Private practice | Deo Debattista

New Labour candidate Deo Debattista firmly believes that the long term solution to Malta's health problems lies in durable partnership between government and the private sector, and agrees with the most controversial aspects of a reform of primary health care proposed by Minister Joe Cassar in 2009: namely, the provision of primary heath services by State-sponsored private doctors engaged in "group practice".

When asked for his views on the government's decision to rent St Philip's Hospital, he succinctly replies that what while the "aim is right the procedure is wrong".

In a recent interview with sister newspaper Illum the new Labour candidate singled out waiting lists and the situation in the emergency department as the major problems afflicting the health system. But concretely, how should these problems be tackled?

Debattista considers the agreement signed between government and three private clinics, with regard to MRIs and arthroscopies, to be a "positive step" towards solving these problems.

"But this thing should have been done a long time ago. Involving the private sector is the only way to reduce the waiting list with immediate effect. Yet this is only a short-term solution. The only long term solution to the waiting list problem to prevent appointments from accumulating again is an ongoing process between the private and public sectors."

While welcoming agreements with private clinics, Debattista expresses his concern that this could be simply a "pre electoral measure" aimed at pleasing voters and not a long-term solution.

Another factor contributing to long waiting lists were the "miscalculations" at planning stage when determining the number of beds at Mater Dei.

"One cannot blame Minister Joe Cassar for this. Unfortunately he has inherited this problem and now has to solve it. But it was a serious mistake not to heed the advice of professionals who had already warned of this problem before the hospital was built."

Debattista thinks that the long term solution will be "either an extension of Mater Dei or an alternative location to keep up with the demand".

But how sustainable is our health system?

"It is sustainable for the simple reason that we always find the money for other things. Just as we find money to build bridges leading to nowhere and to build a new parliament when we already have one, we can find the money for these purposes."

Debattista also signals his agreement with the principle guiding the reform of primary health care proposed by the government three years ago, which aimed at encouraging 'group practice' and shifting the burden from policlinics to the private sector, with  government still footing the bill.

Debattista complains that this system was never implemented.

"I am in favour of a reform in primary health care. The problem is the way it was how such a reform is implemented."

The reform was first proposed by Minister Joe Cassar back in December 2009. One of the main thrusts of the reform was that patients would have had to register with their family doctor. This would have forced doctors to cater for their registered 1,500-2,000 patients on a 24/7 basis. This would have forced family doctors to engage in group practice. This aspect of the reform was resisted by backbenchers Jean Pierre Farrugia and Michael Gonzi, who argued that it would penalise family doctors.

Debattista recognises that some older doctors are not used to the idea of group practice.

"Instead of setting deadlines which were never met, we should have implemented a pilot study in a particular area which already has a system of fully equipped private clinics in place and then analyse the pros and cons of the system, and learn from this experience."

Ironically Debattista's proposals suggest an ideological convergence in the health policies of the two major parties and a continuation in the current government's policy of farming out public services to the private sector.

Is there a risk that government would end up forking more money to compensate the private sector to offer services presently offered by the public sector?

"That is why I am proposing a pilot study."

He cites reforms being currently implemented in the United Kingdom, through which the government would allocate a budget to private clinics and in return cater for a specific number of patients while employing doctors at its own expense.

The system would put the burden away from the public sector, as it would also provide services like radiology and arthroscopy. Ironically,  British Labour leader Ed Miliband has vowed to reverse the NHS reform bill, which would give GPs control of much of the NHS budget and open up the health service to greater competition from the private and voluntary sector.  

But according to Deo Debattista,  the approach taken by the UK would represent the long-term solution to the waiting list problem.

"This system would be monitored by both government and patients."

Has Debattista proposed the reform of primary health care which he is proposing for inclusion in the PL's new electoral programme?

He replies that he regularly passes on his ideas to Labour but makes it clear that such proposals can only be implemented after serious studies.

"The Labour Party's outlook is to first conduct studies on the viability of any proposal."

In his interview with Illum, Debattista had said that he failed to understand the urgency of building a new parliament arguing that this money would be better spent on health.

"We could well have retained the existing parliament and I cannot see the urgency for a new parliament, we could well have spent this money on greater priorities like addressing the problems in the public health sector."

But doesn't Malta deserve a modern and fully functional parliament considering the physical limitations of the present one?

Debattista replies that even if one were to accept the urgency of developing a new parliament, this could well have been accommodated in an existing building like Auberge de Baviere, which could have been refurbished to accommodate parliament while retaining its classical architecture.

Debattista, who hails from Valletta, also makes a distinction between building a new parliament and the need to renovate City Gate.

"I talked to several people about this, including the late Fr Peter Serracino Inglott... the idea to rebuild City Gate was a brilliant one and I had been clamouring for this for years. Therefore, I praise Lawrence Gonzi and Austin Gatt for this decision, but what counts is the result... it is like deciding to repaint the house and than decide to paint it with an inappropriate, permanent paint."

But the Labour candidate is non-judgmental on the design presented by internationally renowned architect Renzo Piano.

"Well, if you assign the job to a hundred architects, one would end up with a hundred different models."

What irks Debattista most is the idea of inserting a new parliament in the project, when this could have been accommodated elsewhere at a far lower cost.

"In this way, we could have still rebuilt City Gate and instead of a new parliament we could either have constructed something else or retained the square as a public open space."

But considering that parliament is the highest institution of a country,  what's so wrong in locating it in the most prominent space and investing money on it? After all, this money will not be invested in a grandmaster's palace, but in the parliament elected by the people?

"First of all, we could have opted for an alternative location which could have been less costly and we should have been more sensitive to the fact that the country is in an uncomfortable financial situation and that money is in short supply. Therefore, it would have been wiser to invest this money to ensure the sustainability of the health sector. One has to choose between embellishment works and the needs of the sick."

Debattista was born and bred in Valletta and is proud of the city's heritage. How does he react to the recent census which shows that the capital city losing a fifth of its population since 1995?

Debattista points out that the entire first district - which includes localities like Hamrun and Floriana - is in decline. He also says that the Electoral Commission had to include parts of Santa Venera and Marsa within the first electoral district.

One of the things that strikes Debattista most is the large number of vacant properties, a reality he faces everyday during his door to door campaigning.

"In localities like Floriana, half the houses I visit are vacant. In Hamrun one finds large houses previously occupied by large families now occupied by a single person."

He attributes this exodus to the fact that newer localities are more accessible in terms of parking than Valletta and other first district localities.

"Parking is a big headache in all localities in the first district. Not finding a parking space after a day at work is stressful".

Debattista is also critical of the fact that open spaces have been created without finding an alternative for the car park spaces lost.

"I am certainly more than pleased with the beauty of St George's Square. But it would have been wiser if we found a replacement for parking spaces we've lost."

He also attributes the decline in business in Valletta and Hamrun to the lack of parking spaces.

"It is obvious that business is diverted to places with better parking facilities, like Sliema."

As regards the other side of the Grand Habour (the Second District), government has to address the housing problems and aid families to achieve better academic goals.

In a previous interview, Debattista said that "social conscience" is the primary motivation in his political commitment. Does he agree with the Labour Party's stance against an increase in the minimum wage over and above the COLA increase until this is sustained by economic growth?

Debattista immediately condemns the PN's attempt to misinterpret Labour's stance, as one against COLA increases which is clearly not the case. But he defends Labour's stance against an increase in minimum wage before the economy picks up.

"One can easily say that one would increase the minimum wage by €10 to please the majority of voters, but it would not be fair to promise something popular which would crucify employers."

But aren't minimum wage earners a small minority (less than 6%) in the working force?

Debattista replies by pointing that an increase in minimum wage would have a domino effect on all wages in the country.

"How can you give an increase in the minimum wage and ignore those workers who presently earn a little more than the minimum wage? Wouldn't these workers also demand an increase not be overtaken by people presently earning the minimum wage? And wouldn't this have a domino effect on all other income groups as those immediately below them get a wage increase? How can one accept that someone's senior ends up getting paid as much as his or her junior?"

But a Caritas report published in April made it clear that the minimum wage has to increase from €158 to €180 to ensure that minimum living standards while stating that the raise should be limited to present minimum wage earners. Is Labour afraid of making similar proposals?

"Probably, because this would not be feasible at the present moment.  Just as it was not feasible to increase the ministers' honoraria by €500."

What is the difference between the Labour and Nationalist Party today?

According to Debattista, while the PN is stuck in the past and always looks back at the past to justify the present, Labour has adopted a forward-looking approach based on the positive aspects of governance in other European democracies.

Debattista is irked by constant references to the 1980s.

"If Japanese politicians kept reminding their American counterparts of Hiroshima and Nagasaki, these two countries would never have become the prosperous allies they are today."

He also criticises the current administration of lacking long-term plans and constantly resorts to crisis intervention, especially in the health sector.

Contrary to the government's claims, another problem which is raising its head in the country according to Debattista is unemployment among young people.

"What we need in this camp is to conduct perspective studies to show young people which kind of jobs are in demand. We should never limit their choices or options but their choices should be informed by these studies. I am against any restriction on the number of students taking any particular subject but young people should know what kind of jobs will be required by Malta and Europe in the future."

One question everyone is asking is: how will Labour decrease electricity rates?

Debattista admits that even during home visits, people ask this question.

"There is an alternative way of producing energy to Heavy Fuel Oil...one does not find a single study on the internet to justify the use of HFO which we would have eventually to replace due to EU directives. Why spend millions when we could have opted for natural gas?"

But does he blame the people for being sceptical about Labour's ability to honour its pledge to decrease utility bills?

Debattista acknowledges that people are losing their trust in politicians in general and attributes this scepticism on electoral promises to past disappointments with the political class.

"Politicians are taken with a pinch of salt. I am committed to try to ensure people that there is nothing between the lines, and politicians are again given more credibility. I feel I have a duty to change this state of affairs. To get my opinions heard and things changed I had to step on a political bandwagon, and I believe this new Labour Movement is ideal for things to change in the right direction.

Debattista claims that his primary motivation in joining the political fray was that of seeing his ideas implemented. 

"The thought has been lingering in my mind for quite some time but I guess that I was looking for the opportune moment.

"My motivation for contesting elections and entering the political scene is to see my ideas implemented.  I did not want to remain an armchair critic."