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News • November 21 2004

‘Confidential’ health reforms propose new work practices and decentralisation

Matthew Vella

The Ministry of Health has outlined its vision for a reformed public health service in a discussion paper it presented to medical professionals and medical workers’ unions entitled ‘Proposals for New Working Conditions’.
A copy of the confidential report, circulated only to medical associations and medical staff unions but seen by MaltaToday, highlights various proposals for a “radical updating and adjournment of work practices,” which will include a three-tier system of management led by the Ministry, the Health Division and ‘Agencies,’ the hospitals themselves.
The reformed healthcare system will see public hospitals, mental health services, primary healthcare centres and elderly services become contracted agency providers of health services, responsible for the day-to-day management of the services in line with parameters established by the Ministry.
The Ministry will continue in its role of devising policies, strategy and performance benchmarks for the health sector, whilst the Health Division will be the regulator of healthcare for the public and private sector.
The report clearly states that the new administrative set-up contemplates changes in employment and positions at various levels, including managerial levels. A clear devolution of power is also outlined, as well as stricter audits and accountable practices for a rationalisation of primary, secondary and tertiary care.
A chief executive officer will have overall responsibility to manage the agency, with directors heading corporate departments and clinical services directly reporting to the CEO. Clinical services will be headed by directors with the support of a nurse or a clinical manager, and a business manager. Clinical units will be responsible for operational and budgetary decisions.
Each agency will be assuming in its employment all those who on the day of its inception were in employment with the government, but changes and redeployment of staff are contemplated at various levels, including managerial.
New internal and external calls for applications will be issued and public officers who will not be re-selected will be offered other positions within the agencies. It will be the management’s sole discretion and prerogative to deploy staff according to the work exigencies.
Staff will also have to undertake new training courses where necessary, otherwise they shall not be considered for the assumption of new responsibilities. Employees who are not performing duties pertaining to their job description will be offered the opportunity to either revert to their former duties or continue performing their current duties.
A re-grading exercise will also be undertaken where required. All management positions will be on a three to five-year performance contract. All employees will have to declare any private practice to the agency authorities, whilst senior management will be precluded outright from the right to practice privately: “It is expected that all agency staff members shall place their loyalty first and foremost with the agency. Non-compliance to this policy shall render the respective employee liable to disciplinary action that may lead to dismissal.”
Staff will also be expected to undertake undergraduate and postgraduate teaching as required, but will not be remunerated specifically for teaching, unless engaged against payment by other institutions such as the University to deliver lectures. Such academic activities will however not be considered to have satisfied working hours obligations, and staff will have to make good on such time.
The new reforms will also be laying down the line for audit initiatives that will establish performance management and quality assurance programmes which staff are expected to participate in as part of their contractual obligations as well as being taken into account for the purposes of their career advancement.
Government is expected to commence dialogue on the reforms in due time as well as meeting separately with the General Workers Union, the Union Haddiema Maqghudin, the Medial Association of Malta, and the Malta Union of Midwives and Nurses, to discuss working conditions for each sector of employees. Working conditions for senior clinical and non-clinical managers will be negotiated individually.






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