Lies, damn lies and the Ministry of Health | Paul Pace

Hardly have we settled down into our chairs before Paul Pace, President of the Malta Union of Midwives and Nurses (MUMN), launches straight to the point.

“The Ministry of Health is totally inefficient. Instead of solving long standing problems it would rather attack the entity that is pointing out the problems.”

Pace claims that the management teams of hospitals have no support from the Ministry of Health. “It is like they are two different entities, operating for their own ends.”

He feels that it is his duty as president of the MUMN to bridge this gap. The MUMN produced a document at the beginning of the last Nationalist administration two years ago advising policy makers of the issues concerning the health division in Malta.

In the document, the MUMN warns against extending health services due to a lack of staff that could barely cope with the services already being offered. In the meantime, new health services were offered without taking into account the manpower issues.

“As a general rule, every nurse should have four to five patients to look after. At the moment nurses in Malta are looking after an average of 12 patients each. In the Intensive Care Unit, where one nurse should be caring for one patient, the ratio is three to four patients to each nurse. In simple terms, the government went ahead with extending health services to the public without so much as a manpower plan.”

There has been an international campaign to recruit foreign nurses to tackle the shortage of 700 nurses. Statistics regarding the employment of 300 new nurses released by the Ministry of Health have been inaccurate. In actual fact, only 44 Maltese nurses have been employed with another 10 awaiting resit results. Another 30 have been employed from Pakistan, though these are clearly having visa problems. Those new nurses are not even going to make up for the 100 nurses lost through retirement, maternity leave and those leaving the profession for personal reasons in the course of the year, let alone begin to tackle the shortage.

“Whilst we have no objection to the recruitment of foreign nurses in the short term, the issue needs to be tackled from an educational perspective. The numerus clausus on students admitted into nursing courses at university needs to be removed. The government has to tackle the all the issues at university so that the every student possessing the right qualifications can be accepted into nursing courses.”

In 1980 – when Pace was studying to become a nurse – student intake on nursing courses was 300 per year, and mentors were not an issue at the time.

“Any qualified nurse or medical specialist can act as a mentor. There was never a problem in my time at university. The system worked well as the nurses coming out of university at the time are now heads of departments. The government would rather hide behind this façade of limited mentorship than deal with the problems at hand.”

Politicians are more interested in defending university, who themselves are placing limits of the number of students taken into nursing courses than on safeguarding patients. The question of mentoring is nothing but a “stupid excuse.”

“Prior to EU succession, former Health Minister Louis Deguara told the Prime Minister that there were sufficient nurses in the Maltese Health care system. This resulted in a numerus clausus on nursing courses at university of just 50 with their stipends slashed from the highest level of stipends to lowest in the entire university. All of a sudden nursing was put at par with unskilled work. Today, through much of the MUMN’s hard work, the numerus clausus stands at 165 and the stipend is at its highest.”

Only 44 new nurses qualified in 2010. This is not nearly enough to compensate for the loss of nursing staff through retirement and maternity leave.

In the next 10 years, Pace envisages an even greater problem for the nursing industry in Malta. He says: “Employment of foreign nurses as a long-term solution poses a number of problems.

“Firstly, the nurses coming from developing countries such as Pakistan are not trained to the standard expected in the EU, as they are only exposed to facilities that are available in their own countries, therefore more training has to be given before they can start work.

“Foreigners can never be relied on to stay in Malta. We have always recruited a handful of foreign nurses, and more often than not they leave to countries where pay packages are better, using Malta as a stepping-stone. Organising contracts is futile. If a foreigner wants to leave all they really have to do is get on a plane.”

“Even if we somehow overcome these problems, there still remains the language issue. The majority of patients passing through hospital do not have a broad knowledge of the English language.

“Maltese nurses will end up being taken by the Mount Carmel psychiatric institution and Zammit Clapp and St Vincent de Paule hospital for the elderly where communication with these vulnerable patients is of utmost importance, leaving the foreign nurses to work at Mater Dei. Maltese nurses who get stuck in these institutions for a number of years will end up leaving the country in search of better jobs. Eventually there will be more foreign nurses than there are Maltese ones.”

The nursing staff is always the scapegoat of the medical division. As a result of the lack of planning all support roles are being dumped onto nursing staff. Transferring of medicines from the pharmacy to the wards, clerical work, data input, transporting patients and running errands are but a few of the roles that nurses are expected to fulfill alongside their jobs.

“We are the laughing stock of the EU. No nurse throughout the rest of Europe has to act as a porter of medicines. There is simply no support staff to help the medical staff perform their basic duties.”

Pace is angered by the minister’s comments appearing in the media this week where Cassar says he respects the commitment and dedication of nursing staff.

“We want to see action not just words. How can you say you respect someone and then do nothing to relieve them of the impossible working conditions they have to endure?

“Where is the respect for nurses who are forced to work up to 80 hours a week and taking leave of absence is almost impossible? For a nurse to take one day’s leave they have to find another nurse to replace them. When everyone else is so overworked it is very difficult to find someone willing to work in his or her time off to cover someone else.

“These people who are willing to cover for someone else only do so if the person they are covering is willing to do the same for them. Therefore mothers with children often find it impossible to cover for anyone else due to family commitments but in turn will not find anyone to cover for them.

“In a workforce made up of 70% women – most of whom are raising children – this becomes a huge problem.”

Nurses are being removed from the wards that they work in and placed in other areas, taking them out of the environment they are used to and putting further pressure on the nurses left trying to cope with the added workload. 

Pace accuses the minister of a number of untruths, one of which is regarding the generator at Mount Carmel, which sparked off one of the directives that instructs nurses to leave the building in the event of a power cut. The minister said that Mount Carmel was never in possession of a generator. However Pace claims that there IS one at the psychiatric hospital, only that it is 50 years old, it stopped working and was never replaced.

Pace says the media coverage of the minister’s willingness to hold talks with the union in the past is a blatant lie.

“The MUMN lifted all industrial action when the government agreed to hold talks with union last April. However only one meeting was held during which the minister refused to talk about the situation at university whereby students are being refused entry onto the nursing course. This is the reason we are refusing to suspend our directives this time until the government has shown some sort of initiative.

“The Prime Minister was invited for talks on two occasions but declined both of them.”

Pace calls for government to stop taking them for fools and to prove their respect for the nursing community by action rather than words. “We know when we are being taken for a ride and we won’t stand for it. Until we see some sort of change we will not lift industrial action.”

“The government would rather attack the unions, accusing us of causing harm to patients, to camouflage the mess that the health sector is in. There is a lack of leadership, management policies and support staff throughout the health sector.”

The MUMN is calling for an open door policy on nursing courses at university, with two intakes per year, more part-time lecturing staff to assist university students and the employment of support staff to aid medical staff complete their duties at the hospitals.  “These are long standing issues that have been highlighted in a document prepared by the MUMN for government over two years ago. It is a predicament that we have foreseen and attempted to avoid, though our efforts have been in vain.”

Pace is particularly concerned about Mount Carmel psychiatric hospital, which, he says, does not feature on the top of government’s list because it is not the showcase of the health system as is the case with Mater Dei.

Overcrowding is a common problem. Twenty-four to 26 patients are often taken into a 20-bed ward. At night, staff send these extra patients away for the night, finding them a bed wherever possible in the health system. However, during the day, if a patient needs to lie down, they have to fight for a bed.

The facility is equipped to handle four male drug addicts or prisoners and two female ones. If they exceed this number the patients are just mixed in with other patients, even though this is contraindicated by medical professionals.

Pace says that there have been plans to extend these wards for two years, but funding was never allocated there. Funds where put into the community at the detriment of the drug addicts ward.

Nurses at Mount Carmel have been working in strike mode since 2008, however government is more interested in tackling the directives than the problems at hand. “This is politics of the lowest nature. There simply is no planning and bad management in the health sector.”

Pace insists on the long-term plan of better community service, making available health care professionals to the homes of people who may be bed-ridden but do not require hospital facilities. “As well as increasing the well-being of the patient, this will also remove pressure from hospitals, leaving nurses to tend to only the patients that really require hospital care.

“We need to move away from the polyclinic attitude to primary health care, where patients have to go to the clinic for services. This is a 1970s attitude that the rest of Europe has moved away from in order to provide more patient-based services. Yet again, how can this be materialised without midwives and nurses?”

In response the ministry’s comments that the European Federation of Nurses (EFN) used “inaccurate and misleading statements”, Pace claims “the EFN know more about the situation in the health sector than the minister himself.

“Secretary General Paul de Raeves has been to Malta on a number of occasions and has met nurses living through these working conditions. They do not just rely on the information relayed to them by the MUMN but have their own monitoring board. They have been in contact with Malta, collecting their own data for the past seven years. They are not to be treated as fools!

“On viewing the tender issued by the Maltese government for employment of foreign nurses, the EFN is fully aware that that this would lead to Malta poaching nurses from developing countries like India, Pakistan or Africa as European nurses would not be attracted to the pay packages offered. This is unacceptable to the EFN.”

On a completely different note, we discuss MUMN’s involvement in Forum and the lack of representation on the Malta Council for Economic and Social Development (MCESD). Again, Pace shows a certain disdain for government.

“The government is being hijacked by two unions – the GRTU and UHM.”

He complains that Forum – which incorporates 11 unions including the Malta Union of Teachers (MUT) and Airline Pilots Association (ALPA) among others – has not been approved a seat on the MCESD because the government does not want to go up against Malta’s two largest unions which have a close relationship with the government.

“Forum went against the increase in water and electricity tariffs last year due to the negative effect it was bound to have on all our members. However UHM and GRTU supported government in the price hike to keep their relationship with the government stable.

“Our not being part of MCESD is an insult to Eddie Fenech Adami, who insisted that all unions were of equal importance in Malta. Gonzi is using the unions to cause fights between themselves to weaken their power, using language that does not bear repeating.”