We were overjoyed when Malta was placed fifth in the health league table of the European Union. The Health Department, justifiably, took the credit and we prided ourselves for leading in the health sector.

We had after all, built a ‘state-of-the-art’ hospital, believing (as we do in most sectors) that form not function is the hallmark of medical practice. Little consideration was given to the fact that the costs to maintain such a hospital in tip-top condition would be exorbitant and would eat up funds badly needed to meet the ever-mounting costs of modern medical and human resources.

A fall from grace

However, joy at our achievement was short-lived. To our astonishment, we were subsequently demoted to 10th place in the European Health League Table. There was not much to celebrate this time around. That we have good and dedicated doctors goes without saying and is a proven fact. It was the function that gave us a creditable fifth place in the League Table, for St Luke’s Hospital could hardly be described as ‘state-of-the-art’.

So, after this fall from grace, where does the future lie? I see danger ahead and it is already in sight. We seem to be resting on our laurels, thinking we are moving forward in the right direction. In a few years’ time, unless we take appropriate measures now, we will find ourselves sitting on the end of a long limb and the things we so much fear and guard against today will become an unavoidable reality sooner than many people anticipate.

The practice of medicine is changing fast. Innovation in the health sector has been phenomenal over the past few decades, and we have seen new drugs come on the market, new medical devices and new health management software. We are witnessing spectacular healthcare innovations. These new realities, like all realities, are demanding. They will place ever-increasing costs on government, hospitals, medical insurance companies and, above all, on patients themselves who, expecting the best in the shortest time possible, and unwilling or unable to pay for private care, assume that the government will step in and provide the necessary cover.

As if the €750 million were not enough, we are now talking of spending another €100 million on an oncology centre, which by the time of its launch will see our present machinery and equipment outdated – if not also the linear accelerators ordered for the new centre itself.

Concomitant with the new machinery and equipment brought about by new technological advances, we will see the emergence of biologics, brought about by genetic engineering. This will interact much more selectively with sites of disease and therefore result in more potent drugs, often with fewer side effects. New companies that specialise in genomics and proteomics have started sprouting up. All this comes at a cost, which will fuel the already spiralling medical budget.

Current stem cell research will revolutionise our current knowledge of anti-cancer treatment and could provide the breakthrough that has challenged researchers for decades.

Personalised medicine and designer drugs, although in their infancy, hold a considerable degree of promise for the development of therapeutics that will be targeted at the specific genes that are involved in human diseases, rather than the current blockbusters strategy of ‘one drug fits all’. Thus, therapeutic treatment will be more closely tailored to the genotype of the individual patient.

Genetic testing will be used to determine the individual risk of developing ailments such as heart disease, cancer, osteoporosis and diabetes. Individual genome decoding is a step towards these ambitious goals. This field of genetic research is advancing rapidly and is expected to have a major impact on drug development and advanced therapeutic disease treatment. All this will come (as always) at a price. The point is, will we be able to afford it?

As ‘baby-boomers’ face the inevitable ageing process, new drugs expected to increase longevity will be in demand. A more radical approach to ageing, a regenerative approach that uses stem cells to grow spare tissues and organs that could be replaced as required, is in progress.

At the same time, we are witnessing the development of new, not-so-evidently-affordable therapies in the emergence of new cutting-edge surgery.

No one could have predicted that more than 50 per cent of prostate surgical procedures in the US would now be carried out remotely by a surgeon using computer-controlled robotic arms. The applications of this innovative technology are now rapidly expanding into other surgical procedures, such as hysterectomies and mitral (heart) valve repair. This will be the future state-of-the-art technology. Robotic surgery is poised to revolutionise the operating room of the future and I was amazed to witness such advanced technology in a private hospital in India.

Other surgical advances are keyhole surgery and minimally invasive surgery, which will replace today’s maximally invasive surgery. Attending international lectures and workshops is enough to show that here in our island we are seriously lacking in this field.

We are a small island with a small population and limited human and financial resources, which will become even more limited as the new advances become mainstay procedures. We have to date concentrated on the past and present. The future has already overtaken us. No plans are in place to face this future, which will demand the application of new methods, the training of surgeons in new procedures and physicians who will need to use completely different approaches. As we talk of ‘state-of-the-art’ hospitals we hear of no plans to take on board ‘state-of-the-art’ procedures.

I believe that the time to restructure our health system is overdue. We must look forward; think forward and act fast forward. We have to make sense of what we have in terms of human and financial resources. Duplicating resources and wasting precious money is nonsense.

As the expectations of both patients and doctors grow, so too will costs, to the point where they become unaffordable. We have to find a system that fits our size and resources before it is too late. Private/Public Partnership is the only sensible answer. We must realise this for we are already late – very late. Time has overtaken us.

We must make some very important decisions in the field of health. We can either carry on stabbing each other in the back, or we can opt to join hands and give our people what citizens in other countries are already enjoying: the best there is.

The land is ours to command, but time is not!