Opposition calls for Maltese language requirement for foreign doctors

The opposition said yesterday that it welcomed the Health Care Professions Bill but said the bill should specify that foreign health care professionals who wished to work in Malta should be fluent in Maltese.

The bill, debated in the House of Representatives yesterday morning, updates the laws which regulate the medical professions. It was introduced by Health Minister Louis Deguara (see story above.)

Dr Karl Chircop (MLP), who was the first opposition speaker in the debate, said there was no doubt that the laws on the medical professions needed to be modernised. In view of EU membership, provisions were also needed for the recognition of the qualification of medical professionals between Malta and the other EU member states.

The bill was not clear whether foreign professionals working in Malta should be fluent in Maltese. This was needed, not least to protect Maltese professionals from a possible influx of foreigners in certain sectors.

Dr Chircop observed that the bill would strengthen the existing regulatory councils, rather than create new ones.

The composition of the councils was being changed, and the government would no longer appoint a majority of the members, which was right. He could not understand, however, why the chairman in all cases had to be a member of the legal profession. If this was to be retained, this legal person should have at least seven years experience in the legal sector.

On the funding of the councils, Dr Chircop observed that the councils may charge registration fees, but the bill did not specify how much these fees would amount to, when they would be charged and whether there would be different fees for different professions. It needed to be ensured that the fees were not so high as to be passed on to patients. An increase of doctors' fees in the private sector would only serve to increase pressure on health centres.

Referring to the Pharmacy Council, Dr Chircop said a longstanding problem which had not been tackled involved pharmacy technicians, who although they were university graduates, still had to sit for another exam set by the council. The opposition felt this bias against the pharmacy technicians should be removed.

Turning to the Council for the Professions Complementary to Medicine, Dr Chircop said that despite the problem of size, all professions should be represented by at least one member, rather than having a situation where a representative was only appointed when the interests of that profession was under discussion.

Dr Chircop said it appeared that certain justified requests made by nurses had not been met with regard to the Council for Nurses and Midwives. Whereas midwives required a warrant, nurses still did not. Possession of a warrant was seen as necessary particularly for nurses who worked privately.

The Labour MP said that with the enactment of this law, the people also expected better management of the Health Division and the health sector in general. Taxpayers expected efficient use to be made of their money. That also applied to after care, including the prompt publication of a discharge letter when a patient left hospital. The people also expected shorter waiting lists and an end to the shortage of medicines given on the health service.

Dr Chircop also appealed to the government to seek to solve the current dispute with the nurses. He had been informed that the government had not called a meeting with the nurses for three months. The nurses' demands, he said, involving mostly relativety in salaries and specialisation allowances and the possibility of early retirement after 25 years of service. He could understand the problems which the third demand could involve for the government, including a shortage of nurses and the possibility of other sectors also demanding such a concession. But the government should seek to improve nurses' working conditions.

Dr Michael Gonzi (PN) welcomed the planned register of specialists. He stressed that everyone in the health care professions needed to be up to date with developments.

The bill was also addressing communication with the patient, another important aspect of the profession. Anybody wanting to practice in Malta must undergo a linguistic competence test, he observed.

The bill was giving a legal standing to those practicing complementary medicine. This was important because it was wrong for complementary medicine to be used when there was no scientific basis for cures being prescribed.

It was not right to convince a patient, on the basis of a computer-based examination, that he was suffering from some sort of allergy and compel him to follow a diet, without referring the patient to a specialist.

Certain chronic illnesses were also being diagnosed through such methods, with the patients being ordered to undergo certain diets without referral to specialists. If such practices had a scientific basis, then they should be retained but handled only by professionals acknowledged at law. Otherwise steps should be taken to safeguard the patients.

How were homeopathic medicine practitioners, chiropractors and masseurs being controlled? Could they have been included in the bill? As things stood, they could practice without any licence.

Mr Joe Debono Grech (MLP) called for closer collaboration between St Luke's and private doctors.

He complained about the system for out-patients' appointments, saying it was not right for patients to be asked to be at hospital early in the morning only to be seen at noon.

Mr Silvio Parnis (MLP) said that compared to other countries, health care in Malta was good. However, like the previous Labour government, the present administration was suffering from a shortage of doctors who were ready to work in health centres. Many doctors in government employ felt they were overworked and underpaid.

Waiting lists at hospitals, particularly at the ophthalmic and orthopedic departments, were getting longer. This bill alone would not solve all the ills in the health sector, he said.

Referring to nurses and midwives, Mr Parnis said that one could not close an eye to the conditions they were working under, especially due to shortage of staff. Their resilience could be seen last Monday, during the storm, when wards were manned by one or two nurses only.

Mr Parnis called on the public to be more responsible in the use of the free healthcare services because, after all, this was being paid through taxpayers' money.

Winding up, Health Minister Louis Deguara said the unions were now realising that rather that a posible influx of foreigners, the risk was that Maltese would opt to work abroad.

Dr Deguara said that in terms of EU rules, language requirements could not be used as a barrier to stop EU nationals from working in another member state. In the health sector, one could not make it obligatory for all professionals to know Maltese, although that was expected in most cases for those who came in contact with patients.

On the chairmanship of the councils, Dr Deguara said having a person with a legal background was useful for the interpretation of the law, the handling of investigations and the handing down of judgments.

Dr Deguara said that since the regulatory councils would be autonomous, they would establish their own fees. Once the majority of the members would be appointed by the members of the professions themselves, it would be up to them to decide. But he did not expect the fees to be high. In Britain, registration with the British Medcal Council was less than £100.

Turning to representation on the Council for the Professions Complementary to Medicine, Dr Deguara said one could not have all the professions represented because some of those professions did not have a structure to regulate themselves or the members of those professions were too few.

On warrants for nurses, Dr Deguara said he had no doubt that as nurses became more specialised, they too would be issued with warrants.

The bill was later given a second reading.