Issue link: https://maltatoday.uberflip.com/i/219723
27 Opinion maltatoday, SUNDAY, 1 DECEMBER 2013 Michael Falzon No light at the end of the Mater Dei tunnel C all me a cynic, but I don't believe that the Mater Dei mess will ever be sorted out. John Dalli's report has been described as an accountant's point of view, and this is probably a fair and correct comment. The report unearths management problems mostly stemming from unproductive work practices and too many concessions from the state to the different unions representing the different people working in the hospital. The lack of coordination between the decisions taken by the state regarding different categories of workers is shocking, but hardly surprising. One need only recall that years after the 2008 election, the former Minister of Health in the first Gonzi administration, Louis Deguara, had divulged that the Ministry of Health did not agree with the final draft of a 2007 collective agreement signed with doctors. In a comment to The Times, Deguara had said the final agreement was considered to be flawed, and he never agreed with the final draft, but still signed it after being forced to do so by "orders from above". In March 2012, MaltaToday had reported Deguara saying that back in March 2007, discussions were ongoing with many unions. At that time, the migration from St Luke's Hospital to Mater Dei Hospital had not yet begun, and an agreement with doctors on working conditions was far from concluded. "All unions had signed a collective agreement except the doctors' union, so it was wise… to start discussions with the doctors… which were held with the Office of the Prime Minister, and not the Health Division, because they were not about work conditions but about remuneration, and that's not our remit," Deguara had said. That story is not about what has created the Mater Dei management mess but it is simply a symptom of the problems created and exacerbated by the mess. Today the issue has resurfaced because of the John Dalli report published last week. The confusion about who is responsible for what still reigns. The actors might have changed but the script is as old as the hills. The current Minister of Health, Godfrey Farrugia, insists that the John Dalli report is not the government's position, even though in his speech closing the initial budget debate, the Prime Minister quoted liberally from it when it had not yet been published. Farrugia even intimated that Dalli was not commissioned to carry out this report and he has two working groups working on different aspects of the management problems at Mater Dei. They do as he bids or as he would like to hear, of course! Apparently, nobody knows who is doing what to whom! Dalli's exhortation for a professional management structure at Mater Dei, removed from the tentacles of politicians, is a cry in the wilderness: it will keep on echoing for years to come but it will never become reality. I can see some progress if Mater Dei adopts an effective IT system to track and control stocks of medicine and equipment, and the computerisation of the payroll. But it will stop there. It will stop there because the politicians will not let go and because the unions are already A good GP does not become a good hospital manager overnight just because he got elected in parliament entrenching their positions, defending the 'status quo' to the hilt. When John Dalli says the Minister of Health should not have an office at Mater Dei, he is correct. The political class should not interfere with the management of Mater Dei. The current minister says that he has an office there because he is concerned with patients' needs and he is just monitoring how patients are treated without interfering in the management of the hospital. This is utter nonsense. The initial decision of the Minister of Health to dedicate a lot of time in the running of Mater Dei Hospital and particularly in its Accident and Emergency Department is a reflection of the wrong idea of what ministerial responsibilities really are. A good GP does not become a good hospital manager overnight just because he got elected in parliament as a candidate of the winning political party and was appointed a minister. Attempting to micromanage a small sector of Mater Dei Hospital is even worse. In our environment, everybody will decide not to decide and would be tempted to leave ordinary run-ofthe-mill decisions to the minister. Dr Farrugia is a successful popular and conscientious village doctor – so much so that his patients elected him to parliament. I do not doubt his good and genuine intentions but I do doubt whether he understands the enormity of the leap from his clinic at Zebbug to the Ministry of Health, with its responsibilities in various hospitals, especially Mater Dei. He is perhaps a perfect example of the Peter Principle: a proposition which states that members of an organisation where promotion is based on achievement, success, and merit will eventually be promoted beyond their level of ability. I cannot imagine Dr Farrugia – or any other politician from any political party, for that matter – to refer complaints about management at Mater Dei to the management without taking any decisions or attempting to influence management decisions. Speaking quite frankly to a journalist, the Mater Dei CEO Joseph Caruana was reported in The Times last Tuesday as saying that political intrusion at Mater Dei Hospital has, over the years, weakened the management and rendered it ineffective. The CEO explained he has no say in strategic decisions that are always taken by the Ministry of Health. He is frustrated with a system that repeatedly sees unions bypassing management to get what they want from politicians. And politicians tend to become putty in the hands of the unions, getting softer the nearer election time beckons. The unions know that administrations, Prime Ministers and Ministers come and go while they go on for ever: over time they have become incredible proficient at the game. The unions representing the doctors (MAM) and the nurses and midwives (MUMN) have already reacted to the John Dalli report by adopting a siege mentality. They will defend their turf till kingdom come – or better still till election time comes, when their victory will be assured. The Mater Dei management has to deal with four out of the five strongest trade unions in Malta. Minister Godfrey Farrugia was reported saying that he believes that mature dialogue and self-discipline would lead to solutions. How naïve can he be? Doesn't he realise that as the Minister, he should not be involved in direct negotiations with trade unions -because that would be giving the management side an unfair disadvantage? So far we have only seen the John Dalli report. No one has come out with a detailed proposal outlining a management structure and system aimed at overcoming the problems. Yet the MUMN is up in arms issuing directives because it feels the John Dalli report insulted its members… and not because someone is proposing changes that it sees as detrimental to its members! This attitude is not as silly as it looks: it serves to put management on the defensive even before management has made any proposal. I do not see any light at the end of the Mater Dei tunnel. And if Joseph Muscat and Godfrey Farrugia do see a light, it may well be that of the train that is hurtling towards them and that will run over them before they realise what is happening. Michael Falzon is Chairman of the Malta Developers Association and a former Nationalist infrastructure minister (micfal@maltanet.net)