Tapping into all Malta’s medical resources | Chris Fearne

Apart from the announcement of a PPP with Vitals Global Healthcare for the construction and management of three hospitals – St Luke’s, Karin Grech and Gozo – separate contracts are being drawn up with local private hospitals, as well as NGOs, such as the refurbishment/management of the Addolorata, the national cemetery. Does this herald the death of healthcare as a government-provided service in Malta? 

Let me start by outlining our basic philosophy of public health. We believe that in a country as small as Malta, we cannot afford not to utilise all our resources. Traditionally – and we intend to keep it that way – the government is committed to providing a fully comprehensive health service, from before you are born, until (now that we’re talking about refurbishing the Addolorata) even after you’re dead.

The service must be of high quality, accessible and free of charge. However, this doesn’t mean there isn’t any room for contribution from other sectors, such as NGOs. We believe all these resources should be tapped into. 

So our responsibility is to work with the private sector, as well as the voluntary sector, especially when it comes to capital projects. If the private sector could provide the infrastructural investment, we would be ready to buy the service from them. The taxpayer would be spared the capital investment; then it’s up to us [government] to negotiate a comparable – ideally, cheaper – price than we would pay at Mater Dei. That’s how we’ve been working. We spend the same in recurrent expenditure, but less in capital expenditure.

Not just with VGH – but also with private hospitals like St James and St Thomas, as well as a number of NGOs. One example is the Richmond Foundation: from whom we are renting hostel services for patients with mental health issues who would otherwise be at Mount Carmel Hospital. Likewise, we work with Puttinu Cares, to provide overseas accommodation for cancer patients who need treatment abroad. And just today, we had talks with the Hospice Movement about an in-patient facility administered by Hospice, with government buying its services. 

All well and good, but isn’t this also an admission that the government can’t afford to invest in the health sector? And if so, how does that square up with the government’s claims of economic success?

No, because we are still investing in capital health projects. For example, when we came into government we found a shortage of beds in the acute health sector. We needed 450 new beds. We provided some of them ourselves, by increasing ward space at Mater Dei. We also opened the oncology hospital, which has just commemorated its first anniversary.

By the end of next year we will have a new health centre in Hal Kirkop, for which the government is providing the capital investment while management will be in private hands. In truth this will still be a government project. We are still fully committed to financing the health sector; it’s just that we don’t believe existing resources should be wasted in such a small country. That, incidentally, is also the idea behind the ‘myhealth’ scheme...

With myhealth, these doctors will have immediate access to health records – with the patients’ consent, naturally – at State hospitals and clinics. The results of a blood test at Mater Dei, for instance, would be uploaded onto myhealth instantly... where before it might have taken months. 

Another important issue is that private doctors will know what medicines you are entitled to on the Yellow Card scheme. Often, when a consultant changes the prescribed medication, the changes would not be reflected on the physical card itself. But they would be registered on the electronic database, so your doctor can prescribe the medication you are actually taking... instead of the outdated version on the card. This also indirectly reduces waste...

All the same, this scheme has already been in existence for four years...

True, but it wasn’t very user-friendly when it was first launched, and couldn’t be said to be achieving its main goal. Initially, only 700 people took part in all of Malta and Gozo... going up to just over 1,000 over the next two years. We decided to revamp the questionnaire, and this time last year we launched a new version. In the last year, the uptake figure shot up from 1,000 to 15,000. But we are still far away from our target of at least 40,000... 

Coming back to the bigger infrastructural projects: the agreement concerning St Luke’s envisages 80 beds being reserved for local patients, while the rest are for paying ‘medical tourists’. It seems that the balance is in favour of the private sector....

St Luke’s is envisaged as a rehabilitation hospital, which is something we don’t have in Malta as yet. That was originally the plan for Karin Grech, but it ended up being a long-term care facility instead: not the same thing. A rehab hospital caters for people who have had a stroke, or an accident, which incapacitated them in some way. They might need help to re-learn how to eat, or walk, or talk, etc. 

That doesn’t exist in Malta?

At present, no. But to answer you about medical tourism; yes, part of the idea is to receive paying patients from abroad. Earlier I said we are committed to providing an excellent, free service... but it also has to be sustainable. Up until now, the philosophy has always been that the taxpayer foots the bill. And to a large extent, that will remain. But medical tourism is part of our vision for the sustainability of the NHS...

Is it working so far? Malta is already advertising itself as a medial tourism destination: are there any preliminary results?

The fact that we managed to convince VGH and Partners Healthcare International – which manages the health facilities at Harvard – to invest over €200 million in a project where the bulk of profits will come from medical tourism... all at their own risk... is already evidence that it is working. 

Earlier you mentioned that VGH is taking a ‘risk’. What happens if VGH similarly pulls out of an agreed project?

That eventuality is catered for by the contracts. There are two types of arrangements we go into. The first is where the hospital or clinic already exists – for example, St James or St Thomas – and we pay for its services. The contract could be by the year, or by a fixed number of operations. Like any other contract, it is subject to conditions and clauses.

A private investor might go bankrupt; but we can also rescind the contract if, for example, we consider the service provided to be below par. Each contract includes KPIs (key performance indicators) to ensure that the service is of as high a standard, or higher, than Mater Dei. But then there is another type of arrangement, as with the Gozo hospital: which is essential for the national service as a whole. In such cases, we cannot afford a project not to be completed because the private investor pulls out.

So the contract is very specific regarding what happens in such a scenario. The entire property – staff, equipment and all – would revert to government, without having to refund the private capital investment. 

So why hasn’t it been published, as demanded by the UHM and MAM? 

As it happens, we have just filed a counter-judicial protest which answers your question. The contracts will be made public in the coming weeks.