Issue link: https://maltatoday.uberflip.com/i/294639
Interview 12 MUMN president Paul Pace has a reputation for being 'vociferous'. It's a word he uses often when we meet at the union's offices in Mosta… though he freely admits he heard it for the first time when used to describe him- self on a radio programme. "At first I thought they were saying 'ferocious'," he says with a sudden laugh. "What they meant was that I am outspoken, that I'm always a thorn in the side of the government. And it's true. I am. I have to be, with things the way they are…" And things certainly do not look altogether rosy in the health depart- ment at the moment. One year into a new administration which promised to take the bull by the horns, many of the problems associated with public health remain steadfastly un- addressed. Pace represents nurses, who stand on the frontline of what is often a chaotic and nerve-shatter- ing situation. If he were to diagnose the specific problems afflicting the health sector, what would the main ailments be? "Let me start by saying what the problem isn't. It isn't about the pro- fessionals, the doctors or the nurses. The issues affecting Malta's heath service were never about the abil- ity or professionalism of the medi- cal staff. The issues are mainly two: work practices in the hospital, and an overall lack of infrastructure and planning." Most of these problems, he adds, were inherited from previous admin- istrations. But this does not exoner- ate the present government from all responsibility: if not in actually caus- ing them, at least in failing to come up with solutions. "I don't expect solutions in the first year. But we have compounded the problems by going too far away from the solution. We got off on the wrong foot. Not only did we not solve exist- ing problems, but we created new ones…" Yet Pace argues that solutions are not beyond the capabilities of this or any other government. "MUMN has been pointing out where the problems are for years. And we have been proved right. The latest sci- entific report by the World Health Organisation, which came out last week, found that we are short of 500 beds at Mater Dei. When I said ex- actly the same thing seven years ago, I was told to stop being ridiculous. They said that I was 'going into poli- tics'. In a word they told me I was being stupid…" He leans back with a shrug. "Now the Prime Minister has admitted it, the WHO has confirmed it…" Disappointingly, he resists the temptation to add: "Who's looking stupid now, eh?" Coming back to the bed shortage issue: as with most medical mat- ters, diagnosis on its own is rather useless without a cure. That there aren't enough beds at Mater Dei is now plain to see. Several medicines remain out of stock, too. But Pace ar- gues that, instead of addressing the issue directly, successive administra- tions have invested their energies in creating committees and taskforces instead. MUMN ruffled no few feathers by pulling out of the latest such com- mittee… earning criticism (among others by the doctors' union, MAM) for refusing to be part of the solution. How does he respond to that? "Under Godfrey [Farrugia] it was a 'management/union joint commit- tee'," he recalls. "Under [Joe] Cassar it was a taskforce. Different names, same thing. We didn't join Cassar's taskforce; we joined Farrugia's, but later resigned from it. We don't want to be part of something that is no solution at all, and that is avoiding the problem. Take the bed shortage at Mater Dei, for instance. What did the Cassar taskforce come up with? The 'bed escalation policy'… this is one of the things we objected to. Do you know what this policy is? When faced with overcrowding, they would choose which corridors of the hos- pital they will fill with beds. Instead of addressing the issue, they put pa- tients in corridors. But they called it a 'bed escalation policy'…" Under Godfrey Farrugia, the same policy was simply given a makeover. "Let's burst another bubble, shall we? Farrugia recently boasted that he decreased the number of beds in corridors. But what he actually did was camouflage corridors as wards. Instead of corridors they became things like 'mixed admissions wards 1, 2, etc'. Nice names. You can play with them all you like… but corri- dors they were, and corridors they remained…" As for MAM, he reasons that it is easy for the doctors' union to criti- cise. "MAM can go for these agree- ments all it likes. MUMN can't. Our nurses work round the clock, taking all the flak from patients and eve- ryone else. I could never agree with an arrangement that simply decides which corridors to put patients in. Consultants? They only spend around four hours a day at the state hospital. After that, they rush of to their private practices…" He doesn't conceal his contempt for this situation. "Mater Dei is an acute general hospital. It is supposed to be run on a 24-hour basis. Day or night, doesn't make any difference. Yet Mater Dei only works three to four hours a day. In the past there was at least an excuse. Consultants working for the government used to be severely underpaid. But the situ- ation has changed since 1977." [the year of the doctors' strike] "Since the agreement of 2007 consultants re- ceive a salary of 70,000 p.a., on top of a fee from university. That's more than the Prime Minister earns…" From this perspective, he argues that it doesn't make sense to con- tinue avoiding the elephant in the operating room. "Now that salaries have been in- creased, there is no longer an excuse for consultants to rush off to attend their private practices. The 2007 agreement should have addressed the hardships of the people… in finding a consultant at hospital when they need one, for instance…" Meanwhile, he wryly points out that the same patients are always able to find consultants in their pri- vate practices. "People are not stu- pid, you know. They can see what the problems are. They can see that it might take a year and a half to get a hip or knee replacement at Mater Dei, but the same operation could be done by the same consultant straight away, for a fee. You can't fool all the people all the time. They know they are being taken for a ride." Nor did the new administration make any effective management interventions at Mater Dei. On the contrary, Pace argues that it exacer- bated matters by giving even more managerial responsibility to the con- sultants. This, he adds, runs counter to the trend in Europe, where hospital management and medical staff are kept distinctly apart. "Management and medical staff should not mix. Hospital management should be in- dependent, and not run by doctors. Conflicts of interest do arise…" Yet Godfrey Farrugia in particular wanted to further empower hospi- tal consultants within the hospital's management structures. "And as usual we would be pre- sented with a fait accompli. At the last meeting of the joint committee, we were shown a power-point pres- entation. It was decided – without any consultation with MUMN – to subdivide Mater Dei into units. Con- sultants were to be responsible for managerial administration of these units. In other words, Farrugia gave an even greater managerial role to people who only stay in hospital for three to four hours a day. Can you believe it? That's why we pulled out." Nor was this the only step back- wards taken since the last election. "Another of Godfrey Farrugia's de- cisions was to place Boffa Hospital under the management of Mater Dei. Boffa, a smooth running oncology hospitable with not even 1% of the problems associated with Mater Dei, is now to be used as a pilot project for the main general hospital. Unbe- lievable!" All the same, we haven't really talked about solutions yet. Criticis- ing government's health policy is easy enough, but proposing work- able solutions is something else alto- gether. How would Paul Pace resolve these issues if he had the authority to take decisions himself? "The solution has been staring us in the face all the time. We proposed it to both ministers. And we didn't come up with it out of thin air… we based it on existing models, on how every hospital in Europe func- tions…" He outlines his vision for Mater Dei: "You would have a patient flow chart – like every other hospital – di- vided into three phases: green, yel- low, red. It's like an alarm system. There will be TV monitors in the hospital corridors, updated every 20 minutes. Green is when everything is running smoothly, yellow for when it is starting to get overcrowded and red for when the hospital is full up. When it's red, consultants will have to be present on site around the clock, signing discharge forms…" And in a situation of 'red alert', he adds, various sectors of the staff may be fined by the hospital management "if they don't do something about it." At Mater Dei, however, it is often difficult to find a consultant at such moments – without whom patients cannot be discharged from hospital – with the result that patients remain in hospital longer than necessary, even when the hospital is severely overcrowded. "By 2pm, there will be no consult- ant to discharge patients. How can you solve a bed shortage without dis- charging patients? And what did the PN government do? Instead of intro- ducing the necessary work practices, they came up with the bed escalation policy. I always challenged both Joe Cassar and Godfrey Farrugia on this. We don't need taskforces. We gave a report to both ministers, with a pro- posed solution. And the model we are proposing already exists, it is in use in every hospital in Europe ex- cept for Mater Dei." Moving on from bed-space con- cerns, Pace observes a similar pat- tern in government's failure to solve the ongoing issue of out-of-stock By James Debono By Raphael Vassallo MINISTERIAL IMPOTENCE Joe Cassar knew what needed to be done; but he never had the courage to do it. As for Godfrey Farrugia, he always was a consultants' lapdog. Always took their advice, even if it never got us anywhere WAITING LISTS People are not stupid, you know... They can see that it might take a year and a half to get a hip or knee replacement at Mater Dei, but the same operation could be done by the same consultant straight away, for a fee maltatoday, SUNDAY, 13 APRIL 2014 The elephant in the operating room