Health: Grabbing the bull by the horns

Health Minister Godfrey Farrugia was given what is possibly the second toughest ministry, following Edward Scicluna's Ministry of Finance. Many people's first reaction was that it was appropriate to have a general practitioner as a minister, since everyone seems to agree that our primary health service needs a complete revamp. However, disappointingly, it appears that Mater Dei is going to be Minister Farrugia's main concern.

There is no doubt that there are several problems at Mater Dei. Long outpatient and operating waiting lists, long waiting times at casualty and a lack of bed spaces immediately spring to mind. However, these problems were inherited from the Deguara era and, as pointed out during the electoral campaign by the PN, progress had begun during the last legislature. Proper management structures and the outsourcing of procedures and tests to the private sector are leading to a gradual but consistent improvement of the situation. The building of an oncology hospital will hopefully also free up some beds at Mater Dei.

Having a minister on site makes one wonder whether Dr Farrugia intends to micro-manage the hospital. This is not his job, and the sooner he realizes that the better. Unfortunately, comments like the one he made after Easter weekend, when patient traffic in the emergency department was light, will only serve to make him the target of criticism next time casualty is overflowing. The claim that he has "instructed" that 2014 and 2015 appointments be moved to 2013 will also come back to haunt him, since people with such appointments will now expect to be seen this year - an impossible feat given the current situation. What has until now been seen as a legacy of the PN administration will suddenly become Godfrey Farrugia's unkept promise.

This brings me back to my previous statement that the new minister's focus should be on primary health care. Most of the people waiting for eight hours at casualty - angry, foaming at the mouth, asking where the minister's office is - could have been dealt with by a well-equipped primary-health service. Unfortunately, as the minister well knows, currently this sector is in a rut. The provision of government primary healthcare is not well organized, equipped or funded. The role of health centres in primary prevention, management of acute illnesses and chronic conditions is blurred and not well defined, while there is virtually no continuity of care between Mater Dei and health centres.

Private family physicians unfortunately have similarly been abandoned by successive governments. No attempts have ever been made to improve the quality of care. Half-hearted changes were made, such as giving GPs the right to order blood tests. However, this right should have come with strings attached, such as obliging GPs to keep notes (which happens with shocking infrequency) or to attend formal, continuing-education lectures. The fact that these doctors do not work for the government does not absolve the ministry from ensuring that they give good-quality service. For example, the over prescribing of antibiotics by Maltese GPs is a clear, well-known fact. Yet while the UK, with over 60 million people, manages to keep tabs on each and every prescription in the country (available for everyone to download from data.gov.uk), Malta has no such system. The health authority doesn't know whether every single antibiotic sold in the country is matched by a prescription, let alone which cowboy is prescribing antibiotics like there is no tomorrow!

My humble suggestion to Dr Farrugia is for him to stop attracting too much attention to himself during these first few months. The health department is staffed by some very competent and apolitical individuals; they know where the problems lie and what needs to be done to resolve them. Unfortunately it is lack of political will that has kept things stagnant over the years.

Dr Farrugia, doing the right thing might mean locking horns with your GP colleagues, but change can only be brought about with bold decisions. Your success is in everyone's best interest. Good luck!