Industrial action over understaffing in health centres resolved

The Medical Association of Malta (MAM) registered an industrial dispute with the health authorities over lack of staff in health centres. MAM’s directives resulted in the closure of half of the health centres in Malta on 18 May 2009. These directives were lifted after an agreement was reached with the government to find alternative ways of increasing the number of doctors in health centres.

Background

Graduate doctors move abroad to specialise

For many years, the Maltese healthcare system has suffered from the fact that many newly graduated doctors move abroad to specialise in particular fields of medicine and do not return to Malta on completion of their studies. As a result, the shortage of doctors in Malta has become more acute in recent years. According to President Stephen Fava of the Medical Association of Malta (MAM), the national trade union representing doctors, the main determinants of whether or not doctors leave Malta are salary and working conditions, specialisation programmes and the prospects of career progression.

Government increases salaries and promises specialisation courses

In a bid to start improving the situation, the government and MAM signed a collective agreement in 2007 with considerably increased salary structures. The European Commission criticised such wage increases, stating that they would jeopardise the government’s budgetary goals by setting a precedent for other sectors to make higher wage demands. As a long-term solution for the shortage of doctors, the government announced that specialisation courses in medicine, psychiatry, intensive care and dentistry would soon be offered in Malta.

Situation worsens despite improvement efforts

Despite such efforts, the general situation appears to have worsened in 2008, probably due to the further stretching of staff related to the opening of the new general hospital Mater Dei, which opened in 2007. The media reported that patients sometimes had to wait for several hours before being visited by a doctor in the hospital’s Emergency Department. The lack of senior doctors also often resulted in patients having to be visited by inexperienced junior doctors. According to MAM, the shortage of doctors at health centres was leading to longer waiting times, creating frustration among patients. As a result, a number of doctors and other personnel have been verbally and physically assaulted in health centres in recent months.

Dispute between MAM and government

On 12 May 2009, MAM registered a dispute with the health authorities and instructed doctors working in three specific health centres to start reporting for work at the other clinics from 18 May, in a bid to reduce the shortage of doctors by concentrating resources. A fourth health centre would only operate in the mornings. These directives meant that half of Malta’s health centres would be shut down indefinitely.

The health authorities were reportedly working on a contingency plan to ease the problems that such actions would create. Meanwhile, talks were held between the government and the trade union in a bid to avert such actions. The Minister for Social Policy, John Dalli, stated that the problems being faced in the healthcare sector were not only caused by a shortage of staff but also by ineffective work practices. Minister Dalli stated that doctors’ output needs to be increased. He argued that decisions relating to work practices cannot be taken by a trade union but by the relevant management of health centres. The minister also accused health centres of referring patients to the Mater Dei Hospital for treatment which they could easily have carried out at health centres.

These arguments were refuted by the President of MAM, Mr Fava, who said that doctors in health centres only referred patients to the general hospital when this was necessary for the patients’ well-being. He argued that while the health centres required around 110 doctors in order to be properly staffed, at present these health centres have only 43 full-time doctors, 20 trainees and a number of part-time workers. According to Mr Fava, the doctors in health centres see some 240,000 patients every year. He argued that the government had not taken on board requests put forward by MAM relating to the management of health centres. Moreover, he stated that the situation is becoming worse as the difficult working conditions are pushing more doctors out of the public sector to work in private practices.

Agreement reached

Meanwhile, a government proposal to subcontract some services offered by public health centres to the private sector was put on hold after being rejected by MAM. Discussions between MAM and the government finally led to an agreement through the mediation of the head of the Department of Industrial and Employment Relations within the Ministry for Social Policy. The directives were lifted by the trade union on 19 May 2009. It was reported that, according to the agreement, health centre doctors would offer services during limited hours, with the health authorities filling the remaining hours by employing part-time doctors or subcontracting services to the private sector. The President of MAM, Mr Fava, stated that such an agreement was a reasonable short-term solution, but further discussion is needed in order to find more feasible long-term solutions.

Manwel Debono, Centre for Labour Studies