The doctors' union will not be ordering industrial action "in the immediate future" although it has been authorised by members to take any action necessary to safeguard their interests.

"We are not contemplating any action in the immediate future. It is unlikely we will issue directives in the coming two to three weeks," the president of the Medical Association of Malta, Martin Balzan said. He said it was still premature to say what directives the association would be issuing if things had to reach that point.

During an extraordinary general meeting on Tuesday evening, doctors approved a resolution listing a number of grave problems in the health sector.

Contacted yesterday, Dr Balzan said one of the major problems was the 100-odd social cases blocking beds in hospital, putting added pressure on the Emergency Department. "Some patients who need to be admitted to hospital end up spending up to 12 hours at Emergency while the staff looks for beds for them," he said.

The resolution said doctors were working under "very difficult and dangerous conditions" because of the shortage of beds, which meant the Day Care Unit could not be utilised for day surgery and the Emergency Department often functioned as a ward with patients sleeping there overnight.

It said the lack of medical manpower and an ever-increasing demand for medical services, doctors at the Emergency Department and health centres continued to face large numbers of patients. Consequently, many doctors were compelled to work very long hours.

It said the association acknowledged the authorities' efforts, in particular those of Health Parliamentary Secretary Joe Cassar, to introduce the foundation programme for newly-graduated doctors and to continue the implementation of structured post-graduate training in an attempt to retain more medical graduates in Malta.

But the association was still disappointed that a number of points in the agreement signed with the government almost two years ago were not yet being implemented.

It said no designate consultant posts had been issued, all public health posts had been blocked while doctors working at the anti-drug agency Sedqa had not had their collective agreement updated.

"The lack of career progression is sending a very negative message to young doctors with the result that the medical manpower shortage may get worse," the motion said.

The government explained yesterday that the available bed capacity at Mater Dei Hospital was dependant on many factors affected by changing demography, more effective health care and a changing culture of family commitment to the elderly. It was working on increasing the capacity of long-term care beds to reflect the increased demand for such a service. Proper bed management by all stakeholders at Mater Dei had also to be ensured.

The Ministry for Social Policy said it remained committed to provide the required opportunities wherein training could occur. The new Foundation Programme was due to be inaugurated on July 13.

The government said it was also committed towards offering a structured career pathway for doctors and, last March, agreed with the MAM on the manner in which designate consultant posts should be issued. These posts, it explained, were due to be issued within the coming weeks. Furthermore, there were 29 HST posts being processed and the other 41 posts mentioned by the MAM were under the consideration of the Ministry for Finance, Economy and Investment and the Office of the Prime Minister. "Hence, there is absolutely no validity in the argument of lack of career progression."

The ministry said it recognised the importance attached to the speciality of public health and was reviewing various public health positions in relation to other administrative posts within the ministry.

There was the need to validate the job plans for 2009 against 2008 clinical performance benchmarks in order to confirm that the public was getting value for money from the health service investment. These evaluations would continue in line with the agreement between the government-and the MAM, it said.

With regard to providing improved access for private family doctors to public health service investigations, the government said this was already being intimated as part of the overall reform for primary health care.