Mamma mia!

The accusations about lack of transparency and alleged irregularities connected with the Mater Dei Hospital made recently on a private TV station by a former Nationalist Party president and MP cannot be dismissed lightly, as the Parliamentary Secretary for Finance has done. They call for a serious independent investigation.

While every effort is being made to turn the launch of the Mater Dei Hospital project into a 'splash and fun' event intended to mobilise the electorate and sway it towards the Nationalist government, I recommend that, if you have the time and patience, you read the 'Mater Dei Hospital Migration Plan Report' prepared by the Office of the Chief Executive of Mater Dei Hospital in October 2002.

We are told that Cyril Sweett Ltd were appointed by the Foundation for Medical Services (FMS) in April 2002 to assist in the preparation of a migration plan for the transfer of services from St Luke's Hospital to the Mater Dei Hospital.

This report describes the work undertaken since April 2002, and sets out the logical (or should it be logistical?) processes that were undertaken to arrive at a preferred option for implementing the relocation of services from St Luke's Hospital to the Mater Dei Hospital.

Apparently three options were formulated to implement the migration between St Luke's Hospital and the Mater Dei Hospital.

A non-financial option appraisal was undertaken using the standard methodology advocated by the English Department of Health, which requires the users to produce a weighted benefits realisation plan.

Meanwhile a financial analysis of the options was undertaken in relation to the budgets held by St Luke's Hospital.

What I found most interested was the GANTT chart showing the preferred option in detail (which one can find attached to Appendix 1 of this 67-page document).

The important aspects of this are that:

In 2003, the majority of the Outpatient Department transfers had to take place.

In 2004, the Day Care Unit was meant to open, together with a substantial number of support services.

In 2005, In-patient services, Accident and Emergency, Radiology, Mortuary and the remaining Outpatient and support services transfer had to take place.

The financial implications of the migration for the preferred option were considered in a greater detail as a greater degree of certainty was considered to have surrounded the proposals.

According to this report, of which I have a copy, the total costs associated with the migration of services from St Luke's Hospital to Mater Dei Hospital over the period 2003-2005 stands at Lm2.9 million. What it will turn out to be in real terms is anybody's guess!

The report states that no modelling of the pay budget changes had been undertaken at that stage as this will according to the same report depend on the outcome of negotiations with the unions.

What is interesting is that while various unions have been complaining of poor or inadequate consultations, the report states: "The Strategic Migration Plan has been reached on the grounds of it presenting least risk, enjoying most support from hospital staff and being the best solution economically."

The Migration Planning Process provides equally interesting reading.

Cyril Sweett Ltd had provided a programme for the drawing up of a complete migration plan with the assignment commencing in April 2002 being expected to last until 2005 "when all services would transfer to the new site".

The main milestones of this process are outlined very clearly in the Migration Plan, indicating dates of completion:

Briefing/Strategy - May 2002
Situational Analysis Report - May 2002
Departmental meetings - June 2002
Option Appraisal - June 2002
Report to Government on preferred option - July 2002
Risk Analysis - September 2002
Costs, Logistics and HR - August 2002
Strategic Migration Plan - October 2002
Draft Departmental Programmes - November 2002 to November 2004
Pre-occupation Departmental Programmes - February 2005
Move Diaries (for each Department) - August 2005.

The document promised that "A Clinical Occupation Sequence Programme for each move phase will then be formulated together with hospital staff. This will identify the preliminary sequence and dates when departments are expected to transfer. It also communicates to all concerned the sequence of their unit moves in relationship to other users."

The report lists various criteria for a Sound Migration Plan ranging from Patient Safety to Minimal Disruption, Deliverability, and Early Release of Project Benefits.

What struck me most was the segment dealing with efficiency, which stated that "the preferred option should support the most effective deployment of staff and other resources and enable more effective working practices and increased throughout to be implemented".

In 2002 the consultants stated that the following was Government's main objective; primarily that "the building and commissioning of the Mater Dei Hospital represents a major investment by Malta and therefore Government is committed to ensure that the benefits emanating from this project are reaped at the earliest opportunity".

The Migration Process Key Objectives spell out 'in theory' a number of ideal criteria for the development of a sound Migration Plan which according to the consultants "should be adhered to". These are that:

• The migration should have no adverse impact on waiting lists.

• There can be no downtime in emergency services.

• Costs should be controlled within set budgets and double running costs should be minimised.

• Disruption to staff, patients and the wider community should be minimised, and therefore transfer of services should be planned on a phased basis.

• The migration should not generate public discontent.

When the consultants' report was drawn up in 2002 they argued that additional investment into St Luke's Hospital can be kept at an acceptable level given that significant services will start operations at Mater Dei within the next two years (i.e., 2004). This option will also give Government the opportunity to evaluate its future strategy for St Luke's Hospital and will allow for the phased decommissioning and re-occupation of this hospital.

The report states (page 18, para. 3.2.7) that removal expenses have been suggested by one of the leaders in major relocation exercises around the world who have suggested that an overall budget of Lm1 million should have been allowed at that stage. Such a figure allows for all labour required to pack up equipment, mark it, put into lorries and deliver to the new site, together with an indemnity insurance at four per cent of move costs.

FMS was meant to obtain formal tenders from appropriately experienced companies for managing the relocation exercise, including insurance costs. Although it will only then be possible to determine an exact cost, it would be interesting to find out what the provisional figures and estimates for such an operation happen to be.

In its "Way forward" the document comes up with various strategic issue, including:

• Endorsement of the Mater Dei Hospital management structure.

• Decision on and implementation of a strategy to eliminate social care cases from St Luke's Hospital by the time of the transfer of services.

• Clarification of the future use of St Luke's Hospital.

• Conclusion of legislative process for the creation of the governance framework for the Mater Dei Hospital. When is this due to happen?

One must bear in mind that this final point was suggested to take place in time for the transfer of both assets and staff to the agencies to take place within the migration planning period.

While unions have been publicly complaining about on/off consultation, the strategy document speaks very clearly on human resources by stating that there should be the formulation and approval of an HR plan and commencement of negotiations with unions to enable the transfer of staff to the employment of FMS and employment of staff to meet new management and clinical service profiles.

When bearing in mind all these pious objectives, I cannot but recall the wry comment of a Nationalist constituent who told me recently that Mater Dei is one reason why not to vote PN: cost overruns, project implementation delays, and whiffs of irregularities and lack of transparency.

Meanwhile by the time this article has been written no formal detailed reply has been forthcoming from the government side about Dr Frank Portelli's serious allegations, except a feeble attempt to brush them off lightly!

Incidentally, the title of the article has nothing to do with Mother's Day. It is a natural outburst I recently heard about this living nightmare!