Dalli on introduction of health insurance

Social Policy Minister John Dalli yesterday told Parliament that he shared an opposition spokesman's dream that the health budget would be drawn up by both sides of the House and urged the opposition to work with the government on making the health system sustainable well into the future.

Speaking on his ministry's votes, Mr Dalli said the government had taken initial steps to consider whether a health insurance system should be introduced by hiving off part of social security contributions and channelling it to the health account. This was a complicated matter and one had to consider whether there should be public or private insurance and what should be covered.

Anthony Zammit (Lab.) had spoken dispassionately of the reality of life at the hospital. However, everything boiled down to management and organisation. Malta had the best human resources and hospital facilities and one must tackle issues with an open mind.

The minister criticised the Malta Union of Midwives and Nurses (MUMN) for ordering industrial action. The government was committed to honouring the collective agreement but many things took time, in view of government bureaucracy - something which needed to be tackled, too.

He agreed with the union that the nursing course should be reduced. Why did the course take three years in the UK and four in Malta?

Mr Dalli referred to the Euro-Health Consumer Index which placed Malta at the 23rd place in the annual league table of friendly health care systems. He suspected that this agency was spurred to do such a survey by the pharmaceutical industry, so much so that what they underlined was the fact that not all medicines in Malta were free. He said Malta had its problems. In today's financial situation, to speak of free medicines was difficult.

The question the country had to answer was what should be available for free, and both sides had to work together to arrive at a solution. They could either set impossible aims, or be responsible and see what steps could be taken to benefit and protect everyone. With the latter option, however, one had to cut down on a number of other things.

The cost controllers would not harass people. They would assure control and provide information on how money was being spent.

The idea of using doctors who were otherwise retired but still very relevant, to offer a service to the community, was hitting two birds with one stone.

Preventive care was something else the minister said he believed in. If everyone had regular checkups, it would be very cost-effective in the long run, as well as saving pain and anguish.

Turning to employment, Mr Dalli said the Employment Training Corporation (ETC) has accomplished a lot in terms of training. The idea was to prepare workers for possible future economies, which might be not as problem-free as the past ones, but one had to be prepared. The government and the Department of Labour were keeping an eye on what was happening while being careful to curb abuse.

When one analyses employment from a gender perspective, while the older generation still had a problem with female participation, the younger generations did not. Opportunities were open to both women and men.

One of the problems was a lack of flexibility. Many women choose to return to work only if it was on a part-time basis and these prospective workers should be encouraged. It was good for women to bring up their children, he said, and they should be granted flexibility to do this, while exploiting their talents.

The government's priority was to strengthen the family, and given the means, the minister noted, he would work towards that rather than building contingency plans for when this broke down. The hardest part of his job, he admitted was signing care orders.

Following a revision of the assessment method of those who apply for a disability pension, many no longer received this pension. Nowadays, the person making the decision had no contact with the patient, but relied on reports from doctors.

Referring to the rent reform, Mr Dalli said he has presented the first reading of a Bill and hoped he would be able to discuss the reform with the social partners and in Parliament.

A lengthy and serious consultation process had been carried out.

Parliamentary Secretary Joe Cassar said that once again, health was at the forefront of the government's agenda. Funds allocated for next year had gone up by €39 million, totalling a record €284 million.

It was no coincidence that Malta placed second in the Healthy Life Expectancy. The high quality health services offered here made the average life expectancy 70, whereas the EU average is 65. These confirmed that this government's direction in the health sector was good for the country.

Mater Dei is a fully-equipped hospital and results are showing: An increase of 900 operations; 4,500 outpatient appointments and 1,500 day cases, compared to the same period last year.

There were 2,400 fewer cases over the past three months referred to the emergency department.

Thanks to investment in information systems, a Picture Archiving and Communications System (PACS) to provide immediate electronic communication of X-Rays, and a Laboratory Information System to keep an electronic record of test results has been implemented. These helped to improve efficiency. A system enabling doctors to order radiology and laboratory tests from theatres and clinics was in the pipeline.

The recent action by MUMN was unjust, he said, and ultimately the patient suffered.

The waiting lists were still a problem, he admitted, but they were working hard to solve this.

With elderly persons expected to reach 22 per cent in 2025, the services for the prevention and cure of cancer had to expand. A number of initiatives, such as the €24 million allocated for the set up of a specialised treatment centre were to be implemented; €4 million would go towards works starting this year.

The decision to build this specialised centre had been revised, as a result of many consultations. It made perfect sense to have such a centre in the vicinity of the main hospital, so it could make use of its facilities, such as those of radiology. This centre would be equipped with three linear accelerators, and funds had been invested in a PET scanner, to help in the treatment. There was an application to finance the bulk of the €2 million needed for this scanner by the Swiss government.

They were also looking into the possibility of obtaining EU funding for this centre.

Thanks to the government's foresight, service tunnels leading to this site, and space for possible future expansion, had been taken into consideration. The aim was to become a centre of excellence in cancer treatment. All efforts would be made to minimise inconvenience during the building process.

Naturally the main aim was prevention, and for this reason, the government would continue to campaign against smoking, and they had even increased tax on cigarettes, as a deterrent. They would also be working with the ministries concerned, towards improving the environment.

Intensive work had been carried out on the Breast Screening Programme promised a year ago. The government was in a position to prepare for the implementation of this programme.

The apparatus at Mater Dei would continue to be used for those who needed a mammogram urgently, and for follow-up for those who had undergone treatment. In fact, 3,616 mammograms were undertaken in Mater Dei this year. Another specialist in breast operations had been employed, to beef up the department.

Two weeks ago, he said, the tender for buying Herceptin to be made available to some breast cancer patients had been issued.

The Pharmacy Of Your Choice Scheme, which distributed medicine to patients in their own community, had seen vast progress since July 2007 with the number of patients registered now standing at around 27,694.

Dr Cassar appealed to the public not to collect medicines they no longer needed to avoid waste, and said the government would be working to control this abuse. The system would be extended as planned to continue bringing the services to the people. The government had earmarked €700,000 towards this aim for next year.

Turning to the problem of obesity, especially in children, Dr Cassar said the fight had to become more aggressive as 30 per cent of children between 11 and 16 were obese. A lot had been done, and €1.2 million had been dedicated to a scheme to distribute fruit and vegetables in schools.

The problem of illegal immigrants, and their particular health needs had to be met, and cures offered, during their stay on the island. Thus, €400,000 were being invested in a reception centre for preventive and protective measures.

A new ehealth portal would be set up to inform the public on health matters and the services offered by the government.

An investment of €300,000 was being made in special programmes for further studies by medical students.

Parliamentary Secretary Mario Galea said every aspect of the Social Policy Ministry affects the quality of life.

Answering criticism levelled by Opposition speakers Mr Galea said last September 18, nurses joined the St Vincent de Paul Residence relieving the nursing pool and another eight were to follow suit. Two consultant geriatricians were employed.

On the 80 per cent single-bed requirement at private homes for the elderly, he said this was no longer the case. Minister Dalli has seen to it after the election.

The night shelter was a pilot project and would not be a public-private project. Talks with the Curia were still going on but an agreement is expected to be signed soon.

Every complaint received about homes for the elderly is investigated.

There was close coordination through the Elderly Monitoring Team made up of representatives from the different services for the elderly. The team meets on a monthly basis and was bearing fruit.

On the nurses situation at St Vincent de Paul, Mr Galea said the agreement with the union stipulated that, for every five inmates leaving the residence, only three would substitute them, thus cutting down on overcrowding and easing the burden.

But it was not right for the union to say that it only wants one new inmate for every five who left. This would create a burden at Mater Dei. Common sense must prevail.

On government homes for the elderly, Mr Galea said that there is no way that in the near future all requests would be satisfied. To meet future demand, 150 long-term beds were needed every year.

He backed a reform in the community service to provide more support so that the elderly would continue to live in the community.

Three working groups were studying how the government could provide home cures and respite services.

An old block at St Vincent de Paul was refurbished and would house 144 beds, two wards for residents suffering from dementia. Sterling University in Scotland was helping with the project and providing training.

Two new floors were being built at St Jean Antide Home at Attard providing 64 new beds. An extension of the Mtarfa home was on the drawing board.

Attention would be given to mental health patients. The Mental Health Act was a priority. Community mental health was being extended.

Stephen Spiteri (PN) said the government was focusing on primary care - a sector which he formed part of - to provide greater efficiency for patients. The government had to build on a solid basis, which could only come from this system.

More than €500 million were being given in emoluments, and this showed how serious the government was about investing in health. The government was also taking various positive steps such as using Karin Grech for patients who are recovering, instead of placing the burden on families.

A partnership with local councils, for diabetic patients who could not make their way to the health centre, was planned. The government wanted to assure primary care of a higher level, which was more efficient.

The government was also investing in a new oncology treatment centre, a PET scan service to improve cancer treatment, and the possibility for patients to travel abroad for treatment.

Turning to housing, Dr Spiteri said the government had taken various initiatives in this area, on old and new schemes. Various other projects were being planned for next year.

The authority had a project under regional development of the EU, to renovate two buildings in Cospicua, those of Verdala and St Nikola. He concluded by saying that this showed the government had a clear vision of strengthening important areas like health and housing.

Jean Pierre Farrugia (PN) said that the ETC had done a lot to help those who were unemployed. The shipyard employment scheme had interviewed 253 workers and was trying to find alternative jobs for them. The same had been done for those who worked in factories such as Bortex.

The ETC did a lot to gain recognition for its training programmes.

When it came to enforcement, the ETC also did a good job: 58 were caught claiming benefits while working, other foreigners were found out to be working without a permit while 1,850 persons who refused training opportunities missed out on benefits.

This budget, he said, had measures to curb this unemployment trap in order to close the small gap between minimum wage and benefits, such as the introduction of community work.

Some positive steps for the elderly and those with a disability included the 53 carers for dementia patients, persons with a disability no longer having to pay succession tax, and facilitators provided in private schools.

Services such as physiotherapy would be offered at home, as there was a need for an outreach of home services.

Frans Agius (PN) said this was the first budget since the introduction of the euro. It was important to have a change in mentality.

The health sector came first and foremost, and every environmental aspect mentioned in budget also impacted on health, as many of these measures benefited health.

According to EU research, Maltese people had the highest chance, not only of a long life, but of a healthy long life.

The government policy on cancer was prevention, diagnosis and treatment. The promise to strengthen screening and other prevention programmes and assuring effective medicines was positive.

It was important to educate women on the importance of mammograms. Voluntary organisations were doing a lot of good in this sector.

Turning to the elderly, Dr Agius said they were dealt very favourably in this budget and many would be benefitting from various projects. Among them was the modernisation of blocks at St Vincent de Paul.

He encouraged Mr Galea, to keep the elderly active and to invest in the quality of life of pensioners. Incentives should be put forward for those who wanted to go on working.

He could not understand, he said, how those who wished to go on working were not encouraged to do so.