The public health sector has had three different ministers in less than two years. One change was inevitable while the other was predicted after long-expected improvements in public health services failed to materialise and internal political differences emerged.

The new minister and parliamentary secretary responsible for health services have once again promised changes in the Accident and Emergency Department of Mater Dei Hospital that should “reduce emergency waiting times by three hours”. Other symptoms that the public health service is not functioning well enough are the frequent incidents of out-of-stock medicines, long waiting times for surgery and “the lack of acute beds at Mater Dei”.

The new Minister of Health has said he is committed to addressing these short-term issues that are affecting the lives of so many people. Meanwhile, with some candour, the Health Parliamentary Secretary admitted that remedying the A&E issues “will not be an easy task”. What is more revealing is his statement: “If, at the end of the exercise, we won’t reach our targets, we will have to make further efforts, revise our plans further and move to another phase”. Does this imply that the tactics being applied to improve medical service are just band-aids – makeshift temporary solutions?

Reports by Johns Hopkins consultants as well as the more recent John Dalli Report that analysed the workings of Mater Dei emphasised the need for radical change in the way local hospitals deliver their services.

Former health minister Godfrey Farrugia remarked that when he was still in charge he had recommended the setting up of a new governance structure for hospitals in Malta. “The intended structure was to comprise a board of directors, an executive board and a medical board at a macro management level, headed by a CEO.”

Giving local hospitals a governance structure that is independent from political involvement would be a good start to plan a strategy for a sustainable ‘free’ health service in Malta. It seems that the setting up of special business units to improve the governance of the medical services provided by the various units in the public health system is finding resistance in certain quarters, especially from trade unions.

While all parties involved in providing medical services in the country’s public hospitals profess that they are interested in improving the quality of service given to patients, there is simply no agreement on how this noble aim can be reached. It is inevitable that change in the work practices of doctors, paramedical staff and non-medical staff will be indispensable if hospitals are to function more effectively.

It is also inevitable that, to improve medical services, relying solely on better administration will not be sufficient. More investment in new equipment, IT systems and, especially, in human resources will be needed to improve medical services in the medium and long term. This, in turn, brings about the question on how this investment is going to be financed. Public finances are still not solid enough to provide more funds to the health sector for necessary investment without raising taxes.

So while the short-term tactics that are being adopted by the Minister for Health are warmly welcome, most people, and, indeed, the European Commission and the IMF, are interested to see the long-term strategy that the government plans to adopt to make free medical service viable.

Band-aid solutions will simply not suffice to put the public health system on solid foundations.