1. Build Tal-Qroqq to the contracted design; invest in St Luke’s to provide acute general hospital services;

2. Expand the Tal-Qroqq design concept to become an acute general hospital; decommission St Luke’s as an acute general hospital; and

3. Downsize Tal-Qroqq; invest heavily in St Luke’s.

The team concluded that on the basis of the view of health care professionals, the health needs of the country would not be well served by splitting acute general hospital services between two facilities. Patients’ health could be at risk and sufficient professional and technical staff are not currently available to operate two such facilities.

The assessment therefore focuses on size combinations of acute and non-acute hospitals. It is possible for government to decide to simply refurbish St Luke’s and cease construction at Tal-Qroqq; alternatively, it can build Tal-Qroqq and terminate the expenses involved in refurbishing St Luke’s. This would reduce the overall amount of money to be spent.

However, we do not think this is advisable. Wherever the acute general hospital facility is to be located, we believe it to be both prudent and necessary to develop further non-acute hospital beds. The real choice is simply where to locate the acute general hospital facilities – in the short term and for the long term.

There is insufficient statistical data on which to project the long-term health needs of the Maltese population. However, there is a consensus between ministry officials and representatives of the medical profession that Malta’s present and future acute general hospital requirements can be suitably met by an 800-bed facility that has the capability of being expanded to 1,000 beds at a future date.

It also seems that the non-acute beds should be approximately 50 per cent of the acute general hospital beds. We believe that this can be best achieved by building Tal-Qroqq to an 800-bed acute general hospital and (reduce) St Luke’s to provide non-acute support facilities.

We would have preferred that the required analytical work should be carried out prior to a decision being made on the size and location of the acute and non-acute hospital facilities. However, the realities of the construction programme underway at Tal-Qroqq will not permit this to happen, except at what will likely to be substantial financial, socio-economic and public apprehension costs. In view of these considerations, we feel that the government should make both immediate and long-term decisions.

Immediately the government should:

• Continue with the existing construction programme at Tal-Qroqq for the structural works only.

• Stop the acute general hospital rehabilitation programme at St Luke’s and transform it to a refurbishment programme in anticipation of it serving as a non-acute hospital facility;

• Review the existing functional layout and building services design at Tal-Qroqq, ensuring it is modified to accommodate 800 acute beds;

• Prepare an Environmental Impact Statement to address the implications of increasing the present design to an 800-bed acute general hospital, that has the capability of expanding to 1,000 beds if necessary;

• Commission the design work for increasing the size and capability of the hospital to recognised hospital design experts.

In our view, the last three measures must be substantially completed in the next six to eight months prior to the end of the current structural construction programme. This would permit the construction activity to continue relatively uninterrupted towards the completion of an 800-bed acute general facility.

Prior to completing the construction of the 800-bed facility, the government must also ensure the undertaking of the following measures:

• Task ministry officials to draw up and implement health care management policies with respect to issues such as Admission, Discharge, Length of Stay, Day Surgery, Case Management and related policies;

• Assess the need for professional management skills and capabilities to ensure the high calibre operation of health care institutions and to provide expert support to the medical profession;

• Undertake a review of the terms and conditions of employment for health care employees.

Addressing the tasks identified immediately above is important because we believe that most people think of the new hospital with a kind of television image of how it will appear once inside the doors of the building: this is natural. However, unless the government urgently addresses issues pertaining to management, terms and conditions of employment, and the introduction of health policies, we fear that the new hospital would soon deteriorate and, as a result of the combined visual effect of new buildings and poor maintenance and operational practices, it would create a much more negative impression than St Luke’s has ever done.

In spite of the larger cost which pertains to the Tal-Qroqq option, we believe that the government should proceed to develop it as the long term solution to Malta’s health requirements. The significance of the additional cost of about Lm9 million in present value terms should be considered in the context of the length of the asset’s life which should not be less than 25 years. This proposal is further strengthened because:

• The rehabilitation programme at St Luke’s is expected to take a longer period of time than that at Tal-Qroqq;

• Rehabilitating St Luke’s is inconvenient to patients and staff;

• St Luke’s can never provide the same level of ‘feel good’ factor as is possible at Tal-Qroqq;

• Tal-Qroqq’s design functionality and growth potential are superior to St Luke’s; and

The limitation to expansion which Tal-Qroqq places on the University is acceptable if it is developed as a full service teaching hospital.