[WATCH] Jo Etienne Abela: ‘I cannot remain shackled by Vitals’

There is a creeping frustration when I sit down with Health Minister Jo Etienne Abela and bring up the Vitals fiasco. 

According to doctors’ chief Martin Balzan, 11 years were wasted running after a public-private partnership project that failed. 

Abela does acknowledge the Vitals-Steward concession did not deliver but insists his only connection to the deal now is the ongoing international arbitration. 

Abela was only appointed health minister in January, having had nothing to do with the concession that was annulled by the court and now sees several people being charged with crimes, including corruption. 

“I am not saying that we must forget but I cannot be shackled by what happened every time I want to move forward and propose new strategies,” he tells me. “I became responsible for health in January 2024 and my job is to prepare the country for the next pandemic.” 

Abela defends public-private partnerships, which he says have long been adopted in the healthcare sector. “Lessons have been learnt from Vitals; public-private partnerships should be solid commitments with people who have a track record in healthcare,” he says. 

And the minister is not shying away from exploring public-private partnerships to ease the pressure on Mater Dei Hospital’s Emergency Department. It is one initiative among several Abela has unveiled to ease the pressure on Mater Dei, boost bed space at the only acute general hospital, and utilise St Luke’s and Karin Grech hospitals. 

Abela says Mater Dei’s administration is being moved out and the space will lead to the creation of a new ward with around 50 beds that can start being used in the coming winter. He insists waiting times at the emergency are also dependent on having available beds in wards where patients requiring hospitalisation can be transferred. 

Eventually, outpatient services will be shifted to St Luke’s hospital, increasing Mater Dei’s capacity. 

But until the medium to long term plans come to fruition Abela wants to introduce two new policies at the Emergency Department where a patient would be seen immediately by a specialist who can determine the treatment plan, and follow through with it.

The following is an excerpt of the interview. 

The full interview can also be viewed on Facebook and Spotify.

[…] Is the situation at Mater Dei Hospital so precarious in normal circumstances that a wave of admissions can cause collapse at the Emergency Department and the hospital in general? 

[...] I have heard and seen with my own eyes people who have waited [for long hours] at the emergency and I reiterate that the fact that every emergency in the world requires people to wait until they are streamed into different treatment channels is not an excuse. 

[…] the hospital system is like a conveyer belt. If a patient comes to the Emergency Department and the specialist doctor determines they require hospitalisation, it means the hospital has to have space to host that patient… there are several beds at Mater Dei Hospital that are blocked by elderly people waiting to be transferred to a home. 

[…] since January, almost 400 people were moved out of Mater Dei and transferred to homes. 

[…] We want to increase the capacity of residential homes for the elderly. As things stand today, every bed available in the market has been bought by the government… 

But at the Emergency Department… The long-term aim is to increase its size from 30 cubicles to 70… this will also enable us to increase the capacity of the ITU from 20 beds to 28 and at the same time build an acute mental health facility. This is one project but it will take years to complete. 

In the more immediate future… and let me make it clear nobody is skiving…

People’s complaints are not about workers at emergency. Patients complain because they have to wait 12 hours and more. 

We need to change the manner by which we assess patients. When a patient arrives at emergency, they should register and move to triage stage – the waiting time between registration and triage has remained around 15 minutes – and then pass on to the first senior medical contact unlike what happens today. This means that a patient is seen immediately by a specialist with the skills and experience to decide the definitive treatment required and will be followed through by that specialist… this will expedite the process…

Will you find resistance from the doctors’ union to introduce these two principles? 

We have been talking with unions and I have given the go-ahead for financial incentives... funding is not an issue. I understand the hurt of patients and their relatives and they should come first. If, with the existing resources, the only way to improve the service is to introduce these two principles then I will push for them. These changes have long been considered and now is the time to implement them.

MAM President Martin Balzan said the country has wasted 11 years amid a population boom during which the government pegged its health vision with the Vitals hospitals contract… The government has to shoulder responsibility for this state of affairs. 

I do not have the luxury to sit down, drink coffee and stay theorising. My job is to improve the health service… my job is to prepare the country for the next pandemic. I have met different unions several times and I believe when we are discussing the way forward it is not right that someone goes into a litany of all past health ministers in an attempt to convey the message that they have more experience than me. It is an insult to my intelligence… We put forward a lot of proposals but having one particular union telling us ‘no’ to every proposal, including the two principles I want to introduce at emergency, is not healthy.

I can understand your personal position given you only became health minister in January this year. But you have to understand that whoever came before you formed part of the same government and 11 years were lost. 

On Vitals and Steward, the government is engaged in international arbitration to recover any money that was wasted… I have spoken with the lawyers fighting our corner and I am happy they are doing everything legally possible [to win the case]. But I cannot remain shackled by Vitals and Steward… government has been engaging in public-private partnerships for many years…

But can you fault anyone who argues the Vitals experience was so bad that the moment you mention public-private partnership red bulbs light up? 

I fault no one but this is an insult to the private healthcare sector in our country… I wholeheartedly believe in the private Maltese healthcare system…

But the private sector you refer to is made up of doctors and people who were always involved in the medical field and know what they are doing. Vitals was anything but this… 

[Vitals] is the past and my connection to it is the arbitration process underway. What interests me is the future. I cannot accept a situation whereby because of the Vitals-Steward case, every type of public-private partnership is labelled bad… we must learn lessons from the past. We should have public-private partnerships with people who have long experience in the medical field.

How can you continue working as a surgeon at the same time as being minister? Isn’t there a conflict? 

My dispensation was to continue operating in those areas where the expertise and skills in Malta are extremely limited. I am not doing small surgeries… This year I carried out 15 surgeries, four of which were emergencies… my dispensation allows me to offer assistance whenever my colleagues believe I can contribute because of my particular skills set… I do not choose my patients. I do not get paid extra for my work…

In Cabinet, there are other ministers who have different professions and they have had to give them up. 

I am a health minister but if a colleague of mine turns to me and tells me a patient requires an operation and the best placed person to do it is me, what should I tell my colleague?

I have no doubt that your instinct would be to help the patient but the argument is should you be a minister if your skills are so needed? 

This argument will be excluding a section of people, in a discriminatory way, from politics and decision-making roles… Given a chance to help a patient, should I say no? It makes no sense to me…

Are you a part-time minister? 

Absolutely not. If anything, I am a part-time surgeon. But a part-time minister definitely not given the measures, plans and strategies we have been developing since January.