told me I needed to buy a new washing machine within 10 seconds of looking at it). Government investment could help improve the quality of the service at a fraction of the cost of doing it in-house. Many people prefer the personal service of a private GP rather than the impersonal polyclinics. However, the quality of private service is highly variable and ranges from excellent to mediocre. The costs of setting up and running a private clinic, with medical records, appointment system, medical equipment and nursing and ancillary staff might make fees unreachable for poorer patients. It is a win-win situation if the government can use private GPs to reduce its burden, while subsidising doctors so they can give patients a higher quality service. CHECK OUT CLAUDINE CASSAR'S LATEST COLUMNS ON http://www.maltatoday.com.mt/en/blogs Career Opportunity: Horizon 2020 Programme National Contact Point The Malta Council for Science and Technology is Malta's national contact point organisation for Horizon 2020. MCST is currently seeking to recruit executives to act as National Contact Points/ Programme Committee delegates in various areas of specialisation. The Horizon 2020 Programme National Contact Point will form part of the Horizon 2020 Unit, and will be assisting researchers and organisations who wish to submit projects under H2020 calls, through dedicated support, advice and in-depth assistance. The National Contact Point will also be required to organise promotional events and workshops to assist applicants, advise on administrative and legal procedures and provide on-going support to applicants. A considerable amount of travelling will be involved. Profile of Candidate: A Master's Degree, preferably in a science or engineering subject, or a recognised appropriate comparable qualification, together with a minimum of two years of relevant work experience in a related field such as research administration and management. The selected candidate should also possess excellent interpersonal skills. Experience in EU R&D Funding will be considered an asset. Applications including a Europass C.V. will be received until Sunday 2nd February 2014 and should be addressed to mario.g.borg@gov.mt ETC Permit Number: 93/2013 MPO Permit Number: MPO/269/2005/04 The Malta Council for Science and Technology, Villa Bighi, Kalkara KKR 1320, Malta Horizon 2020.indd 2 www.mcst.gov.mt 20/01/2014 11:44:08