Not accidental but certainly an emergency

Accidents and emergencies, accusations and counter-accusations. It is a tragedy of tremendous import in the health service driven by incompetence, political opportunism and laissez-faire.

The Accidents and Emergency Department at Mater Dei Hospital is constantly flooded with patients and in winter this tide increases, a predictable phenomenon but one to which the Health Department seems oblivious to.

Matters continue to deteriorate, with a 9.3 per cent increase in patients attending Emergency in December and January over the same period last year. Almost a third were not emergency cases and could have been dealt with by a general practitioner or at a health centre.

Overcrowding at Emergency also occurs because of bed shortages in the hospital, which delays transfers of admitted patients from Emergency to the wards. Patients, therefore, end up being cared for in corridors.

One of the strategies proposed was that patients would be transferred from Mater Dei to Karin Grech Hospital for rehabilitation, thereby creating bed space at Mater Dei but this is not succeeding in coping with the load at Mater Dei.

The wisdom of building a larger hospital with fewer beds in the setting of an ageing population has often been questioned, including by this newspaper.

The hospital appears to be in denial with its CEO lately saying that the Emergency Department and the hospital overall were coping. He was more realistic when he noted that the health system set-up in place is unsustainable. This had the two main political parties falling over each other to publicly declare that the health service will never charge any sort of fees whatsoever.

A recent directive instructs Emergency to send to health centres those people who inappropriately turn up with minor complaints or do not have a doctor’s referral. The new policy is in force between Mondays and Fridays from 8 a.m. to 5 p.m. The pressure may be eased and waiting time cut as a result. But what will happen after 5 p.m., over the weekend and on public holidays? There are few GPs available after hours and too few health centres are available, with limited opening hours too.

The Health Minister has been criticised for blaming hospital overcrowding issues on everyone but himself, an accusation that could be addressed at many levels in the health care system. This is because these problems had been predicted by many individuals, notably doctors, by the Medical Association of Malta, the doctors’ union, and by other quarters too.

However, such sound advice or warning, call it what you will, was disregarded by the health authorities and the problems that were anticipated were not dealt with.

Mater Dei, notwithstanding the area it covers and irrespective of the excellent service offered, has too few beds, a matter of poor planning – or political pique – given the cost of the edifice.

An extension of some kind that increases the number of beds, onsite or elsewhere, is inevitable and necessary. Failing that, other sites, such as the old Karin Grech and St Luke’s Hospital sites must be refurbished to take on stronger rehabilitation roles. This county’s bed capacity must increase.

Equally important, primary care services such as health centres should be strengthened and GPs should be encouraged to be more available through group practices.

Unfortunately, both of these courses of action require hard cash, hence, the state’s reluctance to more than dance around these issues and hope that they will go away or be dealt with by others if there is a change in government.