Transfer of hospital services to take three years, cost Lm2.9m

A three-year, Lm2.9 million plan for the transfer of services from St Luke's Hospital to the new Mater Dei Hospital at Tal-Qroqq was tabled in parliament yesterday by Health Minister Louis Deguara.

The plan was prepared by Cyril Sweett Ltd, which was commissioned by the Foundation for Medical Services in April following a call for tenders.

The priorities of the plan are patient safety, minimal disruption, deliverability, early release of project benefits and efficiency.

First to make the move from St Luke's will be outpatients services, which will be provided from Tal-Qroqq next June.

Day Care services and a number of hospital support services will commence from Mater Dei in the third quarter of 2004 and inpatient services will transfer in the third quarter of 2005.

Although the experts had proposed three options, the migration plan report says the selected option had seven advantages: It reaps project benefits as early as possible, it keeps inpatient acute services together, thus minimising risk to patients, it allows more time for the procurement of the majority of medical equipment and IT, except for outpatients, and it allows more time for the carrying out of reforms, organisational change and operational preparations.

The selected option also involves the lowest risk of the new building no being ready on time; it is the lowest cost option, and it has the greatest support of clinical staff.

The report says the Outpatients Department will be transferred first because this was a facility which was more operationally appropriate to open as a stand alone unit as it did not require clinical support facilities immediately on site.

The opening of the outpatients' block at the earliest opportunity would enable patients to gain the benefits of the new facility and relieve the pressure on St Luke's Hospital.

The department would be housed in a block located in an area to which access could be easily separated from the construction site traffic. It could also be linked with the existing IT at St Luke's Hospital until the IT infrastructure at Mater Dei was made active.

Some outpatients facilities, however, would not transfer until the third phase of the migration plan was implemented, for reasons of clinical risk. These included obstetrics and gynaecology, physiological measurement and possibly ENT and ophthalmology.

Some offices/administration, a car parking area and the outpatient pharmacy would be open in June 2003 with the Outpatients' Department.

Temporary facilities would be required to support the department, including radiology, reception and therapy assessment/appointment booking.

Certain support services would continue to be provided from their existing base at St Luke's Hospital, including CSSD, pathology, medical records and domestic services.

The Day Care Unit, which would be transferred in the second phase (2004) could also operate as a stand alone unit.

The report explains that operations carried out in the Day Care Unit had a lower risk than those carried out for inpatients with less recovery time needed. Therefore, the same levels of back-up and emergency facilities were not required as for in-patient services.

As the Day Care Unit was a new service, it required a high level of preparation and implementation. Having it introduced a year in advance of the other inpatient services would prevent pressure of too much change being introduced at the same time as staff were preparing to move.

Departments which would be transferred with the Day Care Unit will include pathology, CSSD, medical records and various facilities management services

The third phase and by far the biggest, in 2005, would involve all inpatient services, accident and emergency, radiology, mortuary and remaining outpatient and support services.

Although the building at Tal-Qroqq would be ready for some inpatient services in 2004 it was felt best to migrate the in-patient services together because only a limited number of inpatient services could open earlier without the need for temporary emergency provisions or without increased clinical risk.

Moving the services together would eliminate the need for double running or remote working of services. It would also prevent the separation of inpatient services and accident and emergency, which would result in more emergency patient transfers.

A financial analysis of the costs of the migration plan shows that Lm548,773 would be needed for the preparation of buildings and orientation of staff.

Additional running costs over the period 2003/2005 were estimated at Lm1.37 million and an allowance of Lm1 million was being made for the contracting of a specialist removals company, probably on an international basis to manage the physical relocation process.

Replying to a question by Opposition leader Alfred Sant over whether organisations such as the MAM had been consulted over the migration plans, Dr Deguara said the last hospital migration plan in Malta was implemented over several years 70 years ago when St Luke's Hospital was opened.

Since there was no one in Malta who had expertise in this matter, the need for formal talks had therefore not been felt.

The Foundation for Medical Services had therefore engaged a specialist company which had just implemented a migration plan to a similarly sized hospital in Britain.

Dr Deguara said the MAM had said that the migration plan's priorities should be patient safety and keeping the disruption of services to the lowest possible.

Indeed those were the priorities of the plan because that was what common sense dictated.

Dr Deguara said that there had been wide consultations throughout the design and building of the new hospital with commissioning teams formed by the service providers, such as the doctors and nurses, and indeed, no one had complained that there was no consultation.

In producing the migration plan, the experts had come up with three options and one of them was selected after consultations with the commissioning teams and all involved.