Bedridden patients are in for another fortnight of discomfort after directives at state hospitals, homes for the elderly and health centres were reinstated yesterday - less than 24 hours after being called off.

The directives are expected to remain in force until at least August 27 as General Workers' Union officials will be unable to attend meetings with the government over the dispute since they will be abroad.

A marathon meeting held yesterday between government officials and the union was inconclusive.

The directives - which are hitting St Vincent de Paul Residence the hardest because of the number of bedridden patients there - call on some 900 nursing aides, care workers and health assistants at hospitals and homes for the elderly to do only food-related jobs, although their job would normally also include helping nurses in the washing and cleaning of patients as well as getting them out of bed. The government has said the workers were only doing some 15 per cent of what their job entails.

The health authorities yesterday reiterated their call to relatives to give a helping hand so that bedridden patients would not suffer needlessly.

Nurses at St Vincent de Paul have had to fill in and have borne the brunt of the directives over the past week. The Malta Union of Midwives and Nurses has expressed concern about possible burn-out.

Although the nurses are bending over backwards to minimise patient suffering, the situation at the home for the elderly was not pleasant, especially at night, when there was only one nurse per ward on duty. MUMN President Paul Pace had explained that it was impossible for a nurse on his own to turn patients around. Bedridden patients are usually turned around every two hours to avoid bed sores, which can be very painful and even fatal if they become infected.

Contacted by The Times, Mr Pace was worried that the nurses would be taking on all the workload, adding that these directives had hit them very hard. It was also the worst time of the year, with many people booking leave.

He expressed his disappointment that yesterday's meeting was unfruitful, adding that the union would be trying to see how the government could help the nurses out.

Health Minister Louis Deguara condemned the action and described it as "irresponsible". The government would be taking all measures permitted by law, he said.

In a press conference - shortly after the union held its own - parliamentary secretary Helen D'Amato said the directives had a big impact on the mobility of the most vulnerable people - the elderly. She said there could be long-term consequences for bedridden patients if they developed bed sores because of lack of mobility.

She highlighted that nurses cooperated fully and were doing their utmost to ensure that discomfort to patients was minimised.

The government's only solution to alleviate patients' suffering was to bring in workers from the private sector, but this was a scarce resource, Ms D'Amato said.

Earlier, GWU section secretary Louis Marsh said the government had been informed that the section's administration would not be available for meetings up to August 27.

Earlier this week, he told The Times that some union personnel needed to go abroad.

He explained that the union had been prepared to temporarily put its request for salary scale 13 for nursing aides on the backburner. The government had also seemed willing to discuss the union's request for a change in the roster.

The third issue revolved around a premium allowance for the three categories, in addition to their wages. The minister said the union had called off directives at midnight yesterday, and a few minutes later the Health Division specified a time for yesterday's meeting. Initially the union had insisted that it would call off the directives on the day of a scheduled meeting, while the government was arguing that it would only fix a meeting once the directives had been called off.

Director of hospitals, John Cachia said the union officials walked out of yesterday's meeting, only to call back after a few minutes asking to go back. They returned after more than an hour accompanied by GWU deputy general secretary Gejtu Mercieca.

The directives could also affect the migration to Mater Dei Hospital since the workers were asked not to do any work related with the move to the new hospital. The GWU has also ordered those working at St Luke's Hospital's outpatient department and health centres not to process medical files or X-Rays while health centre employees are not taking appointments.

Mr Marsh said the union would be asking the Health Division to launch an investigation into threatening letters sent to employees at work. He stressed that this was not a political fight. It was also considering taking action against a health official who disrupted peaceful picketing.

Both Mr Marsh and the Health Division clarified that no meeting had been held on Thursday, as reported in yesterday's The Times.

A meeting was also held yesterday between the government and the Union Haddiema Maghqudin, which also represents a number of nursing aides. Union section secretary Joe Bonello said discussions are expected to continue next week and a working group, made up of the UHM and division representatives, would look into adjusting working hours.