Distribution of anti-cholesterol pills to the elderly to resume

The government will next week be reintroducing the distribution of anti-cholesterol pills (statins) to all people who need them, including those aged over 75, Health Minister Louis Deguara told Parliament yesterday. The measure is expected to involve 36,000 new beneficiaries.

He said the government is also planned to introduce a pilot national breast screening programme next year.

Dr Deguara was concluding the budget debate on the Ministry of health and care of the elderly.

Earlier in the debate, Opposition health spokesman Michael Farrugia asked how the estimates showed that Lm5.58 million were to be spent on salaries by the Health Department next year from Lm5.74 million this year. Did this mean there would be fewer workers?

He also queried the financial allocation for the purchase of medicines. Did this mean that fewer medicines would be bought, or would the money owed to importers, currently Lm10m, continue to grow? Wasn't provision being made for the pandemic flu?

He said it was shameful that government pharmacies were now not being opened because security officials were not available, and he hoped this practice would not be extended to health centres.

Referring to the registration of medicines, Dr Farrugia said the tariffs had meant that 75 per cent of medicines disappeared from shop shelves. He augured that agreement reached with the importers would see an improvement in the situation, but it would have been better had the government heeded opposition advice so that medicines already on the EU market, such as in Luxembourg, could be certified for sale in Malta without complicated and expensive registration procedures.

The government was claiming that its agreement with the importers would mean lower prices, but it needed to be more effective in price comparisons with the same products abroad.

Dr Farrugia expressed concern over MRSA, which had reared its head in hospital and even in the community.

He said the Health Department needed to increasingly focus on childhood obesity, smoking by children and early, unprotected, sex. Legislation needed to be accompanied by education and effective enforcement. He was also concerned about the number of abortions on Maltese women abroad and the creeping upward trend of HIV.

Dr Farrugia said the contamination of the sea, such as at the new perched beach in Bugibba, was a serious public health issue. Air quality was another issue, with Maghtab producing clouds of dust as well as toxic gases.

Malta also had a problem in that despite strong demand for the purchase of graves, supply was very low. Furthermore, the Addolorata Cemetery, which was an architectural gem, was falling to pieces and needed to be restored.

Dr Farrugia said it was shameful that the health centres at Qormi, Cospicua and Rabat were still opening on restricted hours. This was supposed to have been a temporary measure because of a shortage of doctors. But years on, what was the government doing to solve this problem and attract more doctors to the health service? The crisis was stifling growth of community health services and adding pressure on state hospitals, notably the Outpatients' Department.

There was also need to improve practices at the emergency department, such as the opening of an observation ward.

The Labour MP said the Health Department needed to set up a health and safety unit for its own staff.

Dr Farrugia said he wanted to signal the fact that last week the Prime Minister, had acknowledged for the first time that there was a growing list for operations in state hospitals. The situation extended to many departments and it was simply unacceptable, and did not apply just for operations but also for several tests and scans. In the case of mammograms, no request made in the past six months had even been given an appointment, and none of these tests was likely before January 2008.

The brain drain of doctors and other medical staff was yet another concern that was hurting the health service and needed serious action by the government. The government also needed to plan for a higher number of consultants, including full-timers. Opportunities for training in the UK were shrinking. There was a need for a teaching programme and twinning with institutes abroad to facilitate specialisation in Malta. Malta also needed new specialities, such as in community care and working with people with disabilities.

Plans were afoot to transfer the Oncology Department to Zammit Clapp Hospital and improve facilities and equipment. But was provision being made for more manpower? If Boffa Hospital was to close, why had a unit within the hospital been moved from one part of the building to another at considerable cost?

Dr Farrugia called on the minister to table the contract with a private contractor for hospital cleaning. Was it true that it cost Lm12 per worker per hour? Was this financially viable? The workers were being paid far less.

The Labour MP said the nursery at St Luke's should be made available to more children to enable trained staff to continue working there. He said reserved parking facilities should also be made available for patients who needed to go to hospital regularly.

Turning to the new hospital, Dr Farrugia asked if the IT system would be commissioned on time. Or would patients' files and X-rays have to be taken to Tal-Qroqq, where space was more restricted?

He said the new hospital building would end up costing Lm149 million, a far cry from the Lm83 million once given by Health Minister Louis Deguara. The procurement of medical equipment was as confused as the construction, which was why the government had not published the contracts.

With the hospital due to open in eight months' time, could the government publish the migration timetable? Would the hospital actually start functioning after July 1? The budget did not provide enough funds for the recurrent costs on the new hospital.

Dr Farrugia said a Labour government was promising to tackle hospital waiting lists, adequately provision state pharmacies, place greater focus on patient care and dignity, and establish benchmarks across the health service.

He also spoke on services for the elderly, and asked when the home for the elderly at Mellieha would be opened.

Labour MP Silvio Parnis, who spoke earlier, complained about missing pills in government pharmacies and asked when the government would reverse its decision not to grant anti-cholesterol pills to people aged over 75. Although the WHO had initially said that such pills did not have a positive impact on those aged over 75, it had since reversed its advice.

Mr Parnis said the modernisation of a section of St Vincent de Paul Home at a cost of Lm3 million was welcome, but the time had come to improve assistance for those who cared for the elderly at home.

He complained that two lifts in the Padre Pio block which opened three years ago were often out of order, the roof leaked and the basement flooded when it rained.

The laundry needed to be better organised, and catering needed to be substantially improved.

Mr Parnis said the surcharge on power and water consumption was unfair on the elderly because their income was low and they did not even get the full cost-of-living increase.

The Labour MP said the Labour Party would soon be publishing its policy document on the elderly, featuring new initiatives to improve their quality of life.

Nationalist MP Joe Cassar praised the government for its policies on mental health and said a new Mental Health Bill was to be presented to Parliament soon, marking another milestone in the evolution of this sector.

He recalled that last August two community hostels were opened for 24 patients. This was a joint project between the Health Department, the Richmond Foundation and Suret il-Bniedem Foundation. This was a first and important step towards the rehabilitation of these people and their reintegration in society.

Another project this year was the refurbishment of female ward 1 at Mt Carmel Hospital and some Lm65,000 were spent on a state-of-the-art occupational therapy department which was situated at one of the homes outside Mount Carmel Hospital. Three lecture rooms with a reception area were also being developed in the hospital, to be used for staff development and training.

It was positive that a number of elderly people undergoing convalescence had been transferred to St Jean Antide ward at Mount Carmel Hospital, as this had also helped remove the stigma and taboo this hospital had endured for many years.

Turning to community services, he said that a pilot project between Qormi/Siggiewi/Zebbug saw family doctors, psychology assistants and nurses giving care in the community. Day centres at Qormi and Cottonera had also been developed.

In the past months, the number of people in the Outreach Programme - which was for people mostly in need of specialised help had been doubled. Parliamentary Secretary Helen D'Amato said the budget should be seen in its totality because various factors affected the elderly. Apart from direct spending by the Department for the Elderly, the elderly population benefited from the heavy outlay on pensions, the improvements in hospital services and the environment.

Silvio Parnis had spoken about the surcharge, but not the fact that power tariffs had still been higher under the Labour government.

He had spoken about a leaking roof but not on any Labour policy on the elderly.

This government over the past year had continued to expand services to the elderly. While institutional care, such as the Mother Theresa ward at St Vincent de Paul Home continued to be improved, so were community services. Thus some 1,000 new Telecare services had been installed and 1,000 more meals had been delivered by the Meals on Wheels Service. There were 100 more people using the homehelp service.

The refurbishment of St Vincent de Paul Home was leading to a better quality of life for the residents and better working conditions for the staff. Refurbishment included the new day clinic and the Mother Theresa ward. Another block would soon be upgraded to the standards of the new wards. Investment was also made this year at the homes for the elderly at Mosta, Msida and Floriana, and works on the new home in Mellieha would start next year.

Two new day centres were opened this year along with the Centru Servizz Anzjan, ensuring that Malta continued to have modern services for the elderly.

Health Minister Louis Deguara said next year presented a number of challenges, prominent among them being the migration from St Luke's to Mater Dei Hospital. The migration process started a year ago when workers started being taken to the new hospital to get acquainted with the new systems. Unfortunately not enough doctors had visited the new hospital, but they would be taken in the concluding stages of the process when the wards were being completed.

Some had complained that consultations on the migration process had not been held, but, Dr Deguara said, talks on migration should not be defined as meaning only working conditions. The budget, the minister said, including Lm1.3 million in extra funding to add staff for the new hospital because the leap of quality would not come from the building or its equipment, but from the people who ran it.

There was also additional funding to cover recurrent expenses while both hospitals were run in parallel.

Reacting to comments by Dr Farrugia, Dr Deguara said the acute admissions ward had just opened at St Luke's.

As for the brain drain, he said the outflow was not any higher than before. Doctors were leaving Malta for the same reasons as doctors were leaving Canada for the US or Germans were going to the UK. There was no brain drain of nurses from Malta, and only three had left for the UK. It had been claimed that 96 of 103 doctors who graduated between 1997-2001 had left Malta. But those figures were taken when the Medical Course started every two years. Now doctors were graduating every year.

Since 1996 there were 408 doctors who graduated and there was a net gain of 162 doctors.

Dr Deguara said that while some doctors had left Malta for purposes of career progression, others had done so for better remuneration. Unfortunately Malta could never hope to match the kind of salaries given in countries such as the UK, but there was a need for an improved training structure to enable more doctors to continue their studies here.

Turning to waiting lists, Dr Deguara said one should first examine the extent of the waiting lists. Unfortunately some consultants were not producing detailed lists. There was no doubt that demand would continue to rise for certain conditions as people lived longer, and one, therefore, needed innovative methods to tackle this problem.

In all cases, there was no waiting list for urgent cases.

The government had tried to launch an afternoon outpatients scheme to cut the waiting list for cataract operations within 18 months based on 10 operations per day four times a week, but pandemonium broke out when the suggestion was made.

Introducing new systems needed everybody's cooperation. One could not have a situation where, for example, some wanted to boycott outpatient sessions in the afternoon in the new hospital.

The majority of people in the medical service worked hard and deserved to be compensated adequately, but no one was being paid Lm12 per hour.

Dr Deguara said the government had acknowledged that medicine prices had gone up for various reasons, not all of which were local. The price of medicines on average rose by between 8 and 12 per cent annually abroad.

The purpose behind medicine registration was the maintenance of high standards. Long negotiations had been held with the stakeholders with different interests, but agreement was finally reached and a new unit had been formed under the competitiveness ministry which would issue a reference price beyond which a medicinal product may not be sold. That median would be calculated on the basis of the lowest and highest prices abroad.

The government had been criticised over a shortage of medicines in government pharmacies, yet the budget for purchases was being raised by Lm1.5 million.

Furthermore, payments to importers were being made within five months.

Dr Deguara said anti-cholesterol pills would again start being given to all those who needed them as from next week, benefiting 36,000 new patients, including those aged over 75.

Turning to the transfer of the Oncology Department, Dr Deguara said this was demanded by the fact that 1,700 new cancer cases were being reported and 700 died every year. Boffa Hospital was far too small for the increase in cases and the space needed to treat them, and operations would, therefore, be transferred to Zammit Clapp which would have 280 beds. The transfer operation would cost Lm5 million.

It was not true that funds had been wasted on the re-siting of a unit within Boffa Hospital, and some change had been needed in the interests of the patients.

A pilot national breast screening programme would also be launched next year, when three specialists would be coming to Malta.

Dr Deguara said a masterplan on the Addolorata Cemetery had been approved and implementation would start next year. Restoration students would also be restoring the cemetery chapel.

On air quality, the minister pointed out that it was this government that had decided to close the Maghtab dump and it would be rehabilitated.

The government's vision was to improve hospital care in a way that was previously undreamed of, but there were other challenges the extent of which was not yet known, such as the impact of the Working Time Directive. He was pleased that the opposition was backing the government's stand to retain the opt-out clause to protect the heath service. Another big question was patient and services mobility from one country to another, the demands of longevity and greater financial sustainability of the health service.

He hoped the people would be united to face the challenges of the future.