The Malta Independent 13 February 2025, Thursday
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‘Big challenge in healthcare right now is manpower’ – PS for the elderly

Andrea Caruana Sunday, 19 January 2025, 08:00 Last update: about 25 days ago

The biggest challenge in healthcare now is having enough manpower to deal with a situation which sees a growing population in terms of numbers as well as a population which is getting older in age, Parliamentary Secretary for Active Aging Malcolm Paul Agius Galea said.

Since not enough Maltese medical personnel are available, there is no other option but to bring in foreign staff to be able to keep up with the demand, he said in an interview with The Malta Independent on Sunday.

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When asked to comment on a common concern raised by elderly patients and their families about encountering numerous foreign medical professionals upon entering a healthcare facility, Agius Galea responded: "The more you provide better health services, the more people will make use of them. Since the government provides excellent free healthcare, you need a lot more people in the healthcare sector. Gone are the days of two nurses per ward due to updated legal and medical regulations, and we can never compromise standards, such as safety."

Pressed on the lack of Maltese healthcare professionals, he said that "locally, we don't have enough. I'd be very happy to have many Maltese nurses, we actually incentivise them, but it is still not enough so we bring in foreign nurses. These would be third country nationals (TCNs), with the majority from India which has a good quality of education, the great advantage of commonly being English-speakers, and a medical background similar to the Maltese one, so they work well in the Maltese system," Agius Galea said.

At the end of the day, "one may see a different person with a different culture but we want a good quality of service which is irrespective of these things. Healthcare is a vocation, and these TCNs have a vocation," he said. Giving an additional and different perspective, he said, "in the UK you would see TCN medical professionals in the wards providing excellent healthcare; what makes us any different?"

On the other hand, Agius Galea said that: "We cannot keep a door totally open to TCNs, keeping in mind that they are looking for job opportunities attracting many. We must shut the door a little." Meanwhile, "in the elderly sector we are not too tight on carers since the government knows how important they are", he noted.

To sketch out the current situation, Agius Galea said that the general population in Malta is growing in numbers but its average age is getting younger. He pointed out that should one scrutinise the numbers however, one would see that the population in Malta is younger due to the influx of foreign workers that are, "by default", of a younger age.

Agius Galea said that while this makes the general population overall younger, the native Maltese population grows older. Additionally, he said that due to a low birth rate, as things stand, there are fewer Maltese children being born.

"Ultimately, the native Maltese population is growing older," he said and explained that this is due to the current provision of health services, particularly due to the government's focus on chronic diseases. He said that the better treatment of chronic diseases, such as diabetes, and their complications increased life expectancy.

When one factors in the low birth rate in Europe, particularly Malta, which has one of the lowest in the EU, he said that the result is a continuously growing elderly native Maltese population. As things stand, he said that currently, over 100,000 Maltese nationals are 60+, equating to 25% of the whole Maltese population.

"There is definitely a strain on the services required by the elderly, since their numbers are growing. In fact, the workforce had to grow to such an extent that the sector of the elderly needs one of the largest injections of foreign workers," Agius Galea said.

Agius Galea pointed out the additional investment in the carer at home scheme. "God forbid that all the elderly reach the stage that they would need to be admitted into homes. We'd end up building more elderly homes than schools. For that reason, we keep looking for new models like the carer at home scheme." He went on to explain that through the carer at home scheme, the government gives a subsidy which has just been raised to €8,500 from €8,000. "We do this to keep the elderly individual in the community as much as possible. This is the concept of active aging, but also to reduce the burden on old people's homes," he added.

"We are aware and conscious of the fact that the elderly and their relatives are running into great difficulties to employ a carer since a lot of permits are needed." He said that "while certain procedures must be done on the parts of JobsPlus and Identita', when the elderly or their relatives must deal with them directly, they find it complicated. For this reason, we are in the process of working with these two entities to simplify the process from their part and reduce the bureaucracy of hiring a carer".

Asked for a response to recent parliamentary complaints on the poor quality of food served to the elderly, Agius Galea said "food is highly subjective. Everyone has their preferences, even for the same dish. The shift from home-cooked food to that of SVDP's food is a shock and can never be to everyone's liking". That being said, he continued, "we can never compromise the quality of the food. Despite an acknowledged dip in quality in the past, we felt that it was important to address food quality. Our reasoning was that on being admitted to an old people's home, some independence will always be lost so good food would be a comfort and that's why we addressed this".

Agius Galea said that the issue was taken up to the OPSA (Older Persons Standards Authority) and to tackle the issue, "we employed a chef with 30 years of experience under his belt in OPSA who now goes around to inspect the meals and how they are distributed". He said, "sometimes it would be small things; for example, better plating which was a factor".

When asked about the apparent injustice between the elderly left waiting to enter a government care home, while others with the liquidity may pay for faster entry to a private care home Agius Galea replied: "SVDP is for free, and even if someone has the cash, it is totally in the government's hands and you cannot pay to enter. If someone chooses to pay to enter a private residence, who am I to stop them? But in SVDP, when someone applies they are first given a referral before going to the Geriatric assessment team, with a current focus on the frailty of the individual, and what the person needs."

"They are then categorised ... with Category 1, being those who need 24/7 care and are also eligible to enter SVDP. These have a very low waiting list, which occasionally doesn't even exist, but currently, it doesn't exceed 20 persons. Meanwhile, those in Category 2 are persons who do need to be admitted to an old people's home and require medical care but not as intensively as Category 1, so a regular governmental or private care home is sufficient."

Agius Galea said that among other upcoming projects, including psychogeriatric care for dementia patients and a renal unit in SVPD, he is highly anticipating the launch of "intermediate care".

"This is innovative to Malta, and as the name denotes, it is neither community nor hospital care. The majority of elderly who are referred to hospital need medical as opposed to surgical attention. Additionally, the majority of these do not need a hospital stay to receive this treatment. This includes very common problems like urinary tract infections, intravenous antibiotics, and so on."

"Instead of admitting the elderly to hospital we can provide them the same treatment outside of hospital with the added bonus of holistic care," he said. One needs to keep in mind that elderly persons who are bedbound deteriorate rapidly. So this concept will provide the elderly with healthcare before a swift return to the community with a care plan and follow-up.

The "intermediate care" concept has been put to the test with apparently positive results so far, "last May, this idea began as a pilot project in SVDP with 16 beds with the individuals being treated as patients not residents. So instead of going to Mater Dei, they were admitted to Narcis in SVDP. Since May we cared for 86 persons but we made a reduction in emergency referrals by 40%," Agius Galea said. "So, we realized that apart from being innovative, it works and is needed with high satisfaction from the patients and their relatives so far."

Galea Agius also pointed out that apart from being practical, "the idea was made in collaboration with doctors and foreign experts. I have much faith in this system: good healthcare tailor-made for the elderly apart from helping the health sector at large by reducing the burden on Mater Dei". Furthermore, "it was very recently approved by Cabinet and we are in the process of launching a project aimed at enhancing intermediate care. This concept is part of ensuring that healthcare in Malta is future-proof".


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