From Prof. J. A. Muscat

Please allow me to dwell a little on such matters as post-graduate medical specialisation, the brain drain, long hospital waiting lists, and so on. These subjects may seem unconnected at first but a little thought should show that they are related.

One can start from the fact that although we are a small country with limited natural resources, our history, tradition and overall human resources are such that explain and justify high expectations where a public medical service is concerned.

We have a fine, modern, general teaching hospital, we have a medical school that goes back some 400 years and today a Medical Faculty at university that is flourishing, and we are rightly proud of a body of medical specialists that have reached a standard of service matching any in the Western world.

As a result, our people naturally expect a national health service of the highest order. These expectations however are often not being met.

To begin with, take the postgraduate medical training and specialisation. The Faculty of Medicine and Surgery working in close liaison with the specialty associations and with overseas institutions is performing well, providing hands-on programmes of training leading to appropriate accreditation both here and abroad. These programmes also contain incentives for young doctors to continue giving their service to their country both as specialists in training and as fully-fledged consultants. Periods of service in prestigious hospitals in Europe and North America form part of these programmes. As has been said, the availability of top training posts abroad is crucial; these are best procured by the relationships that exist between our senior members of Faculty and Specialist Associations, and corresponding senior figures in medical bodies abroad. The Department of Health can best help by endorsing assignments and underwriting the periodical hospitality we would extend to such personalities from time to time.

The idea has been mooted that a local Medical Academy be set up that would incorporate the Faculty of Medicine, the Specialist Associations together with the Department of Health, as a statutory body having as its main objective post graduate medical training, specialisation and continuing medical education for our doctors.

The idea certainly deserves further study and discussion, and a focus group from the local medical fraternity to look into and come up with a preliminary report is suggested.

One needs to be convinced at the outset of the need to create such a bureaucratic structure and to be aware of the problems inherent when trying to bring together such a motley group of professional entities to best promote postgraduate training and CME.

The number of specialist associations has grown every so often and it may be opportune to set up a federation of specialists associations as a first step.

Certainly, our ‘medical trade unions’ should be kept out of it.

What are generally considered the most urgent and intractable problem besetting our public hospital service are our unduly long waiting lists.

To have to wait for a service is an indication that the service is in demand and is worth waiting for. Therefore, hospital waiting lists are inevitable when the services it offers are of good standard. It is when these lists keep getting bigger and lead to an unduly long period of waiting time and have an impact on the quality of life of the community that the situation becomes unacceptable.

Dr Karl Chircop, the Labour shadow minister for health has recently published figures, which show that the waiting lists for operations shot up to 18,900 in 2008 from 4500 in 1998. This surely demands a more detailed explanation than that given by MAM’s general secretary in a recent letter to the press (ToM, 21 July), when he offered the usual general explanations of increase in population, ageing population, and so on.

MAM of course is not responsible for the local NHS and the explanations should come from the ex-Minister responsible. We know what the present Minister thinks of our waiting lists today and we appreciate that the problem is far from simple. But however complex the subject one cannot go on evading the issue, treating it as if it were a top military secret, or one of such little import as to deserve to be ignored, or swept under the carpet.

Prior to the recent general election, the Malta Labour Party came out in the open and proposed measures (which included a definite financial commitment) to address the problem. MAM’s general secretary in his letter mentioned above also called for increased investment in our NHS.

It is apparent to most that basically it is financial constraints on the part of the administration that is keeping it from alleviating the problem, due to its reluctance to find and employ more medical, nursing and paramedical personnel to get the idle operating theatres at Mater Dei working.

The government is caught between delivering a ‘state-of-the-art’ service, a completely free health service and a balanced budget and, being a human institution, it cannot perform miracles. It has quietly chosen for a ‘not so state-of-the-art’ but free health service.

This may be good politics for the time being but will ultimately tell on the rating of the ruling party at the next election.

J. A. Muscat

TA’ XBIEX