The Malta Independent 18 January 2020, Saturday

MDH did not implement NAO advice on real-time information on waiting times for consultants

Wednesday, 30 October 2019, 17:29 Last update: about 4 months ago

While Mater Dei Hospital implemented, or at least partially implemented, a number of recommendations proposed by the National Audit Office in 2017, some recommendations were not tackled at all.

A follow-up audit which aims to report on the progress registered since the publication of the performance audit report: Outpatient waiting at Mater Dei Hospital, which was published in November 2017, was issued yesterday.


The 2017 Report concluded that over the years the Outpatient Department experienced a rise in patient visits.  Nonetheless, the provision of services within an increasing number of clinical specialties and the work practices adopted, excessive waiting time for an outpatient consultation appointment remains an issue of concern.

In view of the findings and conclusions emanating from the 2017 performance audit report, the NAO had proposed a number of recommendations, the implementation of which is the primary focus of this follow-up audit.  The 16 recommendations proposed in the 2017 Report broadly related to strategic, operational and administrative capacity issues. This follow-up audit generally showed that most recommendations have been accepted and partly implemented.

However, a few of the recommendations were not implemented at all.

One such recommendation was that Mater Dei Hospital (MDH) was to consider the feasibility of extending the provision of services through contracting out and PPPs to decrease waiting time.

“In 2017, MDH sought to evaluate the extent to which outsourcing of certain outpatient clinics would contribute to the reduction of patient waiting times. Outpatient clinics under consideration included Urology, Rheumatology, Respiratory, Diabetes and Gastroenterology. However, after various discussions between the main medical stakeholders and committee members, it was decided that such a proposal was not feasible and so was put on hold. This was mainly due to infrastructural limitations within the private sector and the unfeasible cost structure proposed.”

“Furthermore, MDH had also considered the option to farm out some of its specialities to health centres or other government institutions. Up to the writing of this Report, MDH contends that farming out outpatient appointments may be a slow process as well as low in numbers. This is due to the need of setting discharge criteria as well as re-appointing criteria. As at the time of drafting this report, MDH were still discussing the establishment of outpatient discharge and appointment criteria and how this could be validated in a farming out scenario.  To date, MDH has not carried out or commissioned any studies in this regard.”

The second recommendation that was not at all implemented had recommended that MDH's autonomy over the recruitment function is to be increased in order to expedite the recruitment of key staff.

“MDH contends that although Human Resources Plans and related budgets are prepared accordingly, MDH follows the recruitment procedures adopted within the Civil Service and which are established centrally. Discussions in this regard were held with the Office of Perm Sec Ministry for Health (MFH) to create a post for Outpatients Director/Directorate. However, this proposal in still not in place.”

Another recommendation by the NAO in the 2017 report was that MDH was to consider publishing real-time information relating to the waiting times pertaining to different consultants. “This implies that patients together with their referring practitioner can make more informed decisions regarding their care.”

This has not yet been implemented, but Mater Dei Hospital indicated that it will be doing so.

Yet another recommendation not implemented was that MDH was to introduce key performance indicators relating to reduction in waiting times

“MDH stated that it is still in the process of identifying and establishing Key Performance Indicators (KPIs) on waiting times at the Outpatients Department.  However, the Hospital is still to establish an implementation timeline.  In the case of SAMOC Outpatients, MDH stated that KPIs of waiting times from referrals are being monitored by the Cancer Care Pathways Directorate. “

The last of the recommendations not implemented was that MDH was to introduce attendance recording for all hospital staff.

“MDH stated that an electronic attendance verification system is already in use for specific purposes but has not been deployed across the board. Further work is being carried out by the IT department. MDH noted that there are no concrete plans or timelines in this regard, especially as factors are related to collective agreements and not technical, but discussions have been undertaken.”

Concluding the NAO noted that situation implies “that MDH is still in the process of introducing Outpatient policies, protocols and procedures.  This exercise is expected to culminate with the transfer of the Outpatient Department to a new building within the MDH footprint.  However, the target date for this important milestone has not been formally established.  In the short-term, the Hospital’s initiatives to implement NAO proposals have been limited to improving and upgrading current systems. While these initiatives have led to improvements in some areas, waiting time for a significant proportion of outpatients continue to exceed MDH established target of 26 weeks.”

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