Reports and analysis on Tal-Qroqq Hospital 1996-1998

From its conception, the Tal-Qroqq hospital was surrounded by controversy. In the early 1990s, the Nationalist government led by Dr Eddie Fenech Adami was convinced by Dr Louis Galea, the minister responsible for health, and his friend, Fr Charles Vella, to introduce in Malta the Fondazzione San Raffaele run by Don Verze.

When it came to choosing whose services to use in building the new hospital, the Nationalist government swiftly hand-picked the Fondazzione San Raffaele. This was done without any issue of a call for tenders. It was a choice based on contacts with friends of friends!

The Nationalist government, together with the Fondazzione San Raffaele, finally decided to build a 450-bed hospital. They also chose to split the acute medical services in Malta into two: part of the services being given at the San Raffaele Hospital in Tal-Qroqq and the rest of the acute medical services being given at St Luke's Hospital - thus duplicating several resources and pushing up recurrent expenditure.

It was decided that the Maltese government would build the hospital and leave the running of the hospital to the Fondazzione San Raffaele. The government was to pay the Fondazzione San Raffaele for the services given to patients!

At the time, the Nationalist Government was contemplating the introduction of a co-payment system, where the patient had to pay partially at source for the medical services provided.

The representatives of the Maltese government and the Fondazzione San Raffaele chose Ortesa as the designers of the hospital, yet again without any call for tenders! Delays and disarray in the initial designs cost government a few million liri in claims by the building contractors Skanska. Up to March 1996, Skanska maintained that 50 per cent of Ortesa's mechanical drawings required adjustment.

It is worth recalling that, although Skanska was chosen after a call for tenders, the process was a matter of controversy, with the courts proclaiming that the Minister of Finance had exceeded his limits.

By October 1996 work started on the San Raffaele Hospital and several million Maltese liri had already been spent on the project. At the time, the hospital was supposedly nearing operational status, yet only two basement floors had been nearly completed.

When the Labour Party won the 1996 general elections, it inherited a hospital concept that it did not agree with. We had to see how to sort out the utter confusion we inherited from the Fenech Adami government. As Minister for Health, I immediately commissioned a number of reports on how to bring order to it.

In the meantime, I held discussions with all the stakeholders in the health sector. All reports from the stakeholders were against the concept of the split acute hospital services. All stakeholders lamented that, prior to October 1996, they were never consulted by the Nationalist government about the San Raffaele Hospital.

We quickly found out that the Labour government inherited construction plans of a hospital service scenario that not even the local medical experts agreed with.

The Labour government decided to rationalise the whole concept based on the medical and surgical needs of our people in the 21st century. For this reason, the Labour government commissioned a number of reports to be in a position to take informed decisions about the hospital.

One of the main reports was commissioned to the Management Efficiency Unit (MEU). Mr Silver, an expert from MEU together with his team, presented a report with all possible scenarios including:

A new acute 1,000-bed hospital in Tal-Qroqq;
Refurbishing St Luke's Hospital to modern standards;
Changing the Tal-Qroqq hospital to a 600+ bed acute general hospital with St Luke's Hospital as a 450-bedded chronic hospital; and
Refurbishing St Luke's Hospital to a 600+ bedded acute general hospital with Tal-Qroqq hospital as a 450 bedded chronic hospital

The difference in capital expenditure in all scenarios was minimal.

As a result of these reports, the Labour government decided on building an 800-1,000-bed hospital in the Tal-Qroqq area. For this reason, fundamental decisions were taken. I commissioned a new medical brief, which was later to be audited by an international firm after a call for tenders.

As a result of the medical brief, a design brief was to be put forward. In the meantime, the contract with Ortesa was terminated and a new tender for designers issued.

The Fondazzione San Raffaele disagreed with the comprehensive changes taking place and pulled out.

After a public hearing in Parliament, it was decided that the contractors Skanska were bound to complete the construction of the hospital building on the agreed footprint at the time, while construction outside the existing footprint was to be tendered out.

The renowned British hospital designers Norman and Dawburn were engaged as the new hospital designers after a call for tender was issued. They had estimated that the cost of the construction, mechanical and electrical services, would amount to just over Lm70 million and the Tal-Qroqq hospital to be commissioned by 2001.

Concurrently, in England, the Norfolk and Norwich 850-bed high technology general acute hospital was being built. Labour singled it out as a benchmark. The British hospital was completed in four years with a total cost of around Lm160 million.

Following the 1998 elections, the Nationalist government unjustifiably terminated the contract of the designers Norman and Dawburn, and instead signed a direct new contract with Skanska for the design, building and supervision of the Tal-Qroqq hospital for Lm93 million and to be opened in 2003 with completion by 2005.

Only to sign another contract in 2004 for Lm145 million and completion commissioned by July 2007. Both these direct contracts included not only the original footprint but also any other construction outside the original footprint.

In The Sunday Times last week, former Minister of Finance John Dalli said: "I have seen no record that any analysis or cost projections were made" under the Labour government 1996-1998. May I direct him to the Health Department and the Foundation of Medical Services to get hold of all the reports commissioned by the then Labour government.

Mr Dalli seems to disagree with the concept of having one general acute hospital. This shows that he is out of synch with the medical advice of all stakeholders. In his column, Mr Dalli said that by changing the Tal-Qroqq hospital from 480 beds to 800-1,000 beds means "a near doubling of all support, technical and mechanical services".

This is a false statement as all services at St Luke's Hospital were to be transferred to the Tal-Qroqq hospital... hence the services were to be terminated in one hospital and transferred to the new hospital! Slight amendments needed to be done but definitely not to the extent Mr Dalli is insisting!

The Labour government was also after a new management system in running all the hospital and health services. Mismanagement in the last few years was the culprit of all evils in the health sector. I can assure Mr Dalli that, due to bad planning by the present administration, the hospital has now been thrown "on the old rails of medical mismanagement that we have at St Luke's".

May I also refer John Dalli to the book L-Isptar Mater Dei... L-Omm ta' Kull Skandlu, written by my friend Dr Wenzu Mintoff. It gives an insight on the 'state-of-the-art' scandals that perturbed the whole project.

As a result of these scandals, the general public has heftily over-paid for a hospital that the public deserves. I reiterate that it is due to the 1996-1998 Labour government's wise decision that today we have one general acute hospital at Tal-Qroqq.

Dr Farrugia is Shadow Minister of Health