Towards the next level of hospital standards

I refer to the article entitled Hospital Standards (July 11). The version of the facts as described by the immediate family members (July 15) concurs exactly with the reports available to this office from the nursing staff of ward WS2 and St Luke's Hospital management.

Our personal solidarity goes to the family for their sad loss, which was complicated by the turn of events as they have said in their correspondence. The immeasurable stress endured by those who experience such heart-rendering life events should never be underestimated. Any further comment is superfluous.

Beyond the twisted facts presented in his article as a pretext for his comments, Kenneth Zammit Tabona fails to acknowledge that the Maltese public overwhelmingly trusts its public health services and that public health services do not discriminate among patients. Anybody who turns up at the Emergency Department is attended to and no selection based on the seriousness of the medical condition is made. If a hospital admission is required, the patient is admitted whatever the bed population. And all of this is at no cost whatsoever to the patient.

The "generosity" of our public health care system was again favourably alluded to in the recent Health Consumer Powerhouse EU-wide survey. Thus, any comparison with the private health care sector is irrelevant.

It is also inappropriate to compare St Luke's Hospital with any of the other public hospitals in Malta. The nature of care delivered at our main hospital is probably unique also for similar-sized hospitals within any EU member state. It provides acute secondary care in all specialities and tertiary care in several sub-specialities for which in other countries, patients and relatives have to travel very far from home. The ease of access to specialised care at the point of use in Malta is often forgotten.

The physical environment of St Luke's Hospital reflects hospital building and design with the care concepts of pre-war Britain. It has served the Maltese population admirably for the past 70 years. St Luke's Hospital has contributed towards the health status of the citizens of this country which has flourished and improved to the levels that ranked Malta's health system performance as fifth best in the world (WHO, 2000) indicating our ability as a nation to maximise health system achievement compared to resources spent.

Hospital standards do not depend only on the physical environment within which care is delivered. The essential building blocks are indeed our human resources and the equipment with which they operate. The quality of medical care delivered in our health service is acknowledged within our local community but especially by our visitors who are in a position to appreciate our health services as compared to those in their own country, at least judging by the letters and interventions in the local media.

The results of repeated surveys carried out over a number of years have spoken very highly of the quality and calibre of all our health care professionals. It must be acknowledged that we have been successful in developing an excellent, well-trained, resilient and flexible workforce which has performed creditably within the constraints placed upon it by the onerous targets of ensuring value for every lira spent on health care.

The challenge ahead is to maintain the public health service attractive for our professional staff. The brain and skill drain to the local private sector is an artificial one. Only a handful of nurses and doctors are engaged full time in the private sector. The majority of staff in the private hospitals are full time employees from the public sector, offering their services privately on a part time basis. This applies both to consultants and nursing and paramedical staff. The stiff challenge really comes from mobility rights applicable to all our professionals within the EU. Our qualifications were always highly regarded even before we joined the EU. The remuneration package but especially career prospects that economies stronger and larger than ours can afford to offer will be more attractive if we do not take care of the physical environment within which staff in the public health care service work.

Health services need efficient buildings from which to operate. The original size of St Luke's Hospital had to be trebled in the last 70 years in order to allow for the expansion in service since its opening in the late 1940s. Successive introductions of modern technology had to be fitted in makeshift arrangements continuing to clutter an already crowded physical space.

The inadequacy of St Luke's Hospital to handle modern care must be assessed also from the support service requirements. There are limits to its electrical supply and, hence, not all wards can be provided with air-conditioning. The water mains needed several major reinforcements in recent years. In order to improve internal accessibility external lifts had to be constructed.

The Maltese public need little reminding about difficulties of access to the hospital through busy roads and the totally inadequate parking facilities available.

Moreover, the shift in medical care from in-patient services to daycare cannot be achieved satisfactorily in a hospital where theatres are scattered in four different parts of the building with obvious duplication. The lack of areas that can be transformed into daycare facilities has caused scattering of day patients in all wards with obvious inefficiencies.

We have no space for emergency wards. There is no room for expanding the diagnostic X-rays and laboratory services. The floor space per bed is inadequate for modern monitoring technology. The hospital cannot be fitted with modern IT systems to allow for transmission of digital images.

For all these reasons the Mater Dei Hospital is needed. The strand of hospital standards that deals with physical environment will improve tremendously compared to what can be achieved within the physical constraints at St Luke's Hospital.

As we migrate to the Mater Dei Hospital we take with us the wealth of human resource capital that was developed despite the many obstacles at St Luke's Hospital. The public health care services and its workforce, operating from the Mater Dei Hospital, can take up new challenges in order to achieve the next level of hospital standards - a patient-centred service, with greater emphasis on informed choice and consent, improved participation of patients and relatives in the care process and empowerment of patients to be really in charge of their health and well-being.