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maltatoday, SUNDAY, 16 APRIL 2017 16 News A prescription for Malta's private healthcare MAT THEW VELLA LIKE much of the Labour ad- ministration's privatisation drive under the Projects Malta auspices, the concession of three hospitals to the Vitals Global Healthcare consortium was shrouded in commercial 'confidentiality'. Under attack from the Nationalist opposi- tion, the government had to re- but claims that VGH – owned by private investment firm Ox- ley Capital through a string of BVI companies – was conveni- ently awarded a PPP agreement, on a tender that attracted lack- lustre competition. Well before the concession, in March 2015 Barts and the Lon- don School of Medicine and Dentistry had already signed an agreement to open a campus in Gozo, where the former general hospital there has now passed under VGH's control. The other two hospitals are St Luke's and Karin Grech in Gwardamangia. Barts is a faculty of Queen Mary University of London, one of 24 universities repre- sented by the Russell Group, which promotes the worldwide research capabilities of these centres of scientific pioneering. Undoubtedly, Barts is lending its name to the otherwise un- known VGH, to host its campus for the €30,000-a-year medical degree. Students at the Malta Medi- cal School, some of which may well go on to become leading doctors in private healthcare one day, have so far come out as vociferous critics of the PPP deal. Barts will need access to Mater Dei Hospital's wards and theatres for its students, and in an already congested environ- ment, with over 450 student- doctors out on ward rounds, the limited access to clinical practice is a bone of contention. Prof. Anthony Warrens, di- rector of Barts's Institute of Health Sciences Education, says he is understanding of the predicament. "They're worried about it. I would flag my con- cerns in their position," he says. Infection control for example is an issue: with the UoM already running ward rounds of some seven students per consultant, less in theatres, adding Barts' strict tutor-to-student ratios means overburdening the ward rounds. But Warrens brushes off suggestions of inflated ward rounds. "As an undergraduate you're not learning to do operations. That's a post-graduate activity. You only need to understand roughly what happens in an operation. You don't need to say 'well you clamp the artery there, you clamp the vein here', that kind of detail … you can't learn the whole of medicine." Technology, therefore, is the solution proposed. Televised ward rounds and e-access; teaching surgery under a cam- era above the patient, sending images into the adjacent room where the students will be, per- haps watching an operation happening in London, from Malta. Warrens hopes that clini- cal fellows can be employed to carry out additional teaching ward rounds in order to make sure that students get the op- portunity to focus on a par- ticular number of things, while keeping numbers relatively sta- ble. "I am convinced that with the sum of cooperation that we now have through the joint committee with the University of Malta, we will be able to en- sure that both sets of students at both universities get the very highest quality of education." Barts has a contract with the government in which the fac- ulty is committed to paying for access to clinical services it us- es, although Warrens does not divulge the figure when asked. The joint committee discuss at a detailed level how to work together to the benefit of stu- dents. "I am very convinced that this can be done… Yes we will be sending students for some time to Mater Dei Hospital. In order to get a breadth of experience, students must get breadth of exposure and there will be some services that are only available at MDH that will not be avail- able at VGH hospitals... "Incidentally with the recon- figuration of services, I think there will be some services that will no longer be provided in sufficient amount at Mater Dei that will be adequate for the University of Malta students to get enough exposure there, and we have said it is therefore en- tirely appropriate that Univer- sity of Malta gets exposure to those things at VGH hospitals. It's all about working in a col- laborative fashion." Upgrade in medical care Barts will take 60 students a year in its Gozo campus, and by the third year of the degree where clinical access will ne- cessitate transplanting those students to Mater Dei Hospital, there will be 180 students, and 300 by the fifth year. Revenue from school fees by that year will be at least €9 million. And with some 450 Maltese medi- cal students at the University of Malta, the concerns about lim- ited access to clinical resources during teaching starts sounding justified. "Actually let's think on the positive side," Warrens says. "We're going to create a very significant community of learn- ers, and I would like to see the learners at Barts and the learn- ers at University of Malta work- ing together." Warrens emphasises the ben- efits he feels Barts can bring to Malta, saying that VGH's plan is "exciting and innovative" in its bid to upgrade medical care. "I'm very impressed by the fore- sight that VGH has and I'm not saying this because these guys are here, but there is greater quality to be had by forming ac- ademic international partner- ships. There are data after data that demonstrate that having a research environment and a teaching environment in a hos- pital improves the outcomes for patient. That's incontrovert- ible, it's known throughout the world. "What VGH is saying is 'we don't want to just come and set up a hospital; we want to set up a clinical environment in which there is education and research'. [We will be] part of that as a well-known, well-es- tablished educational research centre." As the oldest medical school in England, coming in second in UK rankings last year, War- rens understands that Barts's reputation as a high-quality producer of medical services is something that Vitals Global Healthcare actually needs to strengthen its own hospital brand. "I feel positively about it. We have had the contractual right to review the application by the successful applicant from the government, which we took, and our business people went through Vitals [and] the terms of the contract. So that in fair- ness… a post hoc analysis, but nonetheless we're satisfied. They said they wish us to be involved in the management of the organisation and we will sit on the board." VGH is also a profit-making vehicle, eager to host Barts's teaching campus, but seeking to capitalise on Malta's emerg- ing role as a provider of health tourism. Warrens suggests that this sells short the business model VGH is actually promot- ing. "The way it's been described to me is there are places quite close to Malta that do not have high quality medical care for reasons that are obvious to us all. And so for some of the very routine stuff, like ordinary car- diology or ordinary orthopae- dic surgery, the people of those countries do not have opportu- nities. "If Malta is very close to them and we can provide high qual- ity care then we are providing standard medical care – rather than fancy private sector or aesthetic medical care – that's quite a social good. Financing is really another matter: there are poor people who won't be able to take advantage of it. It's a sad reality that we can't provide medical care for the world. But the model Vitals has… is that it can turn Malta into a major centre for the region of quality medical care, [and] that strikes me as socially a good thing. It's a good thing for Malta in terms of collateral benefits of indus- try, it's a good thing for us be- cause it will increase the num- ber of patients... in other words, pathological diseases that will be an education to our students and will have research poten- tial as well. As I understand the business model, it is potentially in everyone's best interest." Prof. Anthony Warrens, director of Barts' Institute of Health Science Education