New hospital at the centre of debate on medicines

The forthcoming opening of Mater Dei Hospital was the focus of a debate in Parliament on a Bill to amend the Medicines Act, even though the Bill itself deals with the transposition of EU directives on medical products for human use.

Comments varied widely, with Nationalist MPs underlining the benefits of the new hospital and accusing Labour MPs of exaggerating the recent rainwater flooding and a Labour MP saying she had been told that walls had been pulled down to drain the water. Criticism was also made of the fact that the new hospital was even being featured on a Sunday tele-serial on TVM.

Michael Asciak (PN) criticised Labour for various U-turns and said Mater Dei was one of them. The party had been against the hospital but doubled its size when it took office. While criticising the current government, Labour needed to remember that it did not have a good track record in medical services. One could recall how medical students had been forced to go abroad, private hospitals were closed down, doctors went on strike and doctors at St Luke's came from Eastern Europe or Asia.

Much could also be said about the state of the wards and the shortage of nurses, particularly when Karin Grech Hospital was opened.

Labour had intended to introduce a fee for every medical prescription at health centres whereas under this government, not only had this service remained free, but medicines given by the health service would soon be distributed through pharmacies where the patients lived.

Dr Asciak said Mater Dei would be a state of the art hospital that would make the Maltese people proud, and serve as a centre of excellence for the Mediterranean.

Carmelo Abela (MLP) said Dr Asciak had conveniently forgotten how under this government waiting lists for operations had grown longer, some health centres were not providing a 24-hour service and the pharmacy of your choice scheme was promised 20 years ago.

The 50c fee on prescriptions was meant to discourage hoarding of medicines in a bid to reduce costs, something which even the present government admitted was a heavy burden.

Mr Abela observed that the Maltese medical service was suffering a brain drain, with many doctors going abroad. Unless action was taken to solve this problem, the quality of service would run into problems, he warned.

Mario Galea (PN) called for a consensual approach to the health sector. The opposition had a duty to indicate the areas which could be improved but criticism should be constructive.

He said criticism being made of flooding at Mater Dei was unfair and exaggerated. This was, after all, a building that was not completed. It had been claimed that the ITU was flooded, when only a little water had leaked down conduits and out from a switch. The same thing happened at his home.

Water had entered the basement because soil being used for landscaping had blocked a drainpipe, an unfortunate incident that could have taken place anywhere.

Moreover, tiles which had been removed were actually still in the process of being laid.

Damages caused by the flooding were far from the thousands of liri which some had claimed, and in any case, the bill had to be borne by the contractor.

The Labour Party was now saying that the ceilings were not sturdy enough and as a result the helipad had to be relocated. The truth was that the helipad had been built at ground level following a request by pilots because they feared wind currents from the nearby valley in rough weather.

Mr Galea spoke on how the number of operations had increased and how operations had become more sophisticated.

He said this progress had been paralleled in the improvement made in the training of medical staff, particularly nurses, many of whom had specialised on particular sectors such as tissue viability and infection control.

Joe Cassar (PN) welcomed the fact that the Bill was drawn up following consultation with the FOI, Malta Enterprise, the Chamber of Commerce, the GRTU and the Malta Chamber of Pharmacists, among others.

He argued that when a patient collected medicines, he should be given a package insert with instructions, even in Maltese, on how the medicine should be used. This was the case in all countries so why not in Malta?

Dr Cassar referred to criticism of the health sector and said one should make comments responsibly because even minor criticism could psychologically affect individuals. The Nationalist MP also spoke on progress made in the health sector over the past years and welcomed progress on the Mental Health Act, with the government and the opposition collaborating in this work.

He also referred to medicines distributed by the government or sold at pharmacies and asked if the time had come for medical insurances to also start covering medicine.

Labour MP Joe Abela referred to problems of access to medicines in several countries in Africa. In the debate on irregular migration one had to also be conscious of the health problems people from these countries had to go through.

Medicines Sans Frontier reported on this problem recently.

He said that as a non-signatory of TRIPS, India produced a lot of generic medicine and thanks to this, thousands of people in Africa had started receiving AIDS treatment. While this cost Lm10,000 a patient in the West, in Africa patients were being treated for $200, a much more accessible price.

This Bill included provisions on herbal remedies. Many people believed that the effects of such remedies were always positive. Yet sometimes they were also harmful. There should, therefore, be controls especially on products promising magical solutions for weight loss. Such claims did not make sense especially when one did not have the whole information on the products being referred to.

There were instances where patients were being listed as suffering from schizophrenia, which they did not suffer from, in order to be able to get medicine from the state. This showed the importance of increasing the number of conditions on schedule five for access to medicines.

He said it was a shame that the 40 hospital beds for psychiatric patients had been reduced to 12, especially when psychiatric problems were on the increase.

The Gozo hospital, he said, was much more advanced than Malta's in psychiatric care.

He said the new hospital offered a nice environment for those who would be working there, and the fact that rainwater had seeped into sections of the building was a disappointment. Everyone, including the opposition, wanted the hospital to be a success.

But the most worrying factor were the expectations being raised among the people. Instead of using money to promote health promotion, money was being used to promote the hospital. This was not the way things should be done.

Helena Dalli (MLP) referred to Mr Galea's comments and said PN policies so far had been anything but consensual. The PN had a history of confrontational politics and discrimination. And everyone remembered how the MLP government's consensual approaches were rebuffed. How could anyone fault the opposition for being critical of the fact that rainwater had flooded parts of Mater Dei Hospital, causing a disaster, given that this had cost Lm250m or Lm350m. She had been told that walls had even been demolished to drain the water. And what sense did it make to spend money on adverts on the new hospital, other than for propaganda purposes?

The hospital was even featuring on Sunday TV drama and was the subject of coffee morning tours. Given that this hospital was over budget and well past its completion date, what the government should have done was open it quietly. How could the MLP consent to an electoral campaign using taxpayers' money?

The new hospital, contrary to the old one, would not even have a childcare centre and staff had to use the one at the university. Yet that was fully booked. The absence of this facility meant the hospital might lose valuable members of staff.

Labour MP Noel Farrugia criticised community health services. He said the doctor of your choice scheme had never been introduced and doctors could not even be found at health centres after 5 p.m. and on weekends in certain circumstances. Moreover, X-Rays stopped being taken at the Rabat health centre, for example.

Maltese families, Mr Farrugia said, were finding they had to spend more on health services.

Mr Farrugia called for an expansion of community services to include activities with local councils to promote healthy eating.

Health centres should also work with voluntary organisations such as the scouts to provide a better community service.

Winding up the debate, Health Minister Louis Deguara said MPs had spoken about everything, some never even mentioning medicines. There were some examples of entertainment, however. One MP insisted that coffee mornings were being held at Mater Dei, which was absurd. People were only going there to visit but tours took three hours and visitors were offered a drink and a biscuit. An MP said the hospital would cost Lm350 million, Lm100 million more than what the leader of the opposition said two weeks ago! And, Dr Deguara said, he could not help but smile when Mrs Dalli said that walls were pulled down to drain rainwater. It was only a roadside kerb which was removed to facilitate flow!

Dr Deguara said all visitors were impressed by what they saw at the new hospital.

The minister praised the speech by Labour MP Joe Abela, particularly his comments on Mater Dei and his caution on the use of herbal medicines. Dr Deguara said it would not be the Medicines Authority which would determine the market prices for medicines. Prices would be established after a process where a number of persons assessed the price of medicines in other European countries. The government's priority was that medicines were safe, but their prices had to be real and fair. Results were expected shortly.

Dr Deguara said there had been no hospital waiting lists at the time of the Labour government because the kind of operations which were being made now were not carried out then or were high risk. For example, cataract operations were riskier and many people used to opt not to go ahead.

The minister said Mater Dei Hospital would help reduce waiting lists, but not perform miracles. In the case of ophthalmic operations, for example, the new hospital would have a dedicated operating theatre and the number of operations would double. The waiting list would thus be exhausted in a few years' time.

On the shortage of nurses, Dr Deguara said 120 nurses were graduating every year but there was competition for nurses across Europe.

Dr Deguara referred to the pneumatic system and said it was obvious that pressured containers could not be carried in a pressurised system. The same applied to blood samples that needed a particular temperature. No one ever said this system would reduce manpower needs, but it would certainly improve efficiency and manpower deployment.

It was true that the location of the hospital childcare centre had been moved, to make way for the medical school. An alternative had been provided within Mater Dei but it was not welcomed for various reasons, notably because it was smaller. If an onsite facility would not be possible, another location would be sought.

Replying to a question by Michael Farrugia (MLP), Dr Deguara said the management of Mater Dei would be under the Health Ministry. During the construction phase, many decisions related to financial matters which fell under the Prime Minister and the Finance Ministry but medical decisions had always remained within the Health Ministry. Once the hospital opened, the influence of the Health Ministry would increase while that of the Finance Ministry would decline.

Dr Deguara said damage by the recent rainfall was in sections which had not yet been tested, commissioned and handed over. Handing over only took place after structures and systems were tested, and contractors would still be held liable for the two-year guarantee period. But all in all, the money spent on this hospital was money well spent, and he was sure the people would agree when they toured the place.

The Bill was then given second reading.