Of health and all that

The Labour Party believes that public healthcare should remain free and Michael Farrugia, a doctor by profession, is the man leading that charge. Here he speaks of the current situation at St Luke’s, Mater Dei and the smoking ban

Many have tried to unravel the cobweb that is Mater Dei, or the new hospital that was supposed to be the Nationalist government’s millennium present to the people. It has been hounded by delays, allegations of corruption, scandal and all sorts of problems that would make a beautiful fairy tale if only this were a banana republic.
There have been few plausible explanations as to why the construction of this hospital has dragged on for years at a cost that is ballooning year in year out. After taking office again in 1998 the Nationalist government had promised that the hospital would start receiving its first patients by 2003 but up until today the hospital remains a ghost building inhabited by scores of Filipino construction workers, engineers and a couple of idle cranes.
Inevitably Mater Dei is one of the first items on my agenda when I meet Labour’s shadow minister for health, Michael Farrugia. His is a simple explanation as to why the hospital has missed its targets at a cost that is crippling public coffers.
“The agreement reached with Skanska in February 2000 did away completely with the tender awarded in 1998 by the then Labour government to a different hospital-design company.
“The new agreement undid what was already in progress but what is more worrying was that it gave the Swedish consortium a 10 year timeframe for completion, which meant that any costs had to be calculated at a higher risk factor. Furthermore, Skanska were entrusted to design the hospital, construct it and act as project managers.”
For him the main reason for the delay is a flawed agreement. But he goes further and draws comparisons with another hospital that was constructed in England, the Norwich and Norfolk Teaching Hospital. “It is 50 per cent larger than Mater Dei and construction started in 1997. The hospital was ready by 2001 at a total cost of Lm150 million. Mater Dei’s estimated completion cost in 2000 was of around Lm110 million but this has already been surpassed with only the infrastructure being put in place. The estimate now is that Mater Dei will cost Lm200 million. When one compares Mater Dei to the English hospital the figures speak for themselves,” Farrugia says.
In pure doctorspeak he says that an autopsy should be carried out on the various controversial decisions that have also contributed to the delay but insists time should not be wasted on them to the extent that work at the hospital site grinds to a halt.
Farrugia says that after the hospital equipment tender was awarded to the Italians, Inso, government has refused to divulge the type of equipment and how much of each item will be installed. “And I can understand why,” he says with a telling smile. “From the information that is reaching me, hospital consultants are not happy with the quality of the equipment being offered by Inso and are asking for it to be changed. This is creating further problems.”
He then delves on the controversial equipment tender: “The appeals board had annulled the tender that was awarded to Inso because it felt they breached a number of clauses in the tender document. After that, discussions were carried out with the Dutch consortium Simed. Whether these negotiations were conducted properly is doubtful but the Foundation for Medical Services decreed that certain levels were not reached.
“When the discussions with Simed led to nowhere a ministerial decision was taken to award the contract to the Italians. Today it is still unclear whether the contract finally awarded to Inso is the same contract which the Appeals Bboard saw fit to annul in the first place.”
Farrugia goes on to mention the proximity of the decision to award the hospital equipment tender to the signing of the Italian protocol. “If government faced pressure to award the tender to Inso because of the Italian protocol it should have said so immediately and awarded the tender to the Italians directly,” he says.
While the Prime Minister grapples with the financial burden that is Mater Dei, the health minister has to sort out the daily problems that arise at St Luke’s Hospital. In a recent statement, Farrugia went on record saying that the quality of healthcare at St Luke’s was mediocre and deteriorating.
I ask him for an explanation and it comes in two parts: a shortage of basic supplies and overcrowding.
“If the shortages of basic supplies lasted for a week or so I would call it a mishap. That can be solved. But when shortages persist for a number of weeks and sometimes months it is not a mishap but mismanagement.
“In a number of wards there has been a shortage of plaster and patients have been asked to buy it themselves. There were other situations where non-sterilised gauzes, usually used to clean blood from patients were not available. In the Emergency Department for some time nurses had either to clean patients’ wounds with normal tissues or else use the more expensive sterilised gauzes. In the latter case it made no economic sense for government,” Farrugia says.
His litany continues: “The same happened with non-sterilised gloves. There was a shortage of them and in some cases the staff complained that the gloves provided were of a poor quality. The only alternative left was for staff to use sterilised gloves even if the situation at hand didn’t necessitate such a high level of safety. This once again made it economically unfeasible.”
While Farrugia’s accusing finger towards government as regards shortages is understandable, surely government cannot be blamed for the overcrowding situation. No government has control on the number of people who get sick thus contributing to the sometimes alarming situation.
Farrugia concedes the difficulty of having just one general hospital where patients cannot be transferred to other hospitals. He expresses concern at what he claims has become normal practice to place patients in beds in the middle of rooms. “This situation already creates privacy problems for patients let alone when they are placed in ward corridors where they have to be washed, medicated and sometimes die in front of everybody else with no privacy whatsoever,” Farrugia says.
But what is his solution to this problem?
Farrugia replies: “Government needs to invest more in primary health care. A major problem that hounds St Luke’s is the bed space taken up by convalescing patients, who are not there for medical cure but simply being rehabilitated to return back to the community.
“We have no rehabilitation centres and although a ward was opened in Boffa Hospital to try and ease the problem, it can only take six or seven patients. However, at the same time the Spinal Unit was closed down and this catered for patients in long term rehabilitation.”
I suggest that this might be a long-term vision, but it won’t solve anything for the current overcrowding situation. Farrugia disagrees. “We can find alternative places if some infrastructural works are conducted in already existent government properties.”
He cites as an example Mount Carmel Hospital where a number of wards are unutilised and can be structurally revamped to serve as a rehabilitation centre.
“It is all a question of whether one can make good use of available structures that are not being utilised. These could be used for a short term to alleviate the pressure overcrowding is putting on St Luke’s,” he says.
And like a ghost lingering in the cupboard, coming out each time somebody dares venture into medical matters, Farrugia mentions the Mater Dei hospital once again. “Government probably did not invest in such temporary measures because it banked on the idea that the St Luke’s outpatients unit would have been transferred to Mater Dei as of last year. If that had happened the outpatient unit in St Luke’s could have provided additional space after minor structural works for rehabilitation cases.”
Talking about having the best healthcare facilities is one thing but picking up a calculator and adding up the bill is another issue altogether. Does Farrugia contemplate having a system whereby fees are charged for public healthcare services?
“Let us look at the current situation. Is this being suggested because we have a deteriorating economic situation or because those speaking on these lines truly believe in this system? Is the healthcare system unsustainable because the country is in an economic rut? If it is so, it jars how government still found Lm9 million to spend on Malta House in Brussels. We have to decide on our priorities: the Brussels millions or more investment in the health sector. If we have a precarious economic situation, should we try and solve it or simply give up and cut down on welfare?
“The Labour Party believes that certain social services should continue to be given free of charge and should be improved. To make this possible the economic situation has to improve and new investment has to come our way. Only with a sound and stable economy can we continue to finance the healthcare system.”
I insist that the Labour Party is not new to charging fees for what was previously a free service, recalling the controversial 50 cents introduced on medicines during the 1996-1998 Labour government.
Farrugia defends the decision that was: “It was a nominal charge and it did not ‘tax’ a service. Apart from that the decision had far-reaching aims. When it was introduced we were discussing with the GRTU and the Chamber of Pharmacists the concept of ‘pharmacy of your own choice’ so patients could collect their free medicine from pharmacies in their community.
“The idea behind the nominal charge was to convey the message that medicines are not there to be stockpiled by patients and simply thrown away. The fee was not going to placate any financial black hole for government.”
He concedes that the Labour government was overwhelmed by the Nationalist Party, which made the issue its battle cry despite having declared in a 1996 article that appeared in The Times that it favoured the principle of cost-sharing in healthcare.
Another issue that is soon to raise its head is the smoking ban in all public places including restaurants and entertainment outlets, which is due to come in force on October 1 for the larger establishments.
“Health-wise it is a good concept and I dare say that even in designated smoking areas one should still insist that air purifiers be utilised for the benefit of smokers,” Farrugia says.
He seems to agree with the ban but still finds an excuse to attack government. “The cardinal point in all this issue was government’s almost dictatorial way of implementing these new regulations. Each time government does this it faces the music afterwards and something that is potentially positive finds resistance,” he muses.
“The issue at stake is whether passive smoking causes harm or not. Both smokers and non-smokers have rights that need to be respected but governments have a general tendency to make a lot of mistakes in the way they ‘sell’ their arguments and go about implementing regulations.”
Farrugia does not stop at that. He realises that the smoking ban regulations could create huge problems for the smaller outlets. “As a spokesperson for health I am interested in my sector but one must take a holistic approach. It is worrying that the parliamentary secretary for the self employed knew absolutely nothing about the regulations that were going to be implemented by the health minister. There seems to be no internal government co-ordination.”
Before we part I ask Farrugia whether it was time to tackle the drug issue in a more progressive way by adopting a different approach on soft drugs. It has been all too characteristic now for politicians to declare war on drugs. Farrugia is not that different even if he believes that certain laws should be re-evaluated.
“Everybody who ended up on hard drugs started by using soft drugs,” he tells me in typical mainstream political-speak. “That one should re-evaluate certain laws we have in place, I agree. We should make punishments harsher for some crimes but in other aspects punishments should be softer. Being more lenient on soft drugs for me means more lenient in the way punishments are meted out by the courts if somebody is caught in possession.”
Legalisation of drugs is certainly not on the mind of this politician and with that we sip our last drops of coffee and part company.