The government's advisor on health this morning called for a bi-partisan approach to the sector as he presented a report on Mater Dei which pinpointed management dysfunction as the cardinal problem at the hospital.

"The cardinal problem at Mater Dei is the dysfunction in management with all stakeholders having their own territory and devising their own working regulations," John Dalli said

He was speaking at Mater Dei’s auditorium during the presentation of his report "Mater Dei Hospital: A Better Social Return".

Mr Dalli, a former EU Health Commission and health minister said that in 2008 he had started implementing the reforms he was proposing now but he was stopped.

He said that at Mater Dei there was a lack of coordination so things could not run efficiently.

“What we need in this hospital is investment in management infrastructure and specialisation in hospital management training."

Resources at Mater Dei were constantly changing their physiognomy with the bed capacity changing as was the demand of illnesses.

Saying he was not pointing fingers at anyone, he stressed that the hospital’s management had to be autonomous.

“There must not be political interference that for many years rendered the management of this hospital as an ineffectual accessory that implemented decisions taken by the health ministry or the OPM.

“My appeal to government is that if we really want an efficient hospital - hands off,” he said.

During question time, Mr Dalli said he did not agree that the minister should have his office at Mater Dei.

PATIENTS SHOULD BE MADE AWARE OF COST OF THEIR STAY IN HOSPITAL

Mr Dalli said he believed all patients who spent time in hospital should be handed a statement of the cost of their stay to help them realise that health was not a free service and encourage a culture of change.

Financial consultant John Abela spoke on the need to set up appropriate financial records. He said that it cost €230 million a year to run Mater Dei, which was half the budget for health.

He said that the payroll for 3,920 employees was still calculated manually and there was no direct relationship between overtime and increased activities. There were more than 580 shifts that needed to be better controlled.

Mr Dalli said that the number of shifts in operation disrupted the operation of the hospital and generated overtime.

Benchmarks had to be set without the need to reinvent the wheel.

He said that unions filled a vacuum that had been created by a weak human resource management and expected to run the hospital.

All those who worked at Mater Dei had to realise they were part of an organisation and should adapt to it, rather than expect it to adapt to them.

Mr Dalli said that a big reform was needed in procurement and inventories. Millions were spent in this area so saving even just five per cent would be a lot.

“We need a mindset change on this as the current practice is a just-in-case inventory. We must focus on what we really need...

“We have a lot of what we don't need and don't have what we need... The reality is that there is a snake in this hospital.”

Mr Dalli noted that management were only informed that a contract was about to expire three months before so they lacked time for a decent tendering process. He said he heard of cases of a contractor charging €200,000 for a €10,000 contract.

On out of stock medicines, he said that a lot of work was being done but the cardinal problem was that the system being used was wrong as it was based on what was consumed the previous year rather than the needs for next year.

FMS COULD BE MADE HOLDING COMPANY

Mr Dalli said the Foundation for Medical Services could be restructured to become a holding company of Malta's hospitals to avoid duplication. Although it would not run the hospital, it would define hospital oversight.

There could be, for example, a performance agreement for all hospitals with the FMS instilling an ethos of management and accountability.

It would be a way to take a step back from political interference.

He said that a bi-partisan approach was needed in the sector. Both major political parties agreed with free healthcare and health should not be a political ball.

The medical sector, he said, could be developed into a strong economic sector, creating more employment.

eHealth advisor Mark Sammut spoke on IT saying that outdated system had to be replaced and supplier power, which resulted in a dictation of prices and services, had to be reduced.

Consultant advisor to the ministry Charles Grixti siad that a better IT system would also take stock of consumables in theaters, outpatients and emergency.

The hospital, he said, should be ashamed of its waiting lists and more control on how much the system was being loaded had to be exercised so as not to build another waiting list.

Mr Grixti noted that, until this morning, 6,080 days had been spent in an acute medical ward by people who could not go home due to social problems and because they needed nursing care.

This cost €1.6 million, affected planned surgeries and caused emergency delays.

Solutions were needed for high dependency patients and more beds had to be created in the community, strengthening community care.

He said that to address problems at the hospital medical and nursing staff were increased by 17 and 20, respectively. The number of consultants and surgeons was also increased.

At the beginning of the presentation, Health Minister Godfrey Farrugia said Mr Dalli’s report was a snapshot of the current situation at Mater Dei and showed the way forward. It was a point of departure and the starting point for a national discussion but it was not the government’s position on health.

The Health Ministry, he said, would be setting up a working group to evaluate the Dalli report and discuss it with stakeholders before it was evaluated by the ministry.

However, issues highlighted in the report were already being addressed and the government was not waiting for the working group’s report to start making the necessary changes.

He said when asked that Mr Dalli was an advisor to the ministry and a colleague.

“I see his role remaining relevant,” he said.

As to why his ministry was at Mater Dei, Dr Farrugia said he based his office there because he was a doctor and had a passion for patients’ dignity. He said he wanted to address the problem that affected this dignity.

The ministry, he said, was working on two other reports - a Health in Transition Systems Report, intended to give a clear image of the health system and a National Health Systems report- a strategy for 2015 to 2020.

REPORT SHOULD HAVE TAKEN BETTER LOOK AT SERVICES PROVIDED - OPPOSITION SPOKESMAN

Opposition spokesman Claudio Grech who was present for the conference, noted that the report focused more on management and finances and not so much on the social aspect.

In a comment given to the media after the presentation, he said he would have expected the report to take a better look at the services provided at Mater Dei and their results.

He said he was concerned about unfair generalisations made about employees and pointed out that 99 per cent of the people working at Mater D Dei were hard workers and genuine and certain things that were said could be very demoralising to them.

Admittedly, there were faults but there were people who worked very hard, he said.

Mr Grech said he would be giving his full reaction to the report at a later stage once he sees the report.