MaltaToday | 09 July 2008 | Come on, Eileen... hospital is for serious cases only

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NEWS | Sunday, 09 July 2008

Come on, Eileen... hospital is for serious cases only

Raphael Vassallo

Gone are the days when you couldn’t switch on your TV set without Dejjem Tieghek celebrity Eileen Montesin telling you all about the fantastic new luxury services at the soon-to-be inaugurated Mater Dei Hospital at Tal-Qroqq: the air-conditioning, the satellite TV, and the five-star gourmet cuisine.
Today – just over a year later – you are more likely to be shown a bandaged middle-finger, and brusquely told to not bother presenting yourself to the Emergency and Admissions Department, unless your ailment really is an emergency.
“Casualty is for serious and urgent cases only”, the wagging finger warns from billboards and on TV: a far cry from the open invitation, issued in June 2007, for everyone and their ailment to come and pay homage to a state-of-the-art hospital which taken over 15 years to build, at the total cost of more than €750 million.

Speaking at the launch of the new campaign yesterday, a sombre John Dalli acknowledged a degree of public discontent regarding certain aspects of the service at Malta’s state hospital: namely, the waiting lists.
But the health minister also pointed out how the efficiency of the new hospital was being undermined by a disproportionate demand for emergency services, very often for cases which were not emergencies at all.
“If you look at the figures, you will find that the number of people to be admitted into casualty every day works out at around 300,” he said. “Of these, only 20% would really be emergencies. The remaining 80% could easily be treated in their own community: by the family doctor, or in health centres...”
On his part, parliamentary secretary Joe Cassar outlined a number of administrative changes to be effected immediately in the E&A Department. Foremost among these is the appointment of two medical specialists – Professors Mario Vassallo and Godfrey Laferla – as co-chairmen.
In addition, Volserv – a voluntary agency run by Mrs Claudia Taylor-East – is at hand to assist with patient-staff relations: which, judging by the repeated complaints of both doctors’ and nurses’ unions in the days of St Luke’s, are very often strained.
On a longer-term basis, the ministry is also looking into key performance indicators to assess methods of reducing treatment time. At present, the E&A department is divided into three categories, with priority (and hence waiting time) depending exclusively on the severity of the case. The ultimate aim, Cassar hinted, is to establish a minimum time-frame within which a patient would either be admitted for treatment, or discharged altogether.
The health minister added that another available option was to strengthen community care. In most cases, he said, it would be preferable for a patient to be treated by a family or community doctor, as these would already be familiar with their patients’ case histories... unlike the emergency medical staff in casualty, who would have to diagnose the problem from scratch.
Still, the irony of this apparent reversal of roles was not lost on certain sections of the media, which quizzed the health minister on what appears to be a U-turn. After all, wasn’t this the same John Dalli who had downsized the health centres – or polyclinics, as they were once known – when still finance minister?
Dalli explained that the decision to cut down on the 24-hour service was dictated by the prevailing exigencies at the time. “In many cases, centres were being manned at night for nothing. What we are dealing with is a shortage of human resources within the health sector. We must address an imbalance of resources...”
Joe Cassar also denied the popular view that all such polyclinics are closed at night. “There are four health centres which are manned and open 24 hours a day, seven days a week,” he pointed out. “These are in Paola, Gzira, Mosta and Floriana.”
As Mater Dei Hospital has often been criticised for carrying over the flawed practices from its predecessor, this newspaper was interested to know how today’s admissions statistics compare with those of St Luke’s.
Mrs Taylor East confirmed that there was a substantial increase in visits to the emergency department from one hospital to another. “There was an overall increase, which peaked soon after the migration process was complete,” she said. “Since then, it has stabilised.”
The 300-a-day figure mentioned by the minister referred to the statistics as they stand today. The number of visitors in the peak period remains unknown, but talking informally after the press conference, Prof. Mario Vassallo explained that it is normal for admissions to increase year by year. “The reason for this is that thanks to advances in medical technology, and the fact that people are living longer, hospitals today can offer procedures which were unheard of a few years ago.”
Confirming that Mater Dei may well be the victim of its own success as a gratuitous pre-election publicity stunt, Joe Cassar also pointed out that contrary to common practice, there seem to be certain “peak hours” for persons to present themselves en masse at casualty.
“An emergency, by definition, can happen at any time,” he said. “There are no times of the day when serious accidents occur more often than others. And yet, we are noticing that the busiest times for admissions are between 2 and 5pm...”
Cassar also added that the emergency department experiences a noticeable drop at certain times, such as for instance, during the penalty shoot-out of a European Cup match. “All this is an indication that many of the cases will not really be emergencies,” he said, adding that what is needed is a “culture change” involving the general public’s entire attitude to the public health service.

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