Barts will eat into Mater Dei resources, doctors and students warn PM

Malta’s medical students and the dean of the University of Malta’s faculty of medicine have raised a red flag over the deal inked with Queen Mary University of London (QMUL) to launch its €175,000 degree course in Malta, because it will involve “sharing” teaching resources at the medical school with student-doctors following the Barts Medical School degree.

Questions are being raised by students and doctors as to whether there are enough consultants to tutor up to 180 paying students from Barts at Mater Dei Hospital (MDH), and whether the government will increase the staff complement. Replies given to MaltaToday suggest the government will remunerate existing staff for the extra time dedicated to Barts students. 

Eyebrows were raised when Mater Dei’s department heads were recently informed in a letter from QMUL dean Prof. Anthony Warrens that clinical resources at Mater Dei will have to be accorded to Barts students.

The arrangement would mean sharing consultants at Mater Dei Hospital, already occupied with some 450 University of Malta students, with those following the expensive QMUL and Barts degree.

We are aware Barts Medical School operate on a very tight and strict tutor-student ratio [creating] an unfavourable situation for our local medical students with first preference being given to the parties of the contractual agreement. Prof. Godfrey LaFerla, dean Faculty of Medicine and Surgery UOM

It was through Warrens’s letter that the dean of the University of Malta’s faculty of medicine, Prof. Godfrey LaFerla, learnt that the government had entered into a contractual obligation to have Barts students granted clinical space at Mater Dei Hospital. “We are aware that Barts Medical School operate on a very tight and strict tutor-student ratio,” Prof. LaFerla told Prime Minister Joseph Muscat and his ministers of education and health, and the university’s rector, in a letter warning that this will create “an unfavourable situation for our local medical students with first preference being given to the parties of the contractual agreement”.

‘Barts will use Mater Dei consultants to teach its paying students’

While the government has been promoting Barts’s campus as a way of attracting paying students to Gozo, their clinical training in the third, fourth and fifth years will actually happen at Mater Dei Hospital – not at the Gozo General Hospital, which is not equipped for students’ clinical practice.

Barts will be lending prestige to the consortium that has clinched a €200 million privatisation deal for the Gozo, St Luke’s and Karen Grech hospitals, which is itself banking on attracting medical tourists to the Maltese islands.

But while Barts can charge €35,000 every year to each of its 60 students at any given year, Mater Dei’s consultants are expected to make room for this cohort of students on top of 445 student-doctors from the University of Malta.

Neither QMUL, nor the parliamentary secretariat for health, are saying if Barts will be paying Mater Dei or the University for access to clinical resources when it will be raking up to €10 million each year when it reaches its full complement of 300 students each year.

“Without the brand name of Barts, the private investors have stated that they will not be willing to commit to an investment in Gozo or St Luke’s hospitals,” says Alexander Clayman, the elected student-representative on the faculty board.

“A high quality medical school, which ours undoubtedly is, must have sufficient access to clinical resources in order to give its students adequate exposure to real-life clinical medicine and surgery – one cannot learn to become a doctor by merely attending lecturers, tutorials and reading textbooks,” Clayman says.

Students want ring-fencing

Mater Dei and Malta’s other hospitals offer university students the vast majority of clinical specialities, but as Clayman says, “too many medical students in operating theatres, wards and outpatients’ rooms is bad for clinicians, students and patients alike”.

With seven Maltese students to each consultant, this ratio is itself testimony to the strained resources at MDH: students even sit out on surgery sessions because only a maximum of three can be in the theatre at any one time.

But Barts operate a strict tutor-student ratio: two students for each consultant at outpatients and in theatre, and four students for ward rounds.

Barts plans on having 60 students every year in Malta. In their third year in 2017/2018, those 60 students will be expected to join another 502 Maltese students at Mater Dei Hospital.

Introducing more medical students into Mater Dei will almost inevitably be to the detriment of UoM’s medical students’ quality of education Alex Clayton, student rep on faculty of medicine board

By 2019/2020, there will be 180 Barts students at any time in the clinical years. “As the number… is being left uncapped, there is no assurance that the numbers will not increase further, with the obvious serious consequences to our local medical students,” Prof. LaFerla told the Prime Minister in his letter.

“In the UK, Barts students have clinical placements in 11 different hospitals. In Malta, two medical schools will have to compete for clinical placements in one general hospital.”

“Introducing more medical students into Mater Dei will almost inevitably be to the detriment of UoM’s medical students’ quality of education,” Clayman says, who is incensed at the fact that the government will not give students access to the Barts’ contract.

“It is unacceptable for UoM’s faculty of medicine to have its resources taken away from it when it is doing such a brilliant job at educating our nation’s future doctors. It is especially disgusting that our medical school is being threatened by organisations which wish to make money out of the Maltese people’s hospital and in doing so, jeopardise their only medical school. I am confident the Maltese will not accept this.”

The Malta Medical Students Association has also entered the fray, writing to health minister Konrad Mizzi and parliamentary secretary Chris Fearne demanding transparency on the contract with Barts.

“As students we were not included in any discussions with regard to any studies/surveys carried out to assess the feasibility of the introduction of Barts,” Steve Sammut Alessi said in a letter.

Indeed, the parliamentary secretariat refused to disclose to MaltaToday a survey commissioned by Malta Enterprise to assess the clinical resources available for both the University and Barts’s medical schools.

“There is the need for a formal agreement, in the form of a contract between the University of Malta and the government to ring-fence the use of Mater Dei Hospital and other health institutions as part of the teaching locations of [Mater Dei],” Sammut Alessi wrote.

Contractual agreement for clinical access

In its replies to MaltaToday, the parliamentary secretariat for health did not reveal whether Barts will be paying Mater Dei Hospital or the medical school for clinical access; nor did it explain how clinical resources will be affected by the introduction of 60 students from the Barts degree every year.

“There is agreement that the resources available and standard of clinical teaching for Maltese medical students will not be compromised,” a spokesperson for parliamentary secretary Chris Fearne said.

There is agreement that resources available and standard of clinical teaching for Maltese medical students will not be compromised... Tutors providing clinical teaching to Barts students will be remunerated at the same rate as tutors at the University of Malta.
 Chris Fearne, Parliamentary Secretary for Health

“Tutors providing clinical teaching to Barts students will be remunerated at the same rate as tutors at the University of Malta.
The University of Malta and Barts have agreed to set up an intercollegiate working group to collaborate on student placement to the benefit of both medical schools.

“The University of Malta Medical School and the Department of Health have agreed to enter into an agreement with respect to clinical training. The government will continue to provide resources for quality teaching for University of Malta medical students.”

A spokesperson for Queen Mary University of London also did not explain who will finance Barts’s access to clinical resources at Mater Dei.

“We have a contractual agreement with the government which takes into account the use of clinical resources. We understand that the government intends to remunerate clinical staff in line with University of Malta rates.”

QMUL says the ratio of medical students to consultant – a sticking point for those who say Mater Dei resources are already strained as they are – will depend on module and learning mode. “We will be working with Mater Dei senior management and the University of Malta in an equitable and collaborative manner to ensure no students are disadvantaged.”

€100 million ‘injection’

Malta Enterprise has said that over 15 years, Barts will bring €100 million to Gozo through students’ lodging needs, per diem spending, visiting relatives and the wages of non-academic staff such as cleaners, who are likely to be Gozo residents - an effect equivalent to a factory employing 500 people.

As part of the Gozo Hospital ‘health hub’ along with St Luke’s and Karen Grech, Barts will not be building the campus itself. That will be up to PHI and Vitals Gobal Healthcare who plan a €200 million overhaul of the hospitals.

Health minister Konrad Mizzi believes medical tourism in Gozo could contribute around €13 million annually, excluding hospital fees. The joint contribution of the Barts campus and medical tourism in Gozo would be equivalent to a cash injection of approximately €20 million per annum.

PPP who’s who

Vitals Global Healthcare is a wholly owned subsidiary of Bluestone Investments Malta which in turn is owned by Bluestone Special Situations 4 Limited, a private equity fund based in Singapore and managed by the Oxley Group. Oxley has a background in healthcare and aged care.

Partners HealthCare International (PHI) is the academically-based global arm of Partners HealthCare, which was founded by Massachusetts General Hospital and Brigham and Women’s Hospital, the two oldest and largest teaching hospitals of Harvard Medical School. PHI partners healthcare systems and health-related academic institutions in over 40 countries.

Barts and The London School of Medicine and Dentistry, a faculty of Queen Mary University of London (QMUL), will develop a branch medical school in state-of-the-art clinical facilities that Vitals is planning to develop.