The latest version of the NAO report out last week highlights deficiencies across the board with the government sector, as is the remit of the individuals trusted with its collation and publication. What is of concern to those of us with a vested interest in the health sector and the formulation of health policy and its actuation, are certain grave and fundamental shortcomings within this same sector. The aim of this short note is not to dwell in depth on each point but to emphasize the importance and relevance of the basic facts elucidated by this report.
The NAO report 2011 review of the Ministry for Health and the Elderly can be easily subdivided into the following criticisms:
I) The lack of control on employee attendance and the brazen refusal of doctors' and dentists' unions to accept such a basic tenet of employment.
II) The fact that tendering procedures for medicines and surgical materials and also non-surgical equipment are routinely circumvented by direct orders, and the limits and approvals required for the latter are disregarded at will.
III) The storage of medicines and surgical materials is not centralized and one of the depots does not provide satisfactory storage conditions under the regulations laid out by the MA. This suggests that sub-standard medicinal and supplies are being passed onto the local treatment chain.
IV) The discrepancy in stocks held was said to be less than Eur 2,000 on a total figure of over Eur 18 million. This range of accuracy is not credible to the trained observer, as it implies no human error in stock transfers and no inventory pilferage. For some reason this did not seem odd to the auditors.
The implications of the NAO report are many and will be discussed in detail in a future note. What these brief points do immediately emphasize is that the Maltese healthcare system is not suffering from a lack of funding, but rather from a very inefficient utilization of the funds available to it. With points of failure at every main cost sector: wages, stocks and purchasing and stock control are all major weaknesses. This implies that major gains are to be had by simply getting the basics done right. Deeper analysis is required to quantify the magnitude of the savings to be had, but the report leaves no doubt that the material impact on the level of local health outcomes would be dramatic, given the gross wastage of resources identified.