The foreign nurses who have found themselves in “legal limbo” owing to a bureaucratic oversight have been regularized, Charlotte Sant Portanier, the Chief Executive Officer of Healthmark, one of the largest private contractors in the healthcare sector which outsources staff provision has said.
Sant Portanier was responding to issues raised by Patricia Graham, the leader of the ‘EU Nationals Advisory’ lobby group in Malta, which represents residents seeking assistance with utility bills, tenancy issues, and obtaining documents. Graham claims many Third Country National (TCN) nurses were employed “illegally” through no fault of their own in the country, amongst other problems facing the healthcare sector.
There were certain “TCN nurses who have no work permits or residency cards yet tax and social security are being deducted from their salary,” Graham had previously told The Malta Independent. “And this isn’t just affecting nurses at Mater Dei, but also nurses and carers in many of our residential care homes.”
This problem arose, Sant Portanier said, because most workers coming from Nepal, India, the Philippines, and Bangladesh are initially employed as carers and after following the required courses, some are promoted to nurses. But this means they need to be employed by a different company structure which requires a fresh work permit application with Identity Malta.
Any delays to this process could result in nurses finding themselves in legal limbo. Sometimes workers have incomplete paperwork, sometimes there are bottlenecks within Healthmark, and sometimes the authorities take long to vet the applications, while the immediate demand for nurses on the ground keeps becoming more urgent.
A Times of Malta article published on the 23 April had previously stated that there were 26 nurses stuck in this situation at Healthmark, and when asked what can realistically be done to tackle this problem, Sant Portanier said the situation had since been resolved and steps have been taken to reduce any delays in procedures to ensure no staff members are left in this position again.
“In Healthmark, there are no employees who are currently stuck in this limbo. Out of a total of 3,800 employees employed by the company, there were 26 individuals in that situation last month but through improvements to the bureaucratic system, we have regularized every single individual working for us.”
“We have seen massive improvements in the Identity Malta process, especially in terms of digitalization and visibility. Neither Healthmark nor Identity Malta are optimal, and we need to keep improving the efficiency of these systems, but I'm happy to share that this is a problem that has been overcome.”
Sant Portanier also denied that she ever heard about employees being threatened to not speak out - a claim Graham had made, when she said the nurses fear an EU-wide ban.
Another issue which Sant Portanier addressed concerned the issue of why some nurses, after being told that they’ll work on a public holiday, which entitles them to triple pay, are later told their shift has been replaced.
Sant Portanier said that it is her company's responsibility to prepare enough workers that government estimates it will need. But sometimes, especially on Sundays and public holidays, fewer people visit the hospitals and so the government requests fewer workers.
“Healthmark has no interest in telling workers they will be needed if they are not needed,” she said.
Global Issues
The current situation in Malta, and in the Western world more generally, is leading to the massive influx of foreign workers in the healthcare sector. “The truth is that Malta and its infrastructure is growing, we have an aging population, and our nursing schools are not producing enough nurses to meet the local demand. We have no option but to employ a foreign workforce to serve the needs of the healthcare system,” Sant Portanier said.
“It is an acknowledged problem that these nurses are being competed for by most Western countries, including Australia, New Zealand, Canada, the UK, the Netherlands and Germany,” she continued, as these countries are also struggling to meet their respective demands.
“You realise how serious this situation is when you see recruiters for the UK National Health Services come to Malta to hold open days to tap into Malta's comparatively small nurse workforce,” Sant Portanier said, adding that some foreign workers are now using Malta as a stepping stone
A foreign workforce comes with certain challenges, including the need for training for clinical and knowledge gaps, cultural difference and language barriers. Some staff also face difficulties being accepted by the community, she said.
Sant Portanier said “the problem that we’re facing is a geographical, political, and economical one and in order to solve it, you need the collaboration and input of key people from both private and public entities.”
When asked whether she believed that this was a much bigger problem than HealthMark can solve alone, Sant Portanier said “100 percent. This is not a question of fault or blame, we need to look for improvements across the whole system holistically."
“And sometimes the problems extend beyond our shores too, for instance when it comes to recruiters capitalizing on this fragmentation between the different stakeholders. You can put all the necessary systems, regulatory and legislative processes in place but the competition between countries will still remain,” she said.
Primary Source Verification
Sant Portanier brought up primary source verification, or the need to “authenticate the qualifications and experience of professionals who are choosing to come to practice their profession in Malta.”
“There are dedicated international companies whose job it is to verify the qualifications of applicants. Our company has recently started adopting this process and we believe it is something important for Malta as a country to factor in.”
The importance of primary source verification lies in the interest of healthcare quality and patient safety, Sant Portanier said.