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Dalli on changes in health service

Social Policy Minister John Dalli said yesterday in Parliament that one of the reasons to which he attributed the current shortage of doctors was the fact that the university entry platform for the medical course was too high, certainly higher than that for any other profession. Accessibility to learning should be more open, so that the number of medical students would remain constant or even go up.

Another problem was that last year the UK had changed the qualification parameters for doctors' specialisation, to the effect that they must follow their post-graduate courses in UK. This invariably meant that graduates headed for UK as soon as possible to complete their post-graduate studies.

Mr Dalli, who was answering a supplementary parliamentary question by Labour MP Noel Farrugia, said he had had talks with the British High Commissioner on the problem. Only last month, about those talks and the resultant agreement, a foundation course was opened to allow graduates to follow specialisation here and still be recognised by the UK. Out of 22 doctors who had graduated in 2008, only five had still decided to do post-graduate studies in the UK.

Going on to the present malaise with the Medical Association of Malta, Mr Dalli said the government maintained that the utilisation of professional personnel - not just doctors - should always be closely analysed.

It was true that at certain times, especially in the afternoons, there were not enough doctors to adequately service the needs of health centres, even liberally allowing 15 minutes for each patient. On the other hand, the number of doctors at night in health centres were triple the requirements, showing the need for better utilisation of human resources.

This, Mr Dalli said, was the crux of the current problems. The health service must be manned according to patients', not the care giver's needs.

There was a similar problem regarding pharmacists. It should not take a qualified pharmacist to pack pills into containers and label them. Nor should qualified nurses be utilised as clerks, with allowances for doing clerical work.

These practices must change for the sustainability of the health sector, said Mr Dalli. Nobody could define the word "free", yet the demand for free health services was growing every day. With the ongoing changes in techniques and technology, the delivery of health services needed to change, and people should be taught about these aspects.

It was very important to better organise delivery structures to ensure a better health service. Asked by Mr Farrugia if the government had a time frame to address these issues, Mr Dalli said they were already being addressed. Once guidelines had been adopted, they would be filtered through intensive dialogue with the people and stakeholders.

Mr Dalli said he believed profoundly in dialogue and change. The value of this had recently been seen in the favourable outcome of the rent law reforms in the House standing committee for the consideration of Bills.

Rather than being confrontational, he had gone for dialogue and consensus, and the Bill had been agreed to.

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Comments

John Schembri (on 28/5/09)
Minister Dalli is the only person in the current administration worthy of trust. The only person trying to reform a service in the true interest of the public, from within, without disputable contracts awarded on the side. The only person to whom dialogue really means something, not just lip service. The rest, especially the PM, have lost all credibility. This is valuable work, even if some of it may be unpleasant. Keep it up. Wish there were more of the likes of you around.
Joe Galea (on 28/5/09)
To those who are still having tantrums about that 50c which was introduced, let me tell you this. With that 50c, those who needed medicine could find it always in time. Now without this doom of 50c, those who need medicines have to go and buy them themselves as most of the times their needed medicines are out of stock. Moreover, the 50c was a slight deterrant for those who abuse the system by taking medicines which they are entitled for but they don't really need them, ending up in many medicines being wasted. So all those blue eyed elves trying to cover all the Gonzi blunders by reverting to this issue, they are just showing how shallow minded they are. If you start thinking outside your blue box, you will start making sense.
Joe Galea (on 28/5/09)
What Dalli is proposing is very dangerous. In medicine is not quantity that counts but quality. The Medical profession deals with lives of human beings not with machines or numbers. So making the course more accessible to everyone is not the solution to our medical problem. There are more realistic solutions than this stupidity. Some of these solutions were proposed by the PL. Obviously there are far more others.
Dr. Savior Tortell Pisani (on 28/5/09)
This is NONSENSE! Does Minister Dalli understand the implications of what he is saying? Should we begin solving our staffing problems by lowering quality? Is this the vision that we intend to adopt for our University product? Do we want to convert the University into another politically convenient sausage factory?...much like MCAST has become....We must not fall into the trap of trading quality for quantity...

At MCAST, we are recklessly accepting students (and I know first hand!) from too wide a spectrum.....Most are clearly much less apt or interested in learning than one would wish. The worrying part is that the *entire* system is utterly incapable and UNWILLING to distinguish between those that are genuinely learning from those that are there merely for the stipend!

Standards have literally fallen through the floor! Examinations are few and far between! Ethical academic behaviour is nonexistent with students freely plagiarizing each other's work and refusing all forms of higher thought. And all this is *CONDONED* by senior management rendering lecturers powerless! The decree comes from high above! All students MUST graduate irrespective of quality!!!...Numbers..Numbers!.Numbers!! and *NOTHING* else matters!!......I pity their future Employers!
Anthony Magri (on 27/5/09)
This is something new. The Minister for Social Services who is not a Medical Doctor wants to lower the standard of Students taking the course. Standards are increasing everywhere not decreasing. Do not even mention it again Hon. Minister. Our health is in the hands of medical doctors, the more they are competent the more our health is taken care of. If their standard is lowered so is lowered the standard of our well being.
The life of the citizens is in the hands of efficient Medical Doctors, and Civil Engineers.
The first to keep us in good health, the others to provide us with a safe lodging.
Silvan Azzopardi (on 27/5/09)
Lowering entry requirements for admission to MD is an irrational suggestion for at least two reasons. There is a limit to the number of clinical students MDH can accomodate in a set up where doctor to student to patient ratios has to be kept at reasonable levels so as to ensure high quality teaching.
Numerus clausus has ensured small numbers with high quality, lowering the admission criteria risks lowering standards to the profession and the service it delivers.
The shortage of doctors is due to poor planning, poor work conditions but more over due to limited opportunities for career progression





Michael Seychell (on 27/5/09)
John Dalli nhux wiehed li joqghod jomod dak li jkun ser jghid.

Jidher car dak li qal Dalli irid jiftiehem fil-kuntest li ghalkemm ilkoll kemm ahna ngjhidu li s-Sahha hija bxej f'Malta, irridu niftakru li l;-haddiema kolljha f'dan is-settur bjhall kull settur iehor governattiv, jithallsu mit-Taxxi taghna, ui kif qal xi hadd tajjeb fil-kumment tieghu konna diga zidna il VAT minhabba is-Sahha. Finalment jekk dik iz-zieda hix qed tmur direttament fuq is-Sahha jew fuq dipartimenti ohra ma jaghmilx differenza, ghax jekk permezz ta' ziedf fil-VAT qed jithallsu haddiema ohra u dan ma jibqax isir, xorta wahda irridu nsibu kif u minn fejn jitthallsu dawk il-haddiema.

Minbarra l-pagi hemm hafna spejjes ohra inklus manteniment u xiri ta apparat mediku biex jibqa jkollna l-ahjar kura ta' sahhitna, anke jekk dan forsi ndumu ma niehduh, ghax ikun hemm minn ghandu urgenza aktar minnha, u jew ghax ghad hemm problemi ta' nuqqas ta staff.

Li hu zguir Il-Gvern ma hux fi hsiebu li jintroduci hlas ghs-sahha. Nittama li meta Dr. Muscat isir Prim Ministru ma jiehux il-Pariri tal-Profs Scicluna kif kien jaghmel Sant, peress li dan il-Professur ta' l-ekonomija jemmen li ls-Sahha f'Malta ma ghandiex tibqa bxejn.
Charles Zammit (on 27/5/09)
So the Hon Minister thinks that by lowering the level of competency of our doctors he would be enhancing the medical service in Malta!! How about that for consistency? Perhps he is of the opinion that we should start visiting an electrician or a mechanic instead of a doctor.

No Mr. minister if changes have to be made its not in the level of competency and ability of our doctors (unless some hopeful wants to join the medicine course and his/her qualifications do not satisfy current entry requirements). The changes that need to be made are at ministerial level.

Arrogance has once again manifested itself in ministerial incompetence.

Hey guys is it not obvioos where changes need to be done?
A BEzzina (on 27/5/09)
Does Mr Dalli know what the MD course entails. If he lowers the entry requirements he will have to lower the level of the MD course. With Grade A and Grade B students still find it very tough. Imagine what lower grade students would do.
Joseph Agius (on 27/5/09)
Isn't it Prof Edward Scicluna who wants us to pay for Health??....I heard him with my own ears.....and it was not taken out of context cause I went to listen to the whole interview!!!!!!!....so is PL going to make people pay for Health?? That is the question!
KCaruana (on 27/5/09)
More medical students won't solve the problem Dalli - it's only when the attitude in this sentence: "The health service must be manned according to patients', not the care giver's needs." is put stright that maybe doctors as service renders and fellow human beings will be recognised and respected, treated and renumerated accordingly.
Why does the most skilled person (i.e. doctor) have to do lesser tasks like phlebotomy, taking the doctor's time away from patients? Why do in-patient investigations have no allocated slots in the daily schedule but need to begged and grovelled for?!
Please - there's more wrong with the health care system than people leaving for postgraduate training (although that is a major part and won't be addressed soon enough and in all departments apparently)
J Spiteri (on 27/5/09)
edwin formosa
"Dak li qed jghid Muscat kien qalu Sant is-sena l-ohra u ma sehhx." (???????!!!!!!!!!!!) What Muscat, and what Sant, Mr. Formosa??
Maybe you need to re-read the article with another pair of glasses having clear lenses, rather than blue ones!
If my computer reads like yours, the article deals about a speech forwarded by Mr. John Dalli, and NOT by any Muscat or Sant. And if I read correctly, Mr Dalli is being much more clear in his explanations and much more credible than Lawrence Gonzi, our Prime Minister!!!!!! I guess the prime minister wants to lose his credibility once for always as I must say: "Qed jaghzaq wahdu!"

Lawrence Gonzi must understand that he is occupying the role of a prime minister and not of a lawyer at present! So beating around the bush makes no sense in his words! Monday I pitied him during this debate with Joseph Muscat! He's swallowing back his own words and his own lies!
A.Borg (on 27/5/09)
Means testing has been mentioned as a possible solution to choose who should be getting free health service. A very dangerous precedent. There will still be those who get away with it. I mean those who by fair means or foul are milking the social services dry yet drive around with a couple of cars and are able to paint the facade of their homes although boarded out will still be getting everthing free while the honest tax-paying citizen will have to fork out for medical treatment to his family.
Paul Busuttil (on 27/5/09)
edwin formosa jidher li mhux jghix f'dinja. Nesa li certu medicini diga mhux qed jinstabu u qed inhallsu ghalihom, u Dalli qed jghid li s sahha mhux ha tibqa b'xejn filwaqt li Gonzi qed jghid li ha tibqa, tnejn mill istess partit u jmeru lil xulxin. U mbaghad jigi bniedem bhal edwin formosa u jipprova jaghtina l impressjoni li Dr Sant u Dr Muscat qed ihawwdu. Ejja ghid li mhux brainwashed ta ukoll!
Roberto Vella (on 27/5/09)
@edwin formosa
allura skond int ghandna nikkunslaw u naccettaw li nibdew inhallsu minn imnehirna semplicement ghax Sant kien dahhal 50c? Ragunar impekkabli...hasra li mhux qed tinkludi wkoll it-3% VAT (over and above the original 15%) li ilna nhallsu zmien twil issa u li suppost kellha tmur biex tiffinanzja s-sahha. Tghid dik tiswa daqs 50c sur Formosa? Ma nahsibx hux!

Sejjah l-affarijiet kif inhuma u mhux thalli l-ghamad partiggjan tieghek inaqqaslek l-oggettivita! il-50c kienet hazina...imma din x'inhi? le zomm, konvint li ser tghidli li din serjeta, tmexxija soda...naqr'ohra manna mis-sema wkoll. U hallina tirdx
Joseph E Briffa (on 27/5/09)
Medicine and surgery is a tough course, only engineering is tougher because the latter incorporates more maths and physics. It is only natural therefore that students going in for medicine and surgery, and engineering are expected to have high grades in the natural sciences (and maths for the latter) than those reading other subjects, like languages, law, accounts. Students with low A-level grades in natural sciences would find it extremely hard when it comes to Physiology and Bio Chemistry, Human Anatomy etc. So we have to be very careful not to lower the requirements for Medicine. We are dealing with human beings here. We should not compromise quality to achieve quantity.
Galea. L (on 27/5/09)
edwin formosa
Ir-rapport tal-Gvern stess igiddeb dak li qed tghid edwin.
Lil Gonzi HADD ma ghadu jafdah ghax kull ma jghid kollox jaghmel il-kuntrarju malli tghaddi l-okkazjoni.
edwin formosa (on 27/5/09)
Serrah rasek Sur Roberto. Dak li qed jghid Muscat kien qalu Sant is-sena l-ohra u ma sehhx. Li sehh tassew kien il-bidu tal-hlas tal-medicini mill-ispizerija tal-Gvern. U, forsi nsejt, kien Sant mhux Gonzi
Joe Grech (on 27/5/09)
Minister Dalli laments ''that one of the reasons to which he attributed the current shortage of doctors was the fact that the university entry platform for the medical course was too high, certainly higher than that for any other profession.'' Hopefully this Minister will not attempt to lower University entrance requirements for the Medical Course! That will certainly be a BIG mistake. People's health should come before the problems connected with the shortage of doctors! Our University churns out graduates by the thousands. Can it truthfully be said that all turn out to be as efficient as the public desires? But the public needs really competent doctors and lowering the University requirements to make it possible for MORE to join the M.D. course will risk having quasi- incompetents becoming M.D.s. That much should be avoided at all costs.
The relecant University authorities are well advised to resist any pressure from Minister Dalli / the government to reduce the entry requirements to the M.D. Course Their chief concern should be not to lower the course standards. It is up to the government to put into place conditions that will ensure the presence of doctors in our hospitals!
mario gellel (on 27/5/09)
Mr Dalli,how can you define the word FREE concerning healthcare if not by change it to
PAYABLE.Maybe you should explain it to prime gonzi.
E Zammit (on 27/5/09)
Yet another case of contradicting statements by a Minister and the Gonzi!!
The message by John Dalli is very clear...Gonzi will put an end to free health care!

Now will Gonzi insist that even Dalli is trying to deceive and politicise health?

Or is it the case that yet again gonzi is being economical with the truth?

The report published by PL is clear...payment for health care is on the cards...Gonzi is once again twisting the truth...he has lost control of everything and has no clue what is going.

Gonzi just cannot be trusted! Gonzi's word counts for nothing - hunters, GO workers, dockyards, Sea Malta, teachers, doctors, nurses .... whats next?
Michael Tabone (on 27/5/09)

Minister Dalli is clearly saying that the delivery of health services needed to change and that nobody could define the word "free". What will Gonzi say now? That there will be another meaning to the word "free". For the normal people, free means that they do not have to directly pay for the health services they receive in hospital or clinics. Such services are paid indirectly through taxation and VAT collection.

Did not Mr Dalli (as Minister of Finance) once increase VAT from 15 to 18 percent simply to subsidize the increased cost in health services? Where did the 3 percent increase in VAT go? Where has the Gonzi government been spending this VAT revenue? On health or on other services? Could Gonzi or Dalli please explain? How many more taxes do we need to impose on the people?
Andrew Camilleri (on 27/5/09)
What is the minister going on about? This year there are 103 1st year medical students. Is that not enough?!
Samuel Scicluna (on 27/5/09)
The entry qualifications for the medical course is not 'too high', I'm afraid. You can sow the seed if you want, but you need good soil for it to grow. If you want more people in the course, then make sure the sixth form teaching bettered, as opposed to worsening the level of the average entrant.

And besides: the medical course can only take so many people. The faculty is clamouring for a numerus clausus, and the minister wants to widen the floodgates! Moreover, any increase in the number of doctors from THIS course of action will take 7 years to come to fruition (more, if you take into account time needed for specialisation).

More seriousness, please.
Roberto Vella (on 27/5/09)
Unfortunately, yet another case of contrasting statements by a senior minister and the PM.
The message being given by Hon Dalli is clear. Free health care will stop.

Will Dr Gonzi insist that even Dalli is trying to deceive and politicise health? Or is it more the case that yet again Dr Gonzi is being economical with the truth?

The report published by the PL is clear...payment for health care is on the cards and has been confirmed by Minister Dalli. Sadly the PM has either lost control and does not know what is going on or else he is twisting facts in which case he just cannot be trusted.

Let the people decide and give their answer on the 6th of June
Mario Tabone-Vassallo (on 27/5/09)
Bir-rispett kollu ghall-On Dalli, nahseb li kulhadd irid l-ahjar nies jehdulu hsieb hajtu. Il-problema mhux li ma jilhqux bizzejjed tobba, izda li ma nzommuhomx maghna. Fejn sirna nisfurnaw lawrji qieshom pastizzi [u tajbin ghal sahhitna daqshom] fis-suggetti l-ohra, issa ser ngharrqu l-Medicina wkoll li dejjem harget il-Malta ta’ nies tul 400sena?

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