Caring for the caring professionals

The reform of the public health sector is often discussed in terms of the investment needed to make the system financially viable. Malta has one of the worst demographic trends in the EU.

This will continue to create substantial pressure on our health system in the coming decades.

Restructuring a public service involves more than sound financial engineering. The health service is labour intensive. Thousands of health workers, many of whom are now from third countries, provide medical and paramedical services to the community in our state hospitals. The well-being of those who care for us when we are sick matters as much as, and even more than, the financial viability of the health service.

Local published surveys on the state of the caring professions are scarce. So, we have to rely on anecdotal evidence or on foreign surveys conducted among health workers in other European countries to understand the issues affecting those who dedicate their lives to healing people.

One recent survey is the UK Royal College of Nursing (RCN) survey, published last December. The nursing profession is the largest of all the caring professions employed in the public health services.

Thirteen per cent of registered nurses working in the NHS were first registered outside the UK, reflecting international recruiting trends. In Malta, the number of foreign nurses working in the public and private health systems is proportionately higher than in the UK.  

One worrying finding is that four in 10 respondents in the RCN survey are considering or actively planning to leave their roles. The main reasons for considering leaving or planning to leave include feeling undervalued, low pay, excessive pressure and emotional exhaustion.

Is it reasonable to conclude that the same situation may exist in Malta? Since the primary cause of this pressure on UK nurses is fiscal constraints that prevent sufficient funds from reaching the public service, the same cause-and-effect may be affecting the health service. However, it would be an oversimplification to assume that fiscal pressures are the sole cause of stress experienced by the caring professions.

Investing more money to improve the working conditions of care workers and their training will help promote a culture of respect for older people

Third-country nationals working in our public health service must contend with living conditions that further strain their finances. To cope with high accommodation costs, some may have no option but to live in crammed apartments that they share with others.

In the UK, nurses perceive pay fairness as low, driven by the failure of pay levels to keep up with rising living costs, a widespread belief that pay fails to reflect growing levels of responsibility, autonomy and risk, and a specific sentiment that roles have expanded without corresponding recognition or reward. It is pertinent to ask whether this is also true of our caring professions.

A survey conducted by the charity Age UK several years ago reveals another sad reality that may be a side effect of budgetary cuts in the public health service. This survey concluded that “care workers abuse 28 per cent of elderly people”. This abuse often takes the form of “neglect, physical attack, mental cruelty and financial manipulation”. Do these statistics reflect poorly on the caring professions?

I am not convinced that it does. The recruitment of care workers is essential, and its success depends on the working conditions offered to recruits, the training provided, and the quality of the managers who will ultimately supervise these workers.

The solution to reducing the incidents of abuse on older people cannot be solely a legal one. Age UK rightly insists on the introduction of “a new crime of ‘corporate neglect’ to punish care home or care agency managers who allow a culture of abuse and neglect”. But investing more money to improve the working conditions of care workers and their training will help promote a culture of respect for older people.

Caroline Abrahams, a social scientist and barrister, is the charity director of Age UK. She wants to increase public awareness on the abuse of older people: Our biggest fear is that there are still many cases of abuse against older adults that are not reported. We would encourage anyone who suspects an older person is being abused to contact their social services or the police straight away.

Like in any other profession, a few rogues can be found in the caring professions. But, generally speaking, medical and paramedical staff go the extra mile to ensure the job is done, often at the risk of burnout.

These people deserve our praise and admiration.