The country “lost 11 years of investment in health infrastructure”, President of the Medical Association of Malta (MAM) Martin Balzan told The Malta Independent on Sunday.

Speaking to this newsroom, he said that “the only real investment in health infrastructure that I can see over the past ten years was the Paola health centre.”

The country’s health sector has been under the spotlight in the past months, following the conclusion of the magisterial inquiry into the Vitals deal. The infamous hospitals deal was annulled in 2022 by the courts in a judgement that spoke of fraudulent intentions. That judgement was confirmed on appeal, in a judgement where the court also mentioned collusion.

A magisterial inquiry into the deal concluded last month, and criminal charges were filed in court against many individuals, including former Prime Minister Joseph Muscat, former Deputy Prime Minister Chris Fearne, former Minister Konrad Mizzi, Central Bank Governor Edward Scicluna (who was minister of finance at the time), former OPM Chief of Staff Keith Schembri and others over the deal. The court cases are scheduled to be heard next week.

Asked what the money given to the hospitals deal concessionaires could have been used for, had it not been given to them, Balzan mentioned new hospitals. "When Mater Dei Hospital was built, it cost around Lm230 million, which is around €650 million today and provided around 1,400 beds.” But, he said, Sir Anthony Mamo Oncology Centre was built with around €45 million in EU funds, and the government forked out around €5 million. “If you ask me what we can do with €400 million, if paired with EU funds, then we should have another two hospitals."
Another problem, he said, was that a very small amount of EU funds has been channelled into health sector infrastructure. "The problem we face today is that our healthcare infrastructure is inadequate." 

"We don't have space as life expectancy has increased, the population has grown and we have 150,000 foreign workers. They are of course welcome in the country, but they also get sick just like everyone else, so the demand for health services has increased but the infrastructure hasn't really increased,” Balzan said.

. "The only real investment in health infrastructure that I can see over the past ten years was the Paola health centre,” Balzan said.

As for how he would describe the lack of hospital bed space, he said that it is worse in winter when it’s cold and summer when there are heatwaves. "There are many beds in former lecture rooms, corridors, and they are not proper wards, they are makeshift wards. Patients deserve better. The treatment provided by doctors and nurses is up to scratch, but the so-called hotel services at the hospital are not like what they were when Mater Dei opened its doors, they are inferior in terms of privacy, space and comfort."

He said that if there isn't space for equipment, that also creates waiting lists. 

Asked whether the Medical Association of Malta felt betrayed by the infamous hospitals deal, he said: "I wasn't the one who was betrayed. The patients were betrayed, especially the ones in Gozo.”

“If funds were supposed to be spent on infrastructure, hundreds of thousands of people would have benefitted from new hospitals. The losers in this case are the people of Malta, especially patients," he said. "We have to get the money back. If Steward Health Care declares bankruptcy in the USA it will be difficult to recover funds."

Asked whether, with hindsight, a public private partnership (PPP) was the right way forward, he said that in retrospect it was "definitely a mistake. But here it was not the PPP that was the problem. It was that we gave €400 million and we got nothing in return. Where did that money go?"
Speaking more generally about PPPs and healthcare, he believes that in the long run with PPPs more money is lost. He said that “the problem in Malta is that if you move an acute health facility into a PPP, the government could be held at ransom. That concessionaire could say for instance that if the government stops the funding, then it would close the Gozo hospital, which would be a problem."

As for his comments on the government's decision to keep on pumping millions into the concession when it was still in effect, despite the National Audit Office having had already highlighted issues in reports about it in 2020, he said that more money was given to Steward Health Care than was given to Vitals Global Health Care. He said that to his understanding Prime Minister Abela had said he was awaiting the court case to conclude before taking action on the contract. "It could be that he was afraid of the €100 million clause," Balzan said, in reference to an agreement which had bound the Maltese government to pay €100 million to the concessionaire if it cancelled the concession. 

"That was a completely absurd clause and to date I cannot understand it. So if money is allegedly stolen from you, you pay more money? Former Prime Minister Joseph Muscat needs to explain what the logic was behind this clause. In my opinion, if anyone is commissioned for a job, but then they don't turn up, they should be fired," he said.

He described the news that a former prime minister and three former ministers have been charged over the hospitals deal inquiry as being a situation the country has never witnessed before in its history. "We have never had a former prime minister or minister charged in court."

“What comes to my mind,” he said, “is a comment regarding the perception of impunity in the country that a socialist Member of the European Parliament had mentioned when she came to Malta soon after the assassination of journalist Daphne Caruana Galizia.” 

"Obviously they are innocent until proven guilty," he said, speaking about those charged over the hospitals deal. "But I compare this with what happened in Italy regarding tangentopoli, where the judiciary began investigating corruption. Whether they are innocent or guilty the court will decide, and they deserve a fair hearing just like everyone else."

He said that "it is also not acceptable for the prime minister or any member of the executive to attack the judiciary.”

"Just as those charged have a right to a fair hearing, in a democracy the judiciary have to be free to decide according to their conscience,” Balzan said. 

Asked whether the government should aim for another Public Private Partnership with regards to St Luke's Hospital and Karin Grech Hospital, Balzan said he disagrees with the idea of another PPP. "Since we only have a few hospitals, the government can be held at ransom by a private investor, and government should be in control. The bad experience we had reinforces our idea that health is better in public hands. Health is not designed for profit."