-
01 September 2025 | Policy Analysis
Prioritization and outsourcing of emergency services to tackle demand -
10 September 2024 | Country Update
Malta launches a Non-Communicable Diseases Prevention Framework for consultation -
10 September 2024 | Country Update
Malta considers outsourcing emergency care to the private sector
5.5. Emergency care
Emergency care in the Maltese health system is defined as any care that is unplanned. This can be care given within an A&E setting, both at health centres and in hospitals. Health centres also operate clinics that deal with urgent primary care consultations (e.g. fever, cold) through walk-in clinics where no prior appointment is required.
Emergency hospital admissions include unplanned admissions, the bulk of which arise from the A&E department but can also result from an urgent admission following an outpatient consultation.
Emergency care is provided in the A&E Department at MDH and in health centres. Although various initiatives have been undertaken to encourage the use of health centres for emergency services, the bulk of emergency care services are delivered at MDH. The decision as to whether to opt for emergency care at MDH or a health centre is at the discretion of the patient. The only exception is in minor emergencies when an ambulance is dispatched and the patient is usually directed to a health centre in order to receive the necessary care. No standard protocols exist delineating the provision of emergency care services at MDH and at the health centres. There are two primary health centres, in Paola and Mosta, which offer emergency services for minor emergencies on a 24-hour basis. Patients in Gozo can access emergency care at the A&E Department within the Gozo General Hospital. There are also licensed A&E facilities in the private sector.
The A&E Department at MDH is made up of the Pre-hospital/Ambulance Service, the Emergency Department, and a short-stay observation unit of 11 beds. A 2012 review found that almost 300 patients per day attended the A&E Department, of which 91 (31%) were categorized as very urgent, 64 (21%) as urgent and 51 (17%) as not urgent, while the remaining 91 (31%) were not seen in the Department but referred to other departments (Vella, 2013). According to investigations conducted by the Health Commissioner in his capacity as Ombudsman, various shortfalls in the provision of care were identified, among which were prolonged waiting times where patients were being left for hours, or even days, on stretchers, devoid of privacy, dignity and general hygiene. The Health Commissioner identified the lack of space and the lack of senior medical doctors to discharge or admit patients as the main problems. The Health Commissioner also observed that patients were using the A&E Department in order to bypass the long waiting lists in the outpatient department in the hope of seeing a specialist more quickly (Messina, 2013).
In response to this report, but also as part of the Government’s overall strategic priorities for the health sector, a series of reforms and targets were implemented in the MDH A&E Department. The number of beds available in A&E was increased and a Paediatric Emergency Unit (catering for paediatric medical and surgical cases) was introduced. In addition, a patient tracking system known as ‘Ctrack’ was introduced in early 2015 and became fully operational by mid-March 2015. This allows the daily monitoring of patient waiting times at A&E. Box5.6 describes the patient pathway in an emergency care episode.
Box5.6
The introduction of Malta’s 1400 freephone helpline denotes a major stride in health system innovation and integrated service delivery. This line aims to guide patients on seeking medical assistance. This service was piloted and ramped up in stages starting in early 2025 with referrals between the public hospital doctors to private clinics, with which agreements were made, to provide faster care. Following that, family doctors were encouraged to make use of this line to obtain information on where best to refer patients. Finally, this service was enabled for the public aged 16–69 years on a 24-hour basis. Staffed by nurses and other healthcare professionals, and supported by algorithm-based triage, the service helps callers manage non-emergency concerns by directing them to the most appropriate point of care, such as private clinics, health centres, or Mater Dei Hospital’s Emergency Department, with the government covering all costs under public–private agreements.
This strategic initiative aligns with Malta’s broader health system transformation. Under the National Health Systems Strategy 2023–2033, launched in September 2024, Malta aims to build on its success in reducing avoidable mortality and unmet needs, while enhancing efficiency and accessibility amid challenges such as demographic shifts, financial constraints and post-pandemic restructuring.
At the same time, Malta continues to contend with financial protection gaps, especially in outpatient care and prescription coverage, a concern underscored by a WHO/Europe report in June 2025, which found that nearly 7% of households in Malta experience catastrophic health spending, with low-income older households being the most affected. The 1400 helpline contributes to addressing these concerns by offering accessible, government-funded medical guidance, helping reduce unnecessary visits to emergency departments and easing financial pressure on vulnerable groups.
Beyond its telehealth innovation, the 1400 helpline illustrates Malta’s increasing reliance on outsourcing and public–private partnerships (PPPs) as a tool to expand capacity and reduce strain on Mater Dei Hospital. Patients requiring urgent but non-emergency in-person care are frequently directed to private hospitals and community clinics, with the government covering treatment costs through contractual agreements. This outsourcing model reflects broader health system trends in Malta, where the expansion of community services, such as long-established domiciliary nursing and midwifery care, and more recent specialist nursing outreach services and inter-disciplinary clinics, has aimed to complement hospital-based provision and alleviate pressure on waiting lists in the public sector. (National Health Systems Strategy 2023–2033, 2024). The integration of PPPs through the helpline is expected to reduce unnecessary emergency department attendances by an estimated 50 patients per day, helping optimize public hospital resources while maintaining universal access to care.
References
Ministry for Health and Active Ageing (2025). Press Release: National 1400 line for medical assistance launched, available from: https://www.gov.mt/en/Government/DOI/Press%20Releases/Pages/2025/05/27/PR250906.aspx. In Maltese.
Malta Independent (2025). New 1400 helpline launched to guide patients in need of urgent but non-emergency medical assistance, available from: https://www.independent.com.mt/articles/2025-05-27/local-news/New-1400-helpline-launched-to-guide-patients-in-need-of-urgent-but-non-emergency-medical-assistance-6736270430.
Ministry for Health and Active Ageing (2024). A National Health Systems Strategy for Malta 2023-2033, available from: https://health.gov.mt/wp-content/uploads/2024/09/A_National_Health_Systems_Strategy_for_Malta_2023_2033_September_2024.pdf.
WHO Regional Office for Europe (2025). New WHO/Europe report identifies coverage policy options to improve financial protection in Malta, available from: https://www.who.int/europe/news/item/22-06-2025-new-who-europe-report-identifies-coverage-policy-options-to-improve-financial-protection-in-malta.