There is no doubt different realities are catching up with us. Not all of our own making but some are. Some realities are major challenges and will continue to be to future generations if unaddressed. Amongst the many challenges there are the environment, pensions and ports in addition to health care reforms to mention a few. There are others some of which are rather pressing issues.
Some of the future challenges have already silently started to nibble away from national excess fat. National excess fat is a term used in private conversations. In the public domain sustainability is used. I would suggest opening up the discussion with terms that are in the grasp of the widest audience.
The term sustainable was introduced in the local context in the late 80s mainly after the dismantling of all forms of protectionism. Market forces and competition became the norm as the old market protectionism practices which supported corruption to the highest pikes were gradually dismantled.
In the previous legislature subsidiarity was also introduced with the advent of the Local Councils. Sustainability and subsidiarity changed the way we are expected to look at and address issues.
Going back to sustainability the perception that government is duty bound to provide all services either in kind or in cash to all has been attacked, though not dead, is bleeding heavily. It is not financially viable for governments to dish out what they do not collect from different revenue streams.
Sustainable, sustainability and other derivatives from the same word became used more frequently. However, at times I suspect that sustainable is the nicety to cover from telling people that they have to put their hands in their pockets to pay additional taxes for different services. Call it with you like, sustainable remains the cornerstone for present and future generations. Nothing is free. Sustainable may be well substituted by replenishing or re-filling what is being utilised, at minimum with the same amounts that is being consumed.
A number of authorities, entities, commissions, specialised teams, focus groups, are set up. Seminars, gatherings, conferences are regularly convened while specialised focused papers are penned on various challenging subjects. Some reports are commissioned for thousands of euros were and are still being commissioned. I have no doubt all with good intentions. It is the implementation of these findings which on many occasions are put in the “put away” tray on the desk of the executive, normally indexed and archived. As one would expect the implementation process may create ripples and may lead to a clash of different magnitudes between the competent authorities and those affected.
The failure from the authorities to bring on board all stakeholders will undoubtedly create more obstacles during the implementation stage. On the other hand weak authorities failing to take action based on findings at the appropriate time will undoubtedly make decisions more difficult to take in future.
It is true on many occasions, different sectors from the electorate put unbearable pressure on authorities resisting change and pushing them to refrain from taking important decisions but leadership is not about taking popular decisions and applause.
An issue which will surface is the sustainability of our health care system. On many occasions it has been rumoured that Malta’s health care system is neither as successful as it should be nor as sustainable as it must be. Prospects for major reforms in the health care system are an enormous challenge.
To achieve a successful and sustainable health care system, all stakeholders must be convinced and willing to do things differently. No single stroke will solve this problem. A successful and sustainable health care system will not be achieved by supporting prevention; it will not be achieved by comparing the effectiveness of different practices, it will not be achieved by changing the way we pay our esteemed doctors, nurses and other professional health care people and it will not be achieved by just reengineering the system, it will not be achieved by championing competition, It requires all these changes and more. We need clear thinking, determination, a clear strategy and above all an implementation schedule.
Presently many would be enjoying their summer holidays and the political appetite for major challenges in the health care sector are not there. Unfortunately, for the taxpayer unless major issues in the health care sector are not addressed the health care system performance in Malta will deteriorate.
The health care reform primarily should take into account the needs of the patient with timely and efficient care. A sustainable health care system should recognize the efforts of the taxpayers. The only morally and politically correct way to improve the performance of the health care system is through getting more value for every euro spent.
Sometimes analysts and reformers would stress a particular idea as the key to reform success leaving by the way side what in their opinion is not important. In the past, on many occasions this has proved to be a recipe for disaster.
Finally, the championing of a sustainable health care system reform should be provoked by the stake-holders in which case a Health Care Works Council should be set-up under the auspices of the Health and Finance Ministries. Ownership of the health care reform should be owned by the practitioners and managed by competent authorities.
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