Hospital migration - towards a sensible solution

The decision over migration plans from St Luke's Hospital to the new Mater Dei Hospital has been made official by Health Minister Louis Deguara (The Times, November 19). The whole process of transfer of services is intended to take over two and a half years!

The Association of Surgeons of Malta (ASM) is very concerned about the lengthy migration period because during this time, the inevitable disruption of clinical services could compromise patient safety at both hospitals. Briefly, it is intended that out-patient activity starts at Mater Dei Hospital as soon as June 2003, with the day surgery department opening one year later and transfer of the wards, intensive care, and casualty towards the end of 2005.

The ASM is also very concerned about the lack of consultation with the Medical Association of Malta (MAM) about the migration and by the attitude of the Director-General of the Health Division (The Malta Independent on Sunday, November 24). Dr Busuttil contends that the migration process is a patient management issue and not a trade union one and as such does not feel that discussions with the MAM are warranted.

The ASM also takes issue with the letter (The Times, November 27) from Edgar Gambin (communications co-ordinator, Ministry of Health) who attempts to justify the lack of consultation with the MAM by explaining that there was extensive consultation with 56 clinical departments. The ASM feels that there is a big difference between consultations about migration and the actual migration process itself.

The discussions that have already taken place have helped to identify the requirements of each individual department in preparation for a smooth and safe transfer to the new hospital.

However, at the Mater Dei Hospital there are intended to be changes in the working conditions for doctors, nurses and other paramedical staff and there will also be a change of employer with the Foundation of Medical Services (FMS) taking over from the government.

In this particular case, therefore, the ASM contends that the migration itself is very much a trade union matter. The ASM feels that the MAM will insist that there will need to be agreement about the new terms and conditions of service before any migration begins.

The ASM strongly supports the original political decision to build a new state-of-the-art hospital and also agrees with the subsequent political decision to increase the size of the new hospital to be able to accept all the acute services from St Luke's Hospital.

Cyril Sweett Ltd was commissioned by the FMS to advise about the migration plan. This company had just implemented a migration plan of a similar-sized hospital in Britain. The ASM agrees with their proposal of a phased migration of clinical services, however the timing of the transfer of services seems to be more related to the state of completion of building works rather than clinical common sense.

To explain this in terms the public might better understand, the ASM compares the transfer to the new hospital like moving into a new house. One does not usually have meals in the newly completed kitchen only to sleep in the old bedroom in the old house because the new bedroom in the new house is not yet ready. It is customary to wait until the new house is completed before moving.

St Luke's Hospital is fully operational and while accepting some shortcomings in décor and comfort, currently, the overall environment is safe for patient care. The quality of care offered is also of a very high standard indeed as assessed by the World Health Organisation placing Malta very near the top of the rankings in the provision of health care.

If Out-patients is to be transferred to Mater Dei Hospital in June 2003, then most clinical departments will be working on two hospital sites for at least two and a half years. This will certainly stretch the already limited manpower resources, will disrupt the convenience of clinical activity during the out-patient days and may have serious consequences for patient care.

Having the clinical team attending out-patients and at least half an hour away from dealing with unforeseen emergencies that might occur at St Luke's Hospital on the ward or through emergency admission for casualty is not an ideal situation. This potential risk has already been recognised by the Department of Health. Indeed the departments of Obstetrics and Gynaecology, physiological measurement, ENT and Ophthalmology have been identified as unsuitable for transfer in the initial phase.

The situation is even more potentially serious with the proposed opening of the Day Surgery Unit in June 2004. Patients who have unforeseen anaesthetic or surgical complications at Mater Dei Hospital will not have the benefit of intensive care facilities on-site and will need emergency transfer to St Luke's Hospital. The transfer of services from one hospital to another will always present inevitable risk.

While accepting that it is much safer to have a phased and gradual transfer, the ASM feels that the proposed period of migration is far too long and therefore the potential for serious consequences is much higher than it needs to be.

Overall, the ASM feels that it would be better to wait until the building of the new hospital is completed before the start of migration from St Luke's Hospital. The ASM also feels that the migration period should be as short as possible to limit the disruption of clinical services and to reduce the risk to patients.

The ASM urges the Health Division to open discussions about migration with the MAM and the other nursing and healthcare institutions so that there is agreement about when and how to migrate to the Mater Dei Hospital, so that the transfer is carried out safely and responsibly.

Dr German is secretary of the Association of Surgeons of Malta