Issue link: https://maltatoday.uberflip.com/i/216204
8 News maltatoday, SUNDAY, 24 NOVEMBER 2013 Mater Dei diagnosis: se "WHAT is distressing of the state of play is that there is no rational reason of why Malta's health system – with MDH, currently, the kernel of such a system – is in the level of disarray that it is." This is how John Dalli prefaces a report into the mismanagement of the €600 million Mater Dei Hospital commissioned by the health ministry earlier in the year. According to the report, and disconcerting in more than one way, is Dalli's assertion that Mater Dei's financial system was "tantamount to being non-existent", with a oneentry bookkeeping system that is not covered by any accounting policies, no proper books of account, no proper records of amounts due or owing to the hospital, no control of payments made, and no management accounts that could assist management in taking proper decisions. "All these are multi-million euro assets," Dalli says, ominously of the fact that there is no effective control to manage yearly hospital operating costs amounting to €230 million; no strategic plans to sustain free health care services; no proper management of yearly contractual obligations amounting to €25 million, and the possibility of double payments to creditors. Dalli also found: No control over consumption of pharmaceuticals (€14m) and medical supplies (€20m) leading to waste and "out-of-stock" situations; Yearly overtime and allowances amount to €37m; same pay rates for "on call" and "on duty" services by doctors; untaken vacation leave and time-off allowances amount to €3.07m; no management control over payroll costs amounting to €105 million. Unauthorized transfers of high value medical equipment from one location to another; financial records disclose medical equipment at €110 million against in- ventory records of €67 million. Information Technology IT at Mater Dei is "in total disarray". No integrated system, with the government infrastructure of MITA inflicting "dictated policies, introvert attitudes, heavy-handed bureaucracy, obsessive control, and a one-track approach in procurement." Dalli even found MDH at the mercy of suppliers in accessing patient data. With the current patient database set to be discontinued by the end of the year because it is outdated, the health ministry now has no alternative but to roll over the contract with the same supplier at a cost of around €2.5 million for a new licence, with an upgrade and a maintenance agreement for a "temporary" period of five years. Staff and rosters Data from the salaries section found 534 different shift patterns among 3242 staff, mainly nurses. The shift patterns generate 22 different working hours per week and many workers who have the same duties operate on different shift patterns in different sections at MDH. "This means that the task of payroll calculation becomes a very laborious and tricky task (20 employees are required to calculate the payroll manually), a lot of disruptions are experienced in the flow of work and overtime is generated to fill the gaps created by these distortions," Dalli said. "For example, it is a frequent occurrence that operations are not started on time because the full team does not report to work at the same time, and the rest of the team has to wait for the last member to appear. Worst still, it also happens that nurses change during an operation because of roster limitations. Apart from gross inefficiency, this can also affect patient safety." Dalli also said that management had been further weakened by "interference from political masters who dictated the appointment of people without any consideration of meritocracy, forced staff movements not necessarily on an asneeded basis and who pushed pet vagaries such as family-friendly measures which, though laudable in themselves, were taken to extremes with the absurd results of myriads of unmanageable roasters." Medical inventory During 2012, Mater Dei consumed €43 million in pharmaceutical and medical supplies, "without even the basic controls and in a free-for-all environment. This must account for the waste of millions of Euros in pilferage, outdated stocks, and consumption of items at higher prices then appropriate." Dalli found that apart from the Central Purchasing Supply Unit (CPSU) that manages three stockrooms in Gwardamangia, Madliena and Marsa, there were sub-stores in Mater Dei outside the CPSU's remit. "There exist in all these stores many months' worth of stock. Everybody tries to have 'just-incase inventories' so we don't run out. Yet, we still run out [and] end up with many thousands of euros worth of expired inventories." Out-of-stock pharmaceuticals Dalli found inadequate computer systems that made it difficult to ensure that medicines were available to patients, without shortages. He blamed government bureaucracy for such problems, such as a purchase requisition taking up to 18 months to get approved. In an example, he explained how when a supplier is late in his delivery of an order, a tender is issued to bridge the expected medicine gap. 'The only way forward is to stay united on health' John Dalli's report on Mater Dei Hospital is straightforward on the challenge ahead, but the Opposition's distrust of him must be overcome MIRIAM 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 tha t has always been buttressed by the principle of a free, taxfunded 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 proc- ess 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