Primary health reform under attack from Nationalist backbencher

Nationalist backbencher Jean Pierre Farrugia yesterday laid into the government's recent White Paper setting out the proposed reforms in the primary health sector, saying some parts of it were unworkable. He also criticised the fact that it was not a White Paper at all because some scenarios laid out therein were already being put into practice.

Dr Farrugia agreed that Malta was beset by problems and that the government was not taking things seriously enough. But he did not agree that the government was taking the people for a ride.

The primary health sector had existed for hundreds of years as a basic free service. He himself had already expressed his thoughts on the White Paper, saying the new system would inevitably result in GPs raising their fees.

No matter what anybody said, Malta was facing a serious shortage of medical practitioners, just like other countries, because up-and-coming doctors were choosing to specialise in other areas of medicine.

For a good general practice, an aspiring family doctor would have to follow a course of 10 years, rather than the present five, before he or she could be called a specialist in family medicine.

The document said fees would be subject to the free market, and the government would not be expected to intervene. To top it all, a document had been sent to every family which said there would be no extra costs for the patient making full use of the new system.

Dr Farrugia said he was fully in agreement with the use of IT in modern medicine for quick and accurate information on a patient. But to say there would be no extra cost for the patient, especially in registering, was erroneous.

Anyone who had neither pink nor yellow card would not receive any free medical service. The only way for doctors to restrict the clamour for their services would be by raising fees.

Why did anyone with a genuine case have to appear before medical boards every three months, and every time having to supply certificates that cost €50 to €65? The minister had refused to agree that this was giving rise to conflicts of interest in specialists.

Dr Farrugia called for the whole system to be reviewed. It was important for all patients to have full access to free medical service. IT in medical services was a PN electoral promise, and should be instituted as soon as possible.

It was no use introducing rigid systems in order to copy other countries. There was no real need for a patient to be formally registered with a family doctor, when Malta was such a small country and every doctor could easily cover any colleague.

It was not completely true that the document was a White Paper, because some phenomena, especially that of not finding a health centre doctor to call at home, were already being experienced in practice.

Group practices, especially in under-developed areas, were all but impossible. There just were not enough GPs in service. Group practices should mean less manhours because an absent doctor would be covered by colleagues, but this would never happen.

Happily, the number of medical students was increasing.

Dr Farrugia said sustainability was another problem. As far as the Pharmacy of Your Choice was concerned, in March 2009 there had been 80,000 holding yellow cards, even though thousands of them could afford to buy medicines out of their own pocket. These had now increased to 110,000 in less than a year - a substantial increase by any measure.

He knew that the service providers at Pietà, for example, were very upset because they had become inundated with a huge volume of work which they could not cope with. The per capita payment given by the government was nowhere near enough to pay for the extra effort.

Dr Farrugia questioned the level of IT being offered. He referred to a parliamentary question answered by Social Policy Minister John Dalli earlier in the same sitting. Mr Dalli had made it clear that the figures given did not include people who had been examined in the Emergency Department but not admitted to any ward. The figures referred to admissions and not number of persons, because it could be that one person was admitted more than once in the same period for the same condition.

The IT system, quipped Dr Farrugia, already needed intensive therapy.

He would expect the feedback from patients and professionals alike to lead to somewhere. It was ludicrous that people receiving an appointment as outpatients were being asked to procure a doctor's referral to hospital, the same paper that would already be at hospital.

On housing, Dr Farrugia quoted a PQ by Labour MP Stefan Buontempo which had answered that social housing was allocated for only five years, after which each case would be reviewed and possibly the rent terminated and allocated to somebody else. This would make the government the worst landlord of all, as if it were encouraging the sprouting of shanty towns instead of urban regeneration. To make matters worse, this topic had never been discussed. Where were the local councils to do their part? He was glad that the pressure he was constantly bringing to bear was partly the reason for the €4 million being spent on reducing waiting lists. It was what he meant by loyal dissent.

Concluding, Dr Farrugia said it might be that he did not belong to any dynasty of power, but he had always given top priority to the common good.