PRESS RELEASE BY THE NATIONAL AUDIT OFFICE Performance Audit: Home-based medical and clinical services for the Elderly

Auditor General Mr Charles Deguara today presented the performance audit report in caption to the Speaker of the House of Representatives Dr Anġlu Farrugia. This audit was carried out as part of an international parallel audit examining governments' preparedness for ageing populations. Four work streams were established, with NAO Malta opting to focus on the medical and clinical services provided by the Government to persons aged 60 and over in their own homes.

The audit confirmed that a wide array of home-based medical and clinical services is provided by the Government to individuals aged 60+ in Malta. The decentralised structure through which these services are delivered may however create avoidable complexities for elderly patients to navigate this system. The NAO notes that, despite the level of development of these services throughout the years, these still require further operationalisation through clearer objectives, timeframes, defined plans, and specific budgeting within the relevant national strategies to support their further strengthening and consolidation, particularly through better coordination between the entities involved.

The report highlights that, although most of these services experienced an overall increase in usage during the scoped period, there is still substantial scope for wider uptake by individuals aged 60+. NAO however cannot express material concern on this fact in view of Malta's specific context, particularly when one considers the barrier-free accessibility to community health centres, the availability of other supporting services, as well as user preferences. This notwithstanding, the absence of studies, trend analyses, and utilisation projections for these services limits the ability of the responsible entities to align service provision with evolving demand. NAO notes that this can potentially affect the timeliness by which such services are delivered, the overall quality, and their long-term sustainability.

While acknowledging that budgeting practices of the involved entities are not necessarily expected to fully and immediately align with this audit's scope, NAO observes that several entities were unable to readily filter or extract financial data so that analysis could be carried out to address this audit's financial related objectives. This limitation raises concerns regarding the adequacy of this data's management and reporting systems, particularly in the context that these could serve as pivotal strategy inputs. This becomes more pressing when Malta's comparatively lower total health expenditure when benchmarked against other European countries is considered.

Shortages in human resources, coupled with a lack of readily filtered and comprehensively collated related data, create further risks to service provision, particularly in terms of delivery timeliness and/or overall coverage. Such information gaps could also prove problematic when this data would be required as input for forward-looking service development, capacity building exercises and the compilation of future strategies.

The Office is of the opinion that government entities providing home-based medical and clinical services should enhance coordination, communication, and information sharing. This may include establishing clearer referral pathways or possibly leading to a one-stop-shop approach which covers all involved entities. In parallel, the MHAA may wish to consider developing a specific strategy for home-based services to ensure better entity collaboration and enhanced cost-effectiveness.

Given the clear indicators of increasing demand, NAO strongly recommends that information management structures are strengthened so that they better allow for easily extractable and comprehensively compiled financial and operational data (which includes staffing levels of medical and clinical professionals). Such data will serve as pivotal strategy inputs if the continued provision and further development of these services (possibly through better coordination between the involved entities) is to be considered in the long term, and/or further acknowledged as an independent concept within the national health system.

These issues, along with others, are comprehensively presented in the audit report together with this Office's recommendations. This Report, in its entirety, may be accessed through the NAO website: nao.gov.mt as well as on the NAO Facebook page https://www.facebook.com/NAOMalta.

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