Audit flags need for better coordination and data management in home-based elderly care

The National Audit Office (NAO) has found that while the Government provides a wide range of home-based medical and clinical services for older persons, shortcomings in coordination, planning and data management could affect the long-term effectiveness and sustainability of these services.

Auditor General Charles Deguara presented the performance audit report to the Speaker of the House of Representatives, Anġlu Farrugia, earlier today. The audit focused on medical and clinical services delivered in the homes of persons aged 60 and over and formed part of an international parallel audit examining governments’ preparedness for ageing populations.

The report confirms that Malta offers a broad array of home-based services to the elderly. However, it notes that the decentralised way in which these services are delivered may create avoidable complexities for older patients trying to navigate the system. Despite their development over the years, the NAO says these services require clearer objectives, defined timeframes, structured plans and dedicated budgeting within national strategies to ensure they are strengthened and better coordinated.

Although most services recorded an overall increase in usage during the period reviewed, the NAO points out that there is still room for wider uptake among people aged 60 and over. It does not, however, express major concern in this regard, citing Malta’s context, including easy access to community health centres, the availability of other support services and user preferences. Nonetheless, the absence of studies, trend analyses and utilisation projections limits the ability of authorities to align service provision with changing demand, potentially affecting timeliness, quality and long-term sustainability.

The audit also raises concerns about financial data management. Several entities involved in providing home-based services were unable to readily extract or filter financial information needed for analysis. The NAO warns that weaknesses in data management and reporting systems could undermine strategic planning, particularly given Malta’s comparatively lower total health expenditure when measured against other European countries.

Human resource shortages, together with gaps in collated and accessible data, were identified as further risks, especially in terms of service coverage and delivery times. The NAO notes that such information gaps could hinder future service development, capacity building and strategic planning.

To address these issues, the NAO recommends improved coordination, communication and information sharing among government entities. This could include clearer referral pathways or even a one-stop-shop approach for home-based medical and clinical services. The Ministry for Health and Active Ageing is also encouraged to consider developing a specific strategy dedicated to home-based services to enhance collaboration and cost-effectiveness.

Given clear indicators of increasing demand, the NAO strongly urges the strengthening of information management systems to allow for easily accessible and comprehensive financial and operational data, including staffing levels. Such data, the Office says, is essential if home-based services are to be sustained, further developed and potentially recognised as a distinct component of the national health system.

The full audit report and its recommendations are available on the National Audit Office website and its official Facebook page.