The Malta Independent 26 May 2019, Sunday

Updated (4): Watch - Doctors’ industrial action 'expected to impact Mater Dei operations'

Julian Bonnici Monday, 5 February 2018, 07:11 Last update: about 2 years ago

Directives ordered by the Medical Association of Malta (MAM) for tomorrow are expected to have an impact on hospital operations and will create inconvenience for patients which scheduled appointments, Mater Dei Hospital said in a statement.

No progress was made during a two-hour meeting between the MA) and government, held earlier today. The union is concerned over the transfer of St Luke's, Karin Grech and the Gozo hospitals.


The directives, a Mater Dei Hospital statement read, are expected to directly affect the Outpatients Department at the hospital. At this stage the hospital is not informed as to what appointments will be affected, but said that arrangements to schedule said appointments to the near future will be made. It is expected that the actions will also create pressure on the emergency department, the hospital said.

"It is important that this service be used responsibly in order to avoid delays for patients who truly need this service." The hospital apologised for any inconvenience.

MAM General Secretary Martin Balzan, speaking with The Malta Independent just after the meeting at the Health Ministry, lamented government's "lack of interest to see things change" over the controversial concession granted to VGH."

He stressed that Stewards is not the problem, but rather the deal itself is.

"If someone is bleeding out, you stop the blood then close the wound, you don't keep the wound open for 30 years. They have exposed the patients, we believe that even if it costs a lot to get out of the deal it will still be more harmful to continue down this path," he said.

"The government has put itself in a weak negotiating position [in the deal] after severely exposing  itself and the patients"

Balzan revealed that the government does agree with the union that the government should maintain control and leadership over Public Private Partnerships. Asked on Fearne's position regarding the potential breach of the collective agreement, Balzan described the government as a 'bulldozer' and said the ministry is insisting that the agreement between VGH and steward was between two parties, and did not effect what is stipulated in the agreement.

"This is not the case  Regardless, the government would have done well by the public, the patients, the staff, the union and itself if it had conducted a 6 week consultation prior to the sale."

In an earlier statement, MAM said that the outcome of this dispute may have implications for the next 30 years so please carefully consider the importance of this moment, MAM said in a statement.

As more privatization looms on the horizon, it is essential that everyone is prepared, and follows the directives to the letter, the MAM statement had read.

Following the meeting, the Health Ministry released a statement, which read that they offered a number of solutions to questions raised by the union. "The MAM holds that it will take industrial action tomorrow in hospitals and health centres."

"It is estimated that around 3,000 patients will be affected through the action at Mater Dei Hospital, the Gozo General Hospital and in health centres around Malta."

The ministry said that it is ready to continue discussions with MAM. "Among the solutions offered, were solutions regarding contracts outside of the sectoral agreement, and how we could work together to make public-private partnerships in our hospital a success."

"The ministry also offered for MAM access to all contracts between government and VGH." 

The ministry appealed for, aside from any industrial dispute, MAM to safeguard the interests of patients.


In comments to The Malta Independent on Sunday, MAM’s General Secretary Martin Balzan remarked that the union is not against Public-Private-Partnerships, but does not agree with the current model agreed upon with Vitals Global Healthcare. Last year, the government announced that a concession for the maintaining and operating of three state hospitals, Karen Grech Hospital, St Luke’s Hospital and Gozo General Hospital, had been awarded to Vitals, which had no track record in the medical sector. In December, two years after the 30-year concession was signed, Vitals transferred the concession to Boston-based Steward Healthcare.

The directives are as follows:


I.                    Pursuant to a letter sent to permanent secretary Mr. Joseph Rapa on the 22nd January 2018 requesting immediate corrective measures in recruitment of doctors in total disregard to criteria and procedures established in the collective agreement by vitals global health care, which remained unanswered and the relative irregularities uncorrected.

II.                   II. Pursuant to notification of an Industrial dispute 29th January based on non-compliance to the collective agreement about to the contracting of Steward Health care ignoring the said clauses 1.“Give prior notice of not less than six weeks to MAM whenever it intends to contract any private entity to manage professional medical services at any health care facility providing free health care to the public on behalf of GoM, including outsourced services; and” “Provided further than any present instances of outsourcing and PPPs, including public health service delivered at the Sites, shall be discussed in specific meetings, to reach a specific detailed agreement in line with the principles established in this section by the end of December 2017.”

21. (a) GoM shall not, without following the procedure established in clause 1, directly or indirectly privatize the operation of medical services provided in part or in full, which are part of the government funded public health services. 30. This Agreement shall remain valid and binding also in the eventuality that VGH and/or Barts Medical School and The London School of Medicine and Dentistry assign, cede or transfer any or all of their rights to operate the Sites to any third party.

This shall also apply in the eventuality that VGH and and/or Barts Medical School and The London School of Medicine and Dentistry allow any third party to operate the Sites on their behalf. (iv) Pursuant to the fact that considerable sums in arrears due to health centre doctors for payment for “off days” in public holidays as from 2013 remain unpaid after 6 months of meetings as notified to the CEO on the 30th of January in breech of the collective agreement.

 (v) Pursuant to the fact that Foundation doctors are currently overloaded with additional work because of the increased need for blood sampling in view of directives issued by another union resulting in a change in working conditions since mid- January. MAM is issuing the following directives. Mater Dei Hospital and peripheral outpatient departments Doctors in all categories, Consultants, Resident specialists, Higher specialist trainees, basic specialist trainees, General practitioner trainees and foundation doctors.

On Tuesday 6th February none of the above-mentioned category of doctors shall perform any duties at the outpatients department in Mater Dei hospital as well as all other peripheral outpatient clinics in both Malta and Gozo from 8.00 AM to 4.00 pm, including Karen Grech and Gozo General hospital. This shall NOT apply to clinics at Sir Anthony Mamo, and Maternity clinics.

 Routine appointments shall all be cancelled and rescheduled. It is recommended that members should refer all urgent cases to the accident and emergency department for assessment. NB. There shall be no directives affecting the accident and emergency department, or any of the acute wards with respect to the full provision or an uninterrupted emergency service.

Health centres and district health centres All Medical practitioners, Principal General Practitioners, Senior General Practitioners, General practitioners, Foundation doctors working at Health centres, or any other medical practitioners working at the Health centres shall On Tuesday 6th February between 8.00 AM and 8.00 PM All doctors report to and shall give their services ONLY from the three main health centres, namely Paola, Floriana and Mosta in Malta, and Gozo Rabat Health centres .

All scheduled nonurgent appointments shall be rescheduled, and routine repeat prescriptions shall be postponed to other dates. Doctors shall NOT report to “district health centres”, and the other smaller health centres, Gzira, Rabat, B’Kara, Qormi and Cospicua.

All walk in, cases needing emergency care shall be seen to. It is recommended that patients are given the benefit of the doubt and seen in such cases. Services for house calls will be limited to one doctor per health centre using the usual protocol to determine which cases need to be seen Public Health doctors

All grades of doctor working in public health shall not answer any email or telephone call on Tuesday 6th February.

MAM directive to Foundation doctors. Pursuant to dispute notified Tuesday 30th January 2018 Pursuant to industrial action ordered to phlebotomists to greatly limit blood sampling from patients MAM is issuing the following directives to Foundations doctors years one and two.

All other grades of doctors shall in no way perform duties normally performed by Foundation doctors.

1. All blood tests ordered by Medical practitioners for patients admitted at Mater Dei hospital to be taken. (even though this is normally not the duty of foundation doctors).

2. No sickness certificates will be issued for discharged patients after 2.30 pm.

3. To facilitate work, no discharge letters, prescriptions or any paper work are to be issued from the discharge lounge. Foundation doctors will only fill in this paperwork, if patients are in a normal ward.

4. Writing of discharge letters, short or long, and any other paperwork such as Schedule Vs, and applications for nonformulary items should ONLY be filled between 8.00AM and 2.30 PM. After 2.30 PM only prescriptions for a three-day supply of medicine will be filled.

5. From 2.30 pm to 8.00 AM Foundation doctors are only to deal with ALL urgent matters of a clinical nature and Limit their paper work as per point 4. Any bloods ordered in the morning are also to be taken.

6. It will be the prerogative of hospital management and NOT of the foundation doctors to decide whether the patient can leave hospital without a discharge letter.

CSN supports MAM

The Civil Society Network publicly expressed its support towards the Medical Association of Malta (MAM) in its dispute with the Maltese government “over the irresponsible choices by government on the subject of the privatization of the services given in Maltese hospitals. CSN believes that it is the patient who will suffer most from bad decisions taken by the government in this field.”

In CSN’s opinion, “the fact that the government did not respect his obligations in respect of MAM on the subject of Steward Healthcare is of grave concern and raises very serious doubts as to in whose interest decisions in the health sector are being taken.”

CSN believes that it is unacceptable “and indeed shocking that the government imposed on the Maltese people the obligation to pay one hundred million Euros and all the investor’s liabilities in the event that any future Maltese government decides to take back into its hands the said hospitals. This is a burden on future generations, and explains why the details of the government’s agreement with Vitals have been maintained secret.”

Wheras CSN expresses its solidarity with healthcare professionals and with the patients who receive care in the said hospitals, it wishes to bring to the attention of the public that the right of workers to strike is a basic right, “and therefore as long as the minimum level of service guaranteed by law is satisfied by MAM, the right of its members to strike should be respected by all, including the government.”

Video by Baskal Mallia

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