On 10 and 11 May of last year, Zammit Clapp Hospital closed its doors and all services migrated to Rehabilitation Hospital Karin Grech (RHKG). All services, which had been split between two sites, were to be, from then onwards, delivered from one place, RHKG. What does this migration actually mean to the general public?
First of all, what does the word rehabilitation mean? Rehabilitation is a specialty concerned with the prevention, diagnosis and management of people with disabling conditions and co-morbidity across all ages. Following the management of various pathologies and events, such as stroke, amputation, or trauma, rehabilitation involves managing a patient through the contribution of members of an interdisciplinary team. Together, the team comprehensively engages in trying to ensure the maximal recovery of a patient, to maximise one’s potential and to re-integrate him or her back into the community accordingly, away from acute and residential care services.
Was this new to the context of Malta? No, it is not because in 1991 a geriatric department was set up in order to deal with problems specifically related with the elderly including their rehabilitation. So, since 1991, patients above the age of 60 years have been offered optimal geriatric care including rehabilitation at Zammit Clapp Hospital. The succes of this initiative has been directly witnessed by many members of public across the decades.
However, despite the success of this initiative the provision of care to patients needing rehabilitation, remained a significant challenge. Where was the patient who is younger than 60 years of age to receive rehabilitation? The unfavourable scenario of having the under 60-year-old patient, who was not able of going home, obliged to remain within the acute care services, until they were able to be independent enough to go home, increased over the years. This scenario falls short of the efficient use of acute care setting beds, and indeed moreover, it falls short of addressing the right of young patients for optimal rehabilitation. There is general consensus that the latter may not be provided through the acute care setting for various reasons.
When Mater Dei Hospital was opened in November 2007, some wards in Karin Grech Hospital were refurbished, and accommodated elderly patients. In addition, one ward in RHKG started to accommodate patients under the age of 60 years, who needed rehabilitation. The establishment of this rehab ward has marked a milestone in the development of the provision of rehabilitation services in Malta.
The scope of this new ward was to widen the field of national rehabilitation services to that which it should be, that is, encompassing patients of all ages. As with any other initiatives and changes, this “new” expanded and widened concept of rehabilitation across all ages, needed to be explained and subsequently endorsed by the general public, and indeed also by the service providers, the health and social care workforce included. This was no small order, but one may now note significant acknowledgement to the concept of new non-geriatric in-patient rehabilitation.
The Rehabilitation Hospital Karin Grech now seeks to cater for all the rehabilitation needs of patients with various pathologies, both on an in-patient and out-patient basis, and from the age of 16 upwards, thus offering a wider service in this respect. This extended and expanded remit of service is possible through the engagement in the last few years of more consultant geriatricians, a consultant in rehabilitation medicine and various other professionals with relevant expertise.
Much effort is being channeled towards moving away from the perception that the Rehabilitation Hospital offers largely long-term care to patients awaiting to be admitted to residential care services for the elderly. The message is loud and clear: The Rehabilitation Hospital seeks to rehabilitate the patient, and the goal is NOT to exclusively provide care, simply until residential care services may accommodate the patient. Surely some patients may nonetheless need to be admitted to a residential home following a period of rehabilitation services provision.
The integration and extension of the rehabilitation services into the newly established Rehabilitation Hospital Karin Grech, will hopefully continue to translate into, not only the continuation of excellent service provision that Zammit Clapp Hospital sought to provide to the elderly, but the development of comprehensive hub of rehabilitation services, comprising the development of extensive in- and out-patient services, paralleled with outreach and community services, for all adults, of all ages.
The work on the premises at RHKG continues to roll. As I write, two additional wards will start to receive patients. Given these two additional wards, the number of beds for rehab patients will continue to rise. Work is in progress to complete shortly the premises for another 50 beds within the hospital. This is surely an achievement we all take pride in. Nonetheless we know, we are indeed fully aware, that there are various other aspects, beyond the bed count and ward environments, which we need to augment. I am here referring to the premises of the services provided to rehab patients, the physiotherapy facilities, the OT and so on.
I would like to assure all, that indeed all are on our mind, all are in our plan. We all wish that everything rolls out faster. I wish to make it known that we are doing our best to make all services roll as fast as possible – it is our duty to do so. We will seek to continue to do our duty as government as best we can but we appeal to all to support us by responding to their respective duty too – as children, brothers, sisters, friends, as workers, as professionals. I trust we will get there and have our rehab patients receive the rehab care they deserve soon enough...
Dr Joe Cassar is Health Minister