Seeing it from a health point of view

Former Health minister Dr Michael Farrugia gives his views on health. He talks to Ramona Depares

The Health sector has been very much under scrutiny these past few weeks. The mystery-ridden death of a Norwegian student as well as the incident where an elderly woman died of natural causes after she was hit by a falling television set are but two of the reasons. Couple that with countless controversies surrounding the building of the new Mater Dei Hospital and it’s no wonder that health is considered such a hot potato.

MaltaToday spoke to Shadow Health Minister Dr Michael Farrugia about various related issues. When asked about the current situation in the health department, Dr Farrugia’s initial reply focused on the good reputation which Malta enjoys when it comes to health services.

"Malta has always enjoyed a good reputation when it comes to health services. Indeed, local health services have always moved for the better, the ambition is there. The major problem is that there is no initiative to change those areas where the system could improve. Unless we tackle the situation immediately, the health sector will simply regress. Many things have to change before we can start boasting about Maltese health services: starting with the removal of certain antiquated laws and the current system of how we run St. Luke’s. The sector has to move with the times. Three sectors where we’ve really fallen behind are the laws regarding mental illness and care, the distribution of medicines and the autonomy or rather lack of it at the hospital," Dr Farrugia started off.

I ask him to elaborate about the hospital administration. The way that some departments are run, he says, is defective. He cites the emergency department as a prime example: this particular department, he explains, should accept only those cases which constitute a genuine emergency. However, this does not seem to be happening.
"We are not educating the people enough, perhaps. Some five years ago the health department had co-ordinated an educational programme about the emergency department on TV. There were no political undertones whatsoever and it seemed to be having some effect. Unfortunately it was discontinued. So now we have a situation where it’s not unheard of that a patient has to wait for eight hours in this department. You can imagine how useful this is if you’re suffering from a real emergency. And the staff get frustrated because they cannot cope with the workload nor with people’s complaints. As I see it, this is not serving the function of a real emergency department," Dr Farrugia continued.

So what solution does he suggest? Educating the public for starters, as well as making more intelligent use of the various Health Centres distributed around the island. In the evenings, Health Centres often have more doctors available than the emergency department does and theoretically should also cater for emergency cases. This is not happening however, with the consequence that patients either end up congregating at St. Luke’s or else seek private aid.

"There are other solutions, of course. In 1997 we had commissioned a report from the WHO , where we’d asked for the organisation’s assessment of our health services and its advice as an uninterested party. The main thrust of the resulting report was that we did not invest enough money and energy in the primary sector, i.e. education and care outside of hospitals," he continues.

Dr Farrugia’s main worry is that instead of following the WHO’s advice, primary healthcare ended up even more neglected in these past years. The problem of shortage of doctors has not been addressed and negotiations with the doctors’ co-operative failed to lead anywhere.

"Although not everyone may agree on the solution it is evident that the Health Centres and the Emergency department are not being run to their optimum efficiency. Someone has to take a decision. It is no use procrastinating any longer. After all, this is one of the main duties of the health department," he insists.

Another area which Dr Farrugia is not happy about is the way that operating theatres are run. He questions whether the surgery time-tables are adequate and fails to understand why the practice of carrying out non-emergency procedures on a Sunday was discontinued.

"This initiative had greatly reduced the waiting list for non-emergency procedures. Yet it was dropped under the Nationalist government. No health issue should be politicised: procedures are either good or bad. It should not matter whether it is a Labour or a Nationalist government that has introduced a particular measure. Consensus is essential if we are to further improve the health sector."

Dr Farrugia mentions as an example that during the last Labour government he gave the go-ahead for Malta’s participation in a particular WHO project called Healthy Schools started under the previous administration. He describes how those projects organised by WHO Europe, such as Healthy Cities, were however discontinued.

"This is not a professional way to do things. Improvement should be encouraged and kept no matter who was the instigator," he says.

I ask him about EU membership and whether he feels that the local Health Sector will be missing out on a number of benefits should Malta disdain membership. He disagrees, saying membership is not always a pre-requisite for Malta to enjoy those same benefits as EU countries do.

"Everything has its own advantages and disadvantages. One has to weigh one list against the other, see whether membership really suits us. After all, let’s say that the EU has a particularly effective regulation regarding medicines. Do we have to become members in order to enact the same regulation? After all, we should be implementing such regulations because we believe they are good and not because the EU tells us to," Dr Farrugia insists.

He explains that any local professors wishing to try their luck at foreign openings can still do so, regardless of whether we are EU members or not. This is happening already, he says, as many local practitioners have taken up posts in the UK, where the shortage of doctors working on the NHS is particularly felt. The same can be said for participation in projects initiated by international organisations such as WHO Europe.

"Let’s take the current situation. There is a whole list of projects that Malta is eligible to take part in. Out of this list, Malta’s name is checked only against a couple. We are not even attempting to reap whatever we can out of these opportunities. There are other sources for funding other than the EU and it’s a fact that we do not try to tap them."

I change the subject to that of the new hospital and the topic seems to open up a whole can of worms. He starts by mentioning the directly awarded contract signed two years ago, which he says contain clauses to ensure a continuous cashflow to the contractor which are never included in these kind of contracts.

"Normally the contractor gets paid after the work is completed. This contract, on the other hand, has a whole schedule of payments that are to be made in advance. And there is also the subcontracting to take into account: the way in which it is done is not always transparent and not always in line with governmental financial regulations. Moreover, the hospital’s capacity has been reduced from a planned 850 beds that could be extended to 1000 to a mere 650 with the possibility of extension up to 825," Dr Farrugia explains.

Another point that is worrying him is whether the hospital will include a rehabilitation centre that is large enough to cope with the likely demand envisioned by the Labour administration catering for all ages, unlike the existing one at Zammit Clapp, as well as the fact that he feels the financial target has already been overshot.

"That’s just the building stage. When it comes to the running stage there are even more obstacles to take into account. Unless we want a White Elephant on our hands there is no way that we can accept that Mater Dei be run in the same manner as St. Luke’s. We cannot just transfer the management system we have at St. Luke’s to the Mater Dei or we’ll be stuck with the biggest medical flop in history," he stated.

I could not resist ending the interview without mentioning the two latest notorious cases to hit the news: that of the Norwegian girl and the elderly lady whose deaths are both shrouded in mystery. When I ask him for his reactions, he states that these incidents do not call for a witchhunt. Instead, the Health Department should try to learn from such mistakes in order to improve its quality of service and quality of care, two concepts which Dr Farrugia places high importance on.

"Mistakes happen everywhere. However, I would not tolerate those mistakes that arise out of negligence. On the other hand, what is important is that we learn from our mistakes. And of course, the person in charge has to shoulder his responsibility. Abroad ministers have resigned for much less than the TV set case. I’m not saying that the minister at this stage should resign, but neither should the Health Department act as though the problem does not exist. The major flaw in the system is that no one wants to shoulder his responsibility and without accountability, how can we expect improvement to occur?"