‘The only way forward is to stay united on health’ | John Dalli

If there is one issue in which the Maltese are not divided upon, it could well be health: here's a dimension of Maltese life that has always been buttressed by the principle of a free, tax-funded quality service.

But for years, the NHS has struggled with the public's demands for a timely service, lower waiting lists, and free medicines that are no longer out of stock. All valid demands, no doubt, and yet all of them carrying a price.

Labour set much store in promising a hospital that gives patients a better service, on time. Upon election, former EU Commissioner for health John Dalli was installed at Mater Dei Hospital to analyse the causes of so many woes inside the general hospital, and resume a reform policy he last stewarded in 2008 as social policy and health minister but shelved by his successor.

Dalli's report 'Mater Dei: a better social return' is quite light in paper count, but then again it should be the quality that counts. John Dalli describes it as "a concise, to-the-point" report.

"The report is a statement of facts. It is not an investigative report and it was not written to point any fingers at anyone. It's there to define a problem, which is the first step to solve a problem," Dalli says.

He says the report is built upon the reform he had last embarked upon in 2008, but which for "unknown reasons" had been abandoned by the previous administration after he took up his post in Brussels. He is quick to point out that he does accept part of the responsibility given his former ministerial post. "But it was effectively Joe Cassar [then parliamentary secretary] who was responsible for health. Under my wing I had rent and housing reforms, government's industrial relations and other reforms. I initiated the process for a hospital reform, including developing an IT system and collating waiting lists into a common system. The question that remains is why everything stopped after I left."

Mater Dei cost taxpayers €600 million to build and today it employs 3,900 people, but Dalli's report says it lacks direction and proper management.

"There is no adequate book-keeping system, no reconciliation of balance sheets, nobody has the full information of the hospital's assets... this is a hospital which was being managed by the civil service in Valletta," Dalli says.

He had - and still has - a vision for Mater Dei as a hub of medical services. In 2008, discussions for a possible twinning between MDH and the Johns Hopkins Hospital in the USA, so that MDH benefits from the successful systems utilised there. "My goal was to see a successful medical sector, just like we had managed with our financial services. We could have created a brand name for Malta where health could have actually become an economic sector. And I'm certain that we could have succeeded, because the Maltese are very good at learning fast from others and making it even better."

The idea was to have Malta offer specialised medical services, attracting foreigners who would pay for a service in Malta.

But the more crucial message Dalli imparts in his report is that Mater Dei must be extricated from the overbearing influence of politicians and their decisions. "Mater Dei can no longer be led by civil servants. A whole different process should be adopted. It should be managed as a business, not a health department," he says, suggesting a reform inside the Foundation for Medical Services which carries out capital projects in the health sector.

The proposal is to have the FMS turned into a holding company for hospitals, under the responsibility of the health minister. "This would change nothing in the principle of free healthcare, but it would lead to a change in culture. We could start saving money and provide different services."

Dalli says that political interference at Mater Dei went as far as interfering even in the management's decisions, for example, in taking disciplinary steps against healthcare professionals or who should or should not be employed in specific posts. "Collective agreements were signed on the eve of an election... this is scandalous. These are things which should not be done, let alone having a minister involved in collective agreements," he says, referring to eleventh-hour deals reached with doctors' union MAM earlier this year.

Dalli argues that the role of the minister should be that of a regulator: giving direction and set targets, objectives and benchmarks that ensure the service is being monitored. "It's not about losing authority, but about allowing the management to work."

And by allowing the management to carry out its job, this comes with Dalli's message that even waiting lists are not for hospital consultants to manage as "their own" as the hospital's, in a reference to the territoriality of firms inside Mater Dei. Former health minister Joe Cassar had completed the collation of waiting lists into an integrated IT system that was ready by 2010, that allowed to cut down on duplication and patients who had already received their treatment but were still on hospital waiting lists.

But a problem that Cassar encountered was a resistance by consultants refusing to submit their own patients' list into the system. "It's not on. The waiting lists belong to the hospital. And we do have a project to tackle waiting lists, but we also need to have all the necessary information in hand."

A proposal that government may soon start analysing is the possibility to tackle such waiting lists "at the hospital's periphery" - that would involve a temporary project to extend administrative work beyond Mater Dei's physical borders, Dalli says, something that would involve additional compensation for doctors and nurses. The aim is to drastically cut down waiting lists, or even eliminate long waiting times.

It would include analysing the hospital's current facilities, turning to the Gozo General Hospital and also private hospitals, to focus solely on the waiting lists.

Making the best use of Mater Dei's facilities will also mean addressing bed shortages, which Dalli says is not a question of bed quantity but how they are being used. "In reality, there are a lot of beds being taken up by social cases... people whose place in reality is somewhere else. And this is a problem which government has to solve."

The solution likely rests in public-private partnerships, but also to have MDH adopt a stringent policy to be an acute-therapy hospital. "But this cannot happen without proper procedures in place. It means that our healthcare system requires a proper measures to cater for elderly patients requiring intensive care."

No hospital reform can be of complete success without the primary healthcare reform. Dalli says primary healthcare is key, and that the health ministry had already been working in this direction. He also lauds efforts by the health minister and his shadow to move towards a bi-partisan approach on health. "Look at the success I obtained on financial services and the rent law. They were all dealt with at a bi-partisan level and they were all a success. But there was the will from both sides to work... and both sides were loyal," Dalli says. "When two sides want to collaborate, there is something that can be achieved unless they are only interested in playing to the gallery".

Amid the talk, Dalli however still labours under a patina of distrust by his own political party. When he was appointed to serve as a government consultant, Opposition leader Simon Busuttil alleged that the post had been in the offing before Commissioner of Police Peter Paul Zammit declared that no charges would be pressed against Dalli over an alleged bribery attempt on the now infamous Swedish Match case.

"I accepted to contribute to something which is 'national'. And the criticism I received was that I had now become a Labour supporter. What sort of logic is that? Does it mean that Claudio Grech's bi-partisan offering would mean turning to Labour? Uniting forces is the only way forward for health... fomenting bad blood is definitely not the right way."

Dalli says he is still a paid-up member of the PN, but that he has yet to understand the source of his estrangement from the party. "I've been the subject of a lot of conjecture and accusations for as long as I have been in politics, all of which, at the end of the day, remained conjectures."

While Busuttil has questioned whether there was political interference in the reason why the police won't arraign Dalli, after a declaration by former commissioner of police John Rizzo that he had intended to press charges against the former commission, Dalli himself accused the PN leader of being dishonest.

"What Busuttil omits is that Rizzo also told the court of interference from parliament. I would like to know what sort of interference there was. Obviously, the Opposition never refers to this.

"Nobody knows what the Attorney General's advice was to Rizzo, because he said the matter was confidential and refused to comment - unless Busuttil knows what the AG said."