A €1.3 million review in 2012 by a top American medical centre on problems at Mater Dei Hospital’s had reached similar conclusions to the Dalli report that was published a year later – yet it lay gathering dust.
The unpublished 2012 Johns Hopkins report – seen by The Sunday Times of Malta – identified common shortcomings plaguing the national hospital.
Although its implementation formally kicked off in late 2012, subsequent reticence to act meant implementing its recommendations was delayed.
Commissioned by the former PN administration and finalised in June 2012, when the government was facing internal strife and heading for a general election, the voluminous report – a blueprint for country’s healthcare system – was practically shelved.
Nine months later, a Labour government commissioned John Dalli, a former Nationalist health minister and former European commissioner, to draw up another report.
Presented last November, the 49-page Dalli report mirrors the conclusions by Johns Hopkins – political interference, non-existent management, waste and pushy unions – but fails to delve into the technical and clinical details set
The Johns Hopkins report portrays a situation where critical decisions lay outside Mater Dei, with management unable to hire or fire staff, or order supplies in a timely manner with medical supplies and drug reserves running out regularly.
“Staffing decisions are handled through lengthy and bureaucratic processes and final decisions made within the Office of the Prime Minister... the hospital’s leadership has no authority to make purchasing decisions on its own,” according to the report.
It also exposed insufficient gate-keeping at a primary care level, with 15 to 30 per cent of referrals to Mater Dei outpatients by GPs and health centres deemed “inappropriate”.
Access to care – inpatient and outpatient waiting lists – is the most significant challenge the hospital faces today, according to the report, and one that “has a negative impact on quality of care, patient safety, operational performance and sustainability”.
Johns Hopkins identified common shortcomings in 2012
The report also urges the creation of a high-level, executive role representing the hospital to prevent unions blocking critical staffing and decisions, “seriously impacting patient safety and clinical quality of care”.
Johns Hopkins recommended establishing the hospital as an autonomous entity to provide the management with the authority to operate it more efficiently.
Health Minister Godfrey Farrugia last week defended the decision not to make the report public due to a confidentiality clause inserted by its authors.
Dr Farrugia also insisted that it was “not hidden in a drawer as it was before” and its conclusions were being heeded to improve the hospital’s clinical practices.
Opposition health spokes-man Claudio Grech has also called on the government to release the report.
“The taxpayer invested heavily in this report which sets out the real and tangible roadmap of what needs to be done to address the management and performance shortcomings of Mater Dei,” he said.
“This report is dispassionate and apolitical; it should be the key guide to realise change in Mater Dei.
“This is why I still firmly believe it should be published so taxpayers and core stakeholders can appreciate and embrace the changes necessary to have a more efficient Mater Dei.
“It offers the basis for a bipartisan jointly owned change programme, without which any radical change in healthcare will not work.”