The president of the Medical Association of Malta Patrick Sammut has told The Malta Independent on Sunday that Malta should prioritise strong investments to upgrade primary care health infrastructure - namely the services offered by health centres and private general practitioners (GPs) - to bolster the national health sector.

Sammut believes that government should invest heavily in what he described as "the backbone of health services in our country".

He said it is important for GPs to have the instruments they need to provide a good service, especially since they "take a big load off the public service".

He also mentioned the importance of bolstering present infrastructure, service provisions, and upgrade medical professionals' working conditions to improve overall manpower and retention rates.

He raised concern that "the population is outgrowing the real estate that we have" and flagged that "in the future, we'll have to find ways of increasing the number of [hospital] beds" and expanding the main hospital.

The tender to enlarge Mater Dei Hospital's emergency department is currently being disputed before the Public Contracts Review Board after it was cancelled by government earlier this summer. The tender, valued at €80 million, was rejected after one bid of €135.5 million came in, and the government refused to finance this project at a 70% price hike.

This newsroom asked Sammut for his views on the Maltese health sector's way forward following the publication of the International Chamber of Commerce arbitration ruling about the now-defunct hospitals deal, which had seen three public hospitals passed on by the government to be run by the private sector.

Sammut was reluctant to comment about the case or its revealed findings and conclusions, stating that it is up to the people to interpret the findings. He said that any view on this political issue "doesn't serve [his] profession or patients."

The only comment Sammut provided in relation to the hospitals deal - which was rescinded by the Maltese courts, a decision that was also confirmed on appeal - was that from now onwards "we cannot accept in the future to have contracts not fully available or parts of them concealed - everything must be fully available."

Sammut told this newsroom that given Malta's presently rising and ageing population and existing health infrastructure, "service demand is outgrowing the availability of manpower." Noting that elderly people require additional care, Sammut said that the proportion of people caring for this demographic is trending downwards. In addition, he says the country needs more nurses, doctors, carers, etc., to be able to cater for increasing demands.

"We are hardly keeping up with these demands. The government is obviously going to find it difficult," he said.

Sammut commented that that the country in general needs service provisions to grow with demand by increasing care investment and manpower.

He stated that people today expect receiving the best treatment possible and the latest medications in today's digital age, with artificial intelligence already making strides in the health sector, amongst other things.

Sammut said that a mentality change is much needed in the Maltese islands for health to be catered for accordingly. He told this newsroom that aside from the traditionally understood sense, even surrounding environmental factors must be accounted for when discussing public health.

"When we say how affluent a country is, we need to think beyond finances. Unless people think outside of GDP, they will not be ready to think on those principles," Sammut said.

While discussing the need to improve retention rates for working doctors and nurses, and attract more, Sammut reiterated that "the time of just talking about finances has passed, even if it is very important."

At the moment, "resident doctors [would] go broke" if they abide by the EU's Working Time Directive and respect weekly working time limits, he said, continuing that "to have a good wage, they must work heavy hours."

Sammut stressed that "we need to find ways to give them respite" as health workers "need time to feel unplugged." He added that the country has lost consultants through the contemporary culture. He added that these professionals must be provided with good pay and conditions, remarking that "this is a very tiring job - it's not a normal job."

A report published by Research on European Junior Doctors' Satisfaction and Working Time (REST-JD) this year has highlighted that in Malta, resident doctors have as few as four to five rest days per month on average - the lowest out of all 19 European countries referenced in this study. Maltese junior doctors, on average, work more night shifts per month (6) than they have rest days (4).

It was noted that across Europe, resident doctors faced "irregular and insufficient" breaks during long shifts. Resident doctors in Malta were found to work the third-most hours per week, at 65 working hours, when compared to 18 other European countries. Maltese junior doctors are only more overworked in Greece (72 hours) and Cyprus (69 hours).

Resultantly, resident doctors in Malta also reported the lowest satisfaction rate from all participating European countries within this study. Dissatisfaction emerged as "the defining feature of junior doctors' working lives in Europe" overall. This study declared that dissatisfaction from resident doctors stems from poor work-life balance due to long working hours; it also signalled "an urgent risk of burnout and workforce attrition" and called for structural reforms to address these issues to retain more doctors for the sake of European health systems.

Similarly, a 2025 WHO report on the Mental Health of Nurses and Doctors (MeND) in the EU, Norway and Iceland found that one in three doctors and nurses report symptoms of depression or anxiety. European doctors and nurses were found to be five times more likely than the general population to experience symptoms of depression (32% v 6%). Over 10% of doctors and nurses in this study admitted to having suicidal thoughts.

21% of Maltese healthcare workers reportedly suffered from depression (lower than the EU average of 28% for general prevalence of depression amongst their peers). However, the prevalence of anxiety among Maltese respondents was sixth highest from the 29 countries in this study, at 29%.

Levels of wellbeing amongst doctors and nurses also seem to have dropped drastically, one third lower, since the European Working Conditions Telephone Survey was conducted in 2021. Malta reported the highest prevalence of sick leave taken due to mental health problems among workers with and without probable major depressive disorder, at 44%, out of all participant countries. Maltese doctors (13.5%) and nurses (23.1%) reportedly both generally use their sick leave due to mental health issues more often than their European counterparts (7.4% and 10.5% respectively).

According to this WHO report, Malta has fewer doctors and nurses per its population than the EU27+2 average (per 10,000 population: 101.5 v 123.5). Their well-being was perceived to be good, standing at around the EU average.