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FRIDAY: 9^TH NOVEMBER 2007

 

 

 

NO. 1700

 

 

Address by The Hon Dr Louis Deguara,  Minister OF Health, the Elderly and Community Care, during a Breakfast meeting organized by the Malta Institute of Management on “The Health Sector in Malta: Is there a human capital issue?”  -  st julian’s  -  9 November 2007

 

 

Good morning distinguished guests, fellow colleagues, ladies and gentlemen,

 

I would like to thank the Malta Institute of Management for having organized this breakfast meeting and for having invited me to share my views on this important subject.

 

The health sector is intrinsically linked to human capital in several ways. Naturally when we think of human capital and the health sector, we immediately think of the particularly labour intensive nature of health services and the myriad specialist skills required to deliver the service. It is however worthwhile to step back for a minute and to reflect upon the inescapable reality that fundamentally the health services sector is a “human capital issue”. This because the product of health care services is good health. Good health is in turn about people, about prolonging life and improving quality of life. The public health sector has as its mission the development of “a society that fosters an environment that is conducive to persons attaining their maximum potential for health and well being”. It is in his sense that the outputs and outcomes of the health services sector go very much towards the creation of human capital.

 

The health sector is one of the most important economic sectors in Malta. It has been selected as a priority focus area in my Government’s vision for Malta over the next seven years. It is widely accepted that human capital is an important pre-requisite for economic growth. Until recently, investing in human capital was mostly perceived as investing in education. There is now increasing evidence that health, usually measured in the form of life expectancy is a very important predictor of economic growth. The European Union  has recently started to recognize this phenomenon and in its 2007-2013 financial programme for structural funds has acknowledged the importance of investment in health and health infrastructure as a mean to develop and build the human capital that is so important for economic growth and the achievement of objectives of the Lisbon Agenda. This Government has never stopped investing in health infrastructure and the culmination of our commitment to invest can be seen in the state of the art Mater Dei hospital with its high quality standards now being experienced by Maltese patients. A new state of the art radiotherapy department will be built over the next few years on the Zammit Clapp hospital site as well as a 280 bed rehabilitation centre on the grounds of SVPR. Both projects will run into millions of liri.

 

Having dwelt on the human capital issue from an investment and output point of view I shall now turn my attention to human resources in health care the engine driving health care delivery. Last year, when drawing up our national strategy on health and long-term care for 2006-2008, the need to focus on health care human resources in a strategic manner was identified as a priority action to ensure the sustainability of our health care sector. We recognized that in order to recruit and retain health care workers, we needed to embrace a coherent human resources strategy to address the main challenges facing this workforce. We not only openly acknowledged that we are facing huge challenges but more important we were determined to address them. 

 

The World Health Report issued by the World Health Organisation in 2006 highlighted the scarcity of health care workers world wide. This means that the health care workforce is much in demand. The health care workforce is also known to be an extremely mobile workforce.

 

The situation where the United States of America, Australia and the European Union continue to deplete Africa and other less developed countries of the Commonwealth of their precious health worker resource is no longer acceptable and has started to be tackled. We have seen ethical and controlled recruitment initiatives developing both at national levels such as that which occurred in the UK as well as at a European level. As a result of the consensus position of not depleting Africa and other less developed countries of their health care workers, some countries within the European Union are now intensively recruiting health care workers from their fellow Member States.

 

This is greatly facilitated by the Directives bestowing automatic mutual recognition of qualifications. The flow of health care workers, as expected, is from the poorer to the richer Member States. From the East to the West. This has had the effect of precipitating an already precarious situation with some of the lower paid health systems having to curtail services. This phenomenon is continuing to exacerbate and compound the prevalent situation with respect to wide health inequalities across the European Union. I am aware that this situation has been noted at the highest levels and that Commission is proposing to tackle this problem in a health professional initiative some time later in 2008.

 

The public health sector in Malta directly employs over 6000 workers. Diversity is the hallmark of this workforce yet every person is important in delivering a quality service from cleaners and porters through to nurses, allied health care professionals doctors and consultants.

 

The health sector is undergoing an unprecedented wave of expansion and service development. The success of this project depends entirely on the health care workforce. The motivation and commitment of our human resources in the health care sector is an inspiring example for other sectors to follow. The competence and expertise of our health care professionals is second to none.

 

Cognisant of the context within which we are operating and of the attractive pull factors enticing health professionals out of Malta, Government took a determined stance to come forward with policies to address this global human capital issue which was beginning to leave an undesired effect in Malta.

 

The specific objectives to address the human capital issue were the following:

 

1.      Provide attractive work conditions with pay linked to performance

2.      Develop structured specialist postgraduate training programmes

3.      Strengthen undergraduate training and enhance capacity

4.      Foster ongoing human resource development

5.      Provide psychological and emotional support to all health care workers

6.      Balancing family and service exigencies

 

I shall now proceed to give a brief overview of the progress Government is making in drawing up national policies to address these specific objectives.

 

·        Provide attractive work conditions with pay linked to performance

 

Government has recognized the need to provide market corrective factors for certain professionals in the health care sector in order to be able to attract, recruit and retain these specialist human resources. Over the past days, historic agreements have been reached with the Unions representing doctors, nurses and allied professionals. We have given substantial pay increases. However, particularly in the case of doctors, these are closely related to performance.

 

We have moved for the first time towards a situation where doctors will be rewarded in terms of output and results obtained.  In all circumstances, reward will be closely linked to performance and outcomes. We have also linked pay increases to the onus of teaching and developing new medical specialists. In this manner we are paving the way for a sustainable health system that in spite of stiff competition looks at the future needs and requirements and plans for these needs by seeking to attract, train and develop young health care professionals.

 

Government has been careful not to topple the delicate balance of human resources providing a service in both the public and private sectors. We have always encouraged the private sector because we believe in patient choice. By retaining an option in which doctors may select to continue to work in both the public and private sectors, we are looking at the health resource needs of the country’s health sector on a macro and national basis. In doing so we are keeping firmly in mind our strategy for Malta to become a European centre of excellence in the Mediterranean. We are supporting the private sector to develop and build up this market and therefore agree that high caliber health professionals should be also available to the private sector.

 

·        Develop structured specialist postgraduate training programmes

 

One of the key advantages of the agreement signed with the Medical Association of Malta is that specialist training is now anchored firmly in the duties of consultants and therefore we are about to embark on the setting up and delivery of structured training programmes locally. Research has shown that the availability of structured specialist training linked to pre-determined career progression, linked to training and competence assessment, will be a determining factor in retaining our young doctors.

 

We are witnessing a phenomenon where because of the lack of structured training, doctors are leaving as soon as they complete their undergraduate training. The pilot project that was funded by the European Social Fund on Post-graduate training for medical specialists has whetted the appetite amongst local specialist associations for the development of structured training systems. This will in turn make it attractive for young doctors and other health care professionals to stay in the system and carry out their specialist training locally. For this exercise to be really successfully, it must be accompanied by alliances with reputable teaching and research hospitals overseas. These alliances are being forged at political, institutional and individual levels.

 

We believe that developing Mater Dei and other services into centers renowned for their specialist training and research programmes is a key element in the development of a service of excellence. In this way the Maltese public will also indirectly benefit both from having larger numbers of doctors available as well as because of the positive competitive culture that drives individuals to excel and continuously improve performance.  A seminar to discuss the detailed implementation of the structured specialist training programmes is being held later this morning with all stakeholders as we are determined to get the programmes up and running as quickly as possible. That is the reason why I will most probably not be able to stay till the end of this meeting.

 

·        Strengthen undergraduate training and enhance capacity

 

In the area of undergraduate training, we have a history of resounding success. We intend to continue supporting and providing the necessary resources for undergraduate training. The possibility of establishing an International Medical School is being actively pursued. We believe that even in this area it is possible to develop Malta into an International centre of excellence for undergraduate training.

 

The Institute of Health Care has revolutionised undergraduate training for nursing and allied professions. We need to continue to support and upgrade the Institute in order to equip it with the necessary resources to provide the much needed nurses and supporting professionals that are a vital element of the overall strategy for health services and long-term care on our island. The creation of the Institute of Health Sciences at Mater Dei will make it possible for the diverse health care professions to be trained in closer proximity thus building an important foundation for sharing and team work beyond the formative years.

 

·        Foster ongoing human resource development

 

Training and human resource development is a key pillar of any successful human resource strategy. Over the past two years, a training and professional development programme has been rolled out. Health care workers, middle and senior managers have benefited from this programme which was the first of its kind. The main focus of the programme was on leadership skills. The recent agreements signed with nurses and allied professionals have recognized the need for all health care professionals to carry out continuous professional development and provided financial assistance to further this aim. Training for non-professional grades is also being given priority. An EU funded project aimed at providing training to unskilled and semi-skilled workers in the health sector is currently being rolled out.

 

·        Provide psychological and emotional support to all health care workers

 

The process of change and service development places even more demands on an already over stretched health care workforce. Our health care workforce has remarkably risen to the occasion. It is dealing with two simultaneous hospital migrations, a reform to expand and strengthen community and primary health care and a series of reforms aimed to drive efficiency and value for money whilst allowing service developments that will give Malta a quantum leap in the standards of health care services. In coping with all of this, there is a risk of stress and burnout.  We shall be further developing staff support systems to prevent stress and burnout in health care workers. This will be done in conjunction with the Employee assistance scheme that is being developed by the Management and Personnel Office within the Office of the Prime Minister.

 

·        Balancing family and service exigencies

 

Facing up to the reality that the health care workforce is predominantly made up of women who traditionally bear the brunt of domestic responsibilities and caring for children / elderly relatives, we need to continue to ensure that we find the right balance between family and service exigencies. Health care workers have featured highly amongst public sector workers who have availed themselves of family friendly measures. It is not always easy to find the appropriate yet necessary balance between service exigencies and family demands.

 

We recognise that financial incentives are not the only incentives that motivate workers. The need to find innovative and flexible solutions that can allow health care workers with caring responsibilities to meet their work / family needs whilst delivering a 24 hour health care service is a tough challenge. We however believe in bottom up solutions and emphasis on team working to implement such solutions. We believe that these will be particularly beneficial for women in the health care workforce as traditionally women in Malta still carry the bulk of the caring responsibilities also within the home.

 

I believe that I have shared with you this morning a short overview of how national policies can be successfully designed and implemented to address the human capital issue in the health sector. I do not by any stretch of the imagination believe we have succeeded yet.  I am however confident that these initiatives will place us in a very good position to tackle the human capital issue that is affecting the health sector globally.

 

 

DOI – 09.11.2007

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