The health of a nation is not just about medical excellence. It has also to do with the economic sustainability of the services offered to the citizens, whether it is a ‘free’ health system or one that demands payment from patients.

New investment in our health system will hopefully add value to various aspects of healthcare in Malta.

Free health services at the point of delivery are an achievement of the welfare state that deserves to be preserved to reinforce social justice. But the harsh economic realities that most Western societies are facing leave no room for delusionary thinking that makes us forget the cost that such free services impose on taxpayers.

When a free health system is not based on a sustainable financing model, one has good reason to fear that sooner or later it will fail.

The recently announced plans should bring about positive changes in the way our healthcare system is managed. Firstly and most importantly, it should ease the pressures on Mater Dei Hospital, which is clearly struggling to offer an adequate service to its patients.

Long surgery waiting lists, crowded wards and shortage of health professionals are symptoms of a failing system. Rationing of services is a not-so-hidden way of bridging the financial gaps of healthcare finances and is an unacceptable solution.

The refurbishment of St Luke’s Hospital will undoubtedly ease the pressures on Mater Dei. The social problems created by a population that is aging will sadly mean that more institutional facilities for elderly people suffering from poor health who can no longer care for themselves at home.

When the healthcare reforms are implemented, the problem of catering for social cases in Mater Dei should be eased. Similarly, transforming the present Gozo hospital into a 200-bed geriatric hospital should ease pressure on the health infrastructure in Gozo.

One of the toughest challenges will be dealing with cultural change. I have no doubt that many stakeholders in our present health system will fear change

Equally important is the involvement of the private sector in healthcare. It would be naïve to argue that a free health system means that the government should build and run as many medical centres as the country needs. The public-private partnership being proposed to ease the upfront and running costs of a reformed healthcare system is arguably the most realistic way of matching noble social ambitions with tough economic realities.

Employers should be encouraged to provide health insurance for their employees to create a culture where dependence on public medical service is eased and the promise of free health services can indeed be kept by our political leaders. In a fair society, those who can afford to support the weak should do so, especially in a time when the gap between the haves and have-nots is increasing.

The advantages of setting up a reputable medical school in Gozo are convincing. Having a Barts campus in Gozo combined with a modern acute 250-bed general hospital should guarantee the success of the strategy to make Gozo a hub of medical excellence.

This project should fit Gozo’s economic ambitions like a glove. Hopefully, this strategy will not impose an irreversible environmental cost on Gozo.

As Anthony Warrens, dean for education at Barts, rightly pointed out, the hard work of implementation begins now. I will never forget the IBM sound bite of some decades ago that “there is a difference between knowing what needs to be done and knowing how to do it”.

The challenges of implementation are undeniably tough. One of the toughest challenges will be dealing with cultural change. I have no doubt that many stakeholders in our present health system will fear change. Unless they are reassured constantly about how they will be affected by these changes, they will try to resist the important changes that need to be made.

I am not referring only to medical professionals and other employees who at present work in our hospitals. Union leaders as well as those involved in the private medical care system will see some threats in the proposed changes.

Hopefully, these changes will not lead to a political tug-of-war because the nation’s health system affects us all.

My humble advice to the sponsors and leaders of these ambitious projects is, to dedicate as much time as is necessary to constantly inform the public and all stakeholders who will be exposed to these changes, on how they will be affected.

They need to be reassured that changes will cause some disruption in their lives but that eventually, all will benefit from a more robust and sustainable healthcare system.

johncassarwhite@yahoo.com