The interests of the Maltese public were “definitely not” protected through the hospitals deal, president of the Medical Association of Malta (MAM) Martin Balzan told The Malta Independent on Sunday.
At best, he said, “members of government were naïve, at worst they were in cahoots with the scam. This is a matter for investigations to find out”.
A court at the end of February annulled the concession deal that saw three of Malta’s hospitals (St Luke’s, Karin Grech and Gozo General) run by a private entity. In a court judgment, Mr Justice Francesco Depasquale ordered that all property be returned to the government. The lawsuit to annul the concession agreement was filed by former Opposition leader Adrian Delia in 2018. Delia had argued that Vitals Global Healthcare, and their heirs in title Steward Healthcare, had not fulfilled the contractual obligations tied to the deal.
MAM said in a statement last week that it had repeatedly emphasised with former Prime Minister Joseph Muscat and former Health Minister Konrad Mizzi that it was not in the national interest to enter into the hospitals deal. “We told you so,” the union said in its statement after the court judgment.
Asked whether any political responsibility should be upheld, he said that it is not the union's role to comment on such matters and will not go into party politics, but giving his personal opinion, he believes someone should carry responsibility.
Speaking on behalf of the union, he said: "We want the government to recover the funds. If you give money to someone to build and refurbish a property, and it is not, then go to court and the contract is rescinded, the money has to be paid back. We feel that it is the government's duty now to get as much of the funds back as it can."
"The money should go where it was supposed to go, to rebuild or refurbish the Gozo General and Karin Grech hospitals and to refurbish St Luke's. Our priority is the needs of the patients and our members' interests."
Asked about the hospitals that were a part of the concession, he said that two are in use, “but are in an abysmal state of disrepair. The Gozo General Hospital needs serious refurbishment,” he said, adding that the plan was for it to be partially rebuilt.
Karin Grech Hospital also needs refurbishment, he said, and St Luke's needs major refurbishment works. "St Luke's Hospital is a listed building, so works will be more costly.”
At present, he said, Karin Grech functions as a rehabilitation hospital, “but the infrastructure is in disrepair".
St Luke's Hospital, he said, “can (after refurbishment works) either be used as a home for the elderly or else as an extension of Karin Grech Hospital, for rehabilitation”.
He said that it is unlikely that St Luke's Hospital can be brought to the same level as Mater Dei Hospital, “but it could be a home for the elderly or a rehabilitation hospital. That is a decision for the government planners to make”.
Balzan explained that since it is an old listed building, it would cause issues for it to be used as a general hospital, stressing the demands of modern technology. "At Mater Dei Hospital, the ceiling above the soffit looks like a spaceship, with networks, electricity wires, gas pipes, air conditioning tubes and more... I don't think that St Luke's can become like it."
Balzan said that through the hospitals deal, “the money that was swallowed up by Vitals did not result in any restructuring of Karin Grech Hospital, no rehabilitation of St Luke's Hospital and no rebuilding of the Gozo General Hospital".
"If you add up the last eight years, going into the ninth, it’s around €500 million."
He stressed that the government needs "to sue to get back the money given for which nothing was done".
Asked about some of those funds given to the concessionaire being allocated for wages, he said that the doctors are under the government payroll, "as we had signed a specific agreement that none of our members had anything to do with either VGH or Steward Health Care". He said that in the government budget estimates, payroll for healthcare workers is listed separately. “To my knowledge all doctors are paid from the treasury.” He also believes that other trade unions had also insisted with the government that salaries should be paid directly from the treasury rather than from a newly formed company.
Speaking about the concession deal in general, he said: “Our (MAM’s) opinion was very clear, we disagreed with the deal to the extent that we took industrial action twice to ensure that none of the doctors had anything to do with Steward. On the other hand, we went out of our way to help Gozo. We sent many doctors from Malta to Gozo and this was a stress on the families of most of these doctors and many of them didn’t like it, but we had to look after the patients. If we wanted to be really tough, we would have said 'nobody wants to go to Gozo, bring patients to Malta'. We didn't do that, we went out of our way to ensure that Gozo has enough doctors."
Difference between VGH and Steward
Asked if he saw a difference when Steward Health Care took over from VGH, Balzan said: "not due to Steward no." He said that the MAM gave government the tools not to be dependant, as doctors were only answerable to the government of Malta. "We thought that the government could use this tool to pressure Steward, which it never did. But on the other hand the government made sure that the people of Gozo received an adequate service, and not only did we not create obstructions to this, we actually encouraged doctors. We have many doctors on rotation in Gozo, but that was our initiative to ensure Gozitans receive the same level of treatment."
"I honestly don't know what Steward's contribution was." He said that nothing was done in terms of infrastructural investment. "Did the service improve? It might have, because we went out of our way to provide enough doctors for Gozo so that the service would be ongoing."
Mater Dei
As for whether, given Malta's population, the island needs a second general hospital, Balzan said that there are at least five wards at Mater Dei Hospital that are “not originally wards, but are make-shift wards. Some were corridors, one was our canteen, one was the students’ library and another was two lecture rooms". Those wards, he said, don't offer privacy, don't have enough toilet and showering facilities. "They are not suitable for 21st century patient demands."
“The rest of Mater Dei is ok, even though the hospital has been open for around 15 years. Every four rooms has a closed bathroom, there are sinks in every room... it’s a proper hospital."
"If one were to remove all the people waiting to go to nursing homes, all the people waiting to go to rehabilitation, we still don't have enough acute beds. When Mater Dei Hospital’s construction concluded, our population was 350,000 and now it is over 500,000."
Referring to government plans, he said that once Mater Dei’s Outpatients department moves out into a new block that is meant to be built, the freed up space would be able to also be used.
"The problem today is not that we don't have enough surgeons, the bottleneck is operating theatre time and space.”
To build the planned Outpatients Block (at Mater Dei Hospital), he said, somewhere in the region of €200 million would be needed. "This is our rough estimate." EU funds should be used for the Outpatients block, he said.
Balzan stressed the need for more acute hospital beds and operating theatres at Mater Dei, saying that the MAM agrees with the government's plan to build an Outpatients building, and for the space made available in the main hospital to be turned into proper wards. "By proper wards, we mean ones that provide facilities that a proper hospital should offer, like most of the original Mater Dei wards do."
He spoke about the number of foreign workers in the country. “As foreign workers start retiring, some might return to their country, some might come to old age here, so we expect the demand for acute services to increase over the next 10 to 15 years." St Luke's Hospital will help Mater Dei if it is turned into a rehabilitation hospital, a long-term residential facility or as a transit space for people waiting to go to homes for the elderly, he said.
As for whether the government should rule out future privatisation deals for the hospitals, he made a distinction between independent private hospitals, which he is in favour of, and the idea of public-private partnerships (PPPs) for the national health service, which he said has its problems.
“In order to survive, the private sector needs to generate profit," he said. "Health consumers are in a very vulnerable position and it is not a question of them having a choice as to whether they could use a service or not, they need to use it. You can take the most honest PPP deal possible and they would still need to generate a profit. So overall PPPs increase the cost of healthcare as the private partner has to generate profit. In Malta, whenever the government issues bonds they are always bought up, so I would prefer that the government has debt with the Maltese people rather than being held at ransom by a private company."
The experience Malta has just had, he said, “was a reality check and public-private partnership failed".