Ministerial and individual opportunities

What does the Prime Minister's decision to make John Dalli the man in charge of housing, health, employment and social care have in common with the huge changes taking place in the UK under the umbrella of individual budgets and more personalised care?

It is quite simply a remarkable opportunity to now put users more in charge of their care, to give individuals the services they need and to ensure much more seamless, real and effective joint working among the key areas of health, employment, social care and housing. At present we have individuals with needs and we had hugely-different ministers and ministries to cater for them. Now one ministry is handling all these areas. If this is handled intelligently and stress is placed on cooperation then there is a great opportunity to improve services on the ground, to put more money in the hands of users rather than departments, authorities or agencies.

Let me give some practical examples.

Firstly, why keep older people and others in hospital longer than they need to?

To get patients out of hospital at the right time requires the input of health, housing, social and personal care. To allow that elderly person to settle down again and move back into the community s/he came from will also require more joint work and the possibility of money to flow from funding a hospital bed to what that person needs to support an independent life in the community. Often this does not happen . The children can't afford to take the elderly person in, whether financially or due to time constraints. We wait for a place in an old people's home and the problem is solved, at least superficially.

But there are many shortcomings. It might not be what the elderly person wanted. The end result may well be much more expensive than allowing an elderly person to go back home and pay for help. Quite simply, as they stand now and are set up, the systems in place don't give the individual any real choice. We don't say: "This is the money at your disposal subject to these parameters. Now you can either use such funds to get yourself a place in a home, or you can go to your own home, or you can also stay with your family and procure the services you need, including paying family members, often women who give up so much to look after relatives in Malta."

Another example: The much-maligned single non-working mother. Yes, there are many scroungers but I met many who needed better housing, who wanted to apply for shared ownership or equity sharing and who wanted to work. But you are definitely much better off not working. You work, you lose your benefit or most of it.

How are you meant to pay for childcare on Malta's low wages? Who is going to support you when your kids are sick and you cannot go to work?

Without parental support it is impossible, so most unmarried mothers settle into the benefit life and, worse, thousands of children are growing up seeing these very frustrated (for all their painted nails, sculpted eyebrows and tattooed lip lines) girls-cum-women relying on boyfriends to fund their playtime while the state essentially shoulders most of their living expenses. The mum who works is very short-changed indeed. Clearly, housing and employment agencies must together make it worthwhile to work and reward people with housing as we did through a project, partly funded by the EU, to take kids from care and settle them back in the community. The carrot of housing created some self-reliant young people who are a real credit to themselves now and this type of work should become mainstream for some of the mothers who are unemployed.

Third example: The person suffering from mental health problems who does not enjoy family support, or maybe only has intermittent family support, and who ends up at Mount Carmel Hospital more often than he would really need to. Are we allowing the release of money from mental hospitals into the community? Are we giving people the money we spend on keeping them in hospital to fund the housing and support they require in the community? We are not. We are only getting there very slowly thanks to some exemplary NGOs like the Richmond Foundation. What they do should be a normal part of government policy. Get people out of hospitals where possible and give money to people, including those encountering temporary mental health difficulties, allowing them to have some choices in the community.

Fourth example: People on the housing waiting list. I think we are realising more and more that just giving people a house is only part of the way there. How are they going to pay for their home? How are they going to raise their children well if there are no role models taking part in the world of work in that family? Why should people work when you are better off on benefits?

Some cannot work. Any decent society must carry that burden, but in Malta there is too big a sub-culture of non-working people accessing free health, housing and more. Those who work hard in low-paid jobs are the hardest hit of all. Those who have become benefit fraud experts are laughing at the rest of the hard-working poor and not-so-poor, and this must be stopped.

Having one minister responsible for housing, employment and health, and more, can now go a long way to addressing these issues collectively, intelligently and for the benefit of taxpayers, users of services and the community as a whole.

marisaml@onvol.net