A prescription for Malta’s private healthcare

Like much of the Labour administration’s privatisation drive under the Projects Malta auspices, the concession of three hospitals to the Vitals Global Healthcare consortium was shrouded in commercial ‘confidentiality’. Under attack from the Nationalist opposition, the government had to rebut claims that VGH – owned by private investment firm Oxley Capital through a string of BVI companies – was conveniently awarded a PPP agreement, on a tender that attracted lacklustre competition.

Well before the concession, in March 2015 Barts and the London School of Medicine and Dentistry had already signed an agreement to open a campus in Gozo, where the former general hospital there has now passed under VGH’s control. The other two hospitals are St Luke’s and Karin Grech in Gwardamangia.

Barts is a faculty of Queen Mary University of London, one of 24 universities represented by the Russell Group, which promotes the worldwide research capabilities of these centres of scientific pioneering. Undoubtedly, Barts is lending its name to the otherwise unknown VGH, to host its campus for the €30,000-a-year medical degree.

Students at the Malta Medical School, some of which may well go on to become leading doctors in private healthcare one day, have so far come out as vociferous critics of the PPP deal. Barts will need access to Mater Dei Hospital’s wards and theatres for its students, and in an already congested environment, with over 450 student-doctors out on ward rounds, the limited access to clinical practice is a bone of contention.

Prof. Anthony Warrens, director of Barts’s Institute of Health Sciences Education, says he is understanding of the predicament. “They’re worried about it. I would flag my concerns in their position,” he says. Infection control for example is an issue: with the UoM already running ward rounds of some seven students per consultant, less in theatres, adding Barts’ strict tutor-to-student ratios means overburdening the ward rounds. But Warrens brushes off suggestions of inflated ward rounds.

“As an undergraduate you’re not learning to do operations. That’s a post-graduate activity. You only need to understand roughly what happens in an operation. You don’t need to say ‘well you clamp the artery there, you clamp the vein here’, that kind of detail … you can’t learn the whole of medicine.”

Technology, therefore, is the solution proposed. Televised ward rounds and e-access; teaching surgery under a camera above the patient, sending images into the adjacent room where the students will be, perhaps watching an operation happening in London, from Malta.

Warrens hopes that clinical fellows can be employed to carry out additional teaching ward rounds in order to make sure that students get the opportunity to focus on a particular number of things, while keeping numbers relatively stable. “I am convinced that with the sum of cooperation that we now have through the joint committee with the University of Malta, we will be able to ensure that both sets of students at both universities get the very highest quality of education.”

Barts has a contract with the government in which the faculty is committed to paying for access to clinical services it uses, although Warrens does not divulge the figure when asked. The joint committee discuss at a detailed level how to work together to the benefit of students.

“I am very convinced that this can be done… Yes we will be sending students for some time to Mater Dei Hospital. In order to get a breadth of experience, students must get breadth of exposure and there will be some services that are only available at MDH that will not be available at VGH hospitals... 

“Incidentally with the reconfiguration of services, I think there will be some services that will no longer be provided in sufficient amount at Mater Dei that will be adequate for the University of Malta students to get enough exposure there, and we have said it is therefore entirely appropriate that University of Malta gets exposure to those things at VGH hospitals. It’s all about working in a collaborative fashion.”

Upgrade in medical care

Barts will take 60 students a year in its Gozo campus, and by the third year of the degree where clinical access will necessitate transplanting those students to Mater Dei Hospital, there will be 180 students, and 300 by the fifth year. Revenue from school fees by that year will be at least €9 million. And with some 450 Maltese medical students at the University of Malta, the concerns about limited access to clinical resources during teaching starts sounding justified.

“Actually let’s think on the positive side,” Warrens says. “We’re going to create a very significant community of learners, and I would like to see the learners at Barts and the learners at University of Malta working together.”

Warrens emphasises the benefits he feels Barts can bring to Malta, saying that VGH’s plan is “exciting and innovative” in its bid to upgrade medical care. “I’m very impressed by the foresight that VGH has and I’m not saying this because these guys are here, but there is greater quality to be had by forming academic international partnerships. There are data after data that demonstrate that having a research environment and a teaching environment in a hospital improves the outcomes for patient. That’s incontrovertible, it’s known throughout the world.

“What VGH is saying is ‘we don’t want to just come and set up a hospital; we want to set up a clinical environment in which there is education and research’. [We will be] part of that as a well-known, well-established educational research centre.”

As the oldest medical school in England, coming in second in UK rankings last year, Warrens understands that Barts’s reputation as a high-quality producer of medical services is something that Vitals Global Healthcare actually needs to strengthen its own hospital brand. 

“I feel positively about it. We have had the contractual right to review the application by the successful applicant from the government, which we took, and our business people went through Vitals [and] the terms of the contract. So that in fairness… a post hoc analysis, but nonetheless we’re satisfied. They said they wish us to be involved in the management of the organisation and we will sit on the board.”

VGH is also a profit-making vehicle, eager to host Barts’s teaching campus, but seeking to capitalise on Malta’s emerging role as a provider of health tourism. Warrens suggests that this sells short the business model VGH is actually promoting.

“The way it’s been described to me is there are places quite close to Malta that do not have high quality medical care for reasons that are obvious to us all. And so for some of the very routine stuff, like ordinary cardiology or ordinary orthopaedic surgery, the people of those countries do not have opportunities.

“If Malta is very close to them and we can provide high quality care then we are providing standard medical care – rather than fancy private sector or aesthetic medical care – that’s quite a social good. Financing is really another matter: there are poor people who won’t be able to take advantage of it. It’s a sad reality that we can’t provide medical care for the world. But the model Vitals has… is that it can turn Malta into a major centre for the region of quality medical care, [and] that strikes me as socially a good thing. It’s a good thing for Malta in terms of collateral benefits of industry, it’s a good thing for us because it will increase the number of patients... in other words, pathological diseases that will be an education to our students and will have research potential as well. As I understand the business model, it is potentially in everyone’s best interest.”