Disorganisation and staff shortages at community health centres were contributing to “avoidable” deaths, according to the Medical Association of Malta.
The doctors’ union’s general secretary, Martin Balzan, told the Times of Malta long patient waiting times in health centres were leading to people either remaining undiagnosed or being funnelled to the State hospital.
“The situation at the health centres is one of disorganisation, mismanagement and understaffing. The result is that patients who could be diagnosed by general practitioners there are often not,” Dr Balzan said.
He was reacting to a report by the EU’s statistical office which found that two out of every five deaths in Malta could have been avoided in the light of medical knowledge and available technology.
The report, published earlier this week, found there were 476 such deaths in Malta in 2013, that is, 42 per cent of the dead. Malta’s “avoidable death rate” was significantly higher than the European average of 33.7 per cent.
According to the report, the term “avoidable deaths” means those that would not have occurred had there been more effective public health and medical interventions in place.
Dr Balzan, a veteran respiratory physician, said only one out of every 10 chronically ill patients should be referred from health clinics to Mater Dei Hospital. The actual figure, however, was much higher as community care was often inadequate.
The MAM has registered an industrial dispute with the health authorities over a number of issues at the clinics, chiefly related to understaffing.
Dr Balzan said about 15 doctors had stopped working in public clinics since 2013 and had not been replaced, nor had any new doctors been engaged. Demand, on the other hand, was increasing.
“The reality is that more people are visiting such clinics and doctors were under even more pressure to see more patients. But, there are fewer doctors to do so,” he said.
The staff shortage problem was mainly due to a legal dispute over a 2012 call for doctors that was deemed to be in breach of their collective agreement.
Meanwhile, Dr Balzan said the clinics were not being properly managed. “We have ill patients waiting to get diagnosed by doctors in the same queue as others who only need doctors’ signatures. The result is excessive waiting lists which people aren’t prepared to sit through,” Dr Balzan said.
He said he hoped the industrial dispute would lead to more doctors being employed this summer. In the medium term, however, the MAM is calling for a comprehensive rethink of the way community clinics operate.
“Most of the diagnosis work and treatment of chronic illness can and should be handled by general practitioners and not at hospital level. We need to shift this back to improve the situation,” he said.
In the statistical report, Eastern European countries topped the list, with Romania having the highest avoidable mortality rate at 49.4 per cent. Malta was ranked in seventh place, whereas France had the lowest rate, with 23.8 per cent.
Health Minister Chris Fearne said the government acknowledged the importance of primary care. Over the last three years, efforts to increase services and upgrade health centres had been ongoing, he said.
Mr Fearne said new speciality clinics – including cardiology and diabetes services – had been introduced, new equipment installed and opening times in some clinics extended. Lifestyle clinics had also been introduced in 13 centres.
Human resource levels were also being looked at. Mr Fearne said he planned to add 20 new doctors to the primary care service this year.
Turning to MAM’s concerns, he said the Eurostat figures referred to were three years old. “We believe that, with the ongoing improvements in primary care service and with the dedication of our family doctors, these figures will improve,” he said.