The last thing that Malta needs is a spat with public hospital doctors and a failure of its public hospitals to live up to the traditional high standards of Maltese medicine. Especially at Mater Dei, which cost so many millions of old liri to build and equip that electronic calculators found it difficult to arrive at the final bill.

Yet, here we are, in the midst of a cold winter of discontent over both the doctors and the hospitals they work in. The prevailing system of seeing to patients and the long waiting lists that have built up drew fire from three quarters. Predictably, from the Labour Opposition. Unexpectedly, from the minister in charge of health. And tellingly, from the Ombudsman.

Criticism welled from all three sources, none so damning as that from Health Minister John Dalli. He has clear views about the situation. The waiting lists, he says, are a scandal. The Mater Dei management is sloppy. For good measure he is unhappy, as becomes a good accountant, over the high accrued bills for medicine supplied by weary importers who count their main customer, the government, as their worst aged debtor, with bills remaining outstanding for well over six months.

The Ombudsman, unable to analyse the waiting lists properly because of what he termed as inadequate transparency, pointed a finger at consultants, especially surgeons. Minister Dalli also looked darkly in that direction.

The medical union would have none of that. Picking up a different part of John Dalli's flaying of the medical system, it reiterated that a dozen or so operating theatres are inoperative because of lack of staff. There is general agreement that a sharp overall shortage prevails, especially of nurses and consultants.

It is all both so damning and so sad. Sad because the public medical services are essentially good. We have top notch consultants, doctors, nurses and paramedics. They could find work abroad any time they like.

They maintain the tradition which the Knights Hospitaliers built up for Malta. They are part of one of the best national health systems around. Those of us who have sampled health services abroad can vouch for that, as can also the many thousands of patients who are treated under the system every year.

There are complaints, for no service is perfect. But the merits of the health service far outstrip any shortcomings within it. What is required at this delicate stage of disagreement is for the stakeholders to build on that basic fact.

It is a fact that there is a grave shortage of qualified and trained medical staff. Very obviously the planning of Mater Dei hospital centred too much on the physical side, without giving enough attention to manpower requirements. Manpower shortages were already felt at St Luke's Hospital and elsewhere in the public health sector. Not enough was done to eradicate them through a well thought out manpower plan.

The stage we are in now is such that the domestic supply in the pipeline will take years to fill up the actual and otherwise identified local positions. The only immediate way out is to recruit more personnel from abroad. Quite a number of expatriates are already in evidence in our private and state hospitals. More are required.

Parallel with that there has to be more professional management of the state health sector. Also, in the short term, operating systems have to be revised to find ways how to address the waiting lists. That had best be done in consultation with the medical profession, in particular with surgeons.

Criticism serves to build up demotivating animosity. What the health service needs is fresh thinking which mobilises the medical profession itself to input new alternatives. It is a fact of life that surgeons and other consultants will not give up their private practice, and that the government cannot afford to pay them enough to do so, despite the recent pay revision. Still a viable public and private health service can and should be structured.

With too many operating tables empty, for heaven's sake, get around the discussion table to work out short-term and medium-term solutions. That would be more fruitful than charges and counter-charges which lead nowhere.