Malta should be proud of its health service. It boasts high standards of medical care and scores highly in patient satisfaction surveys.

The Maltese health service consistently does well when key performance indicators are compared to those of larger and richer European countries.

This success is largely due to the dedication and commitment of the staff despite far from ideal working conditions.

It is true that there are some problems with waiting lists and lack of beds but these are problems with capacity of a health service which has become a victim of its success.

The main preoccupation is long-term financial sustainability. The national health service in Malta became free of charge in the 1970s and is modelled on the British NHS, which was introduced after World War II as part of the ‘cradle-to-the grave’ welfare state reforms in the UK.

It was launched by health minister Aneurin Bevan in 1948 with three core principles: that it meets the needs for everyone; that it is free at the point of delivery; and that it is based on clinical need and not the ability to pay.

The British NHS prospered to become one of the largest employers in Europe, but in the 1970s and 1980s it became increasingly clear that, due to financial constraints, it was unlikely to have the resources necessary to provide unlimited access to all the latest medical treatments, especially in the context of an ageing population and the increasing complexity and costs of treatment. Over the years various ‘reforms’ and ‘modernisation programmes’ have been implemented, with little success.

In the UK, private finance initiatives were introduced as a way of funding public infrastructure projects with private capital. This aimed to keep public debt off the balance sheet and to improve efficiency. Private consortia were contracted to build hospitals with their own funds, which were then rented to the NHS.

Privatisation of parts of the NHS in Britain led to financial disasters and we must not repeat the same mistakes in Malta

Experience has shown that these private finance initiatives can end up being an expensive long-term loan which distorts clinical priorities and has an impact on the treatment given to patients. Hospitals find it hard to pay their dues and they economise on patient services and staff costs to make ends meet.

In 2012, seven NHS trusts were unable to meet the repayments for their private finance schemes and were given £1.5 billion in emergency funding to help them avoid cutting patient services. Their financial future is in jeopardy and this might lead to hospitals decreasing services or closing down.

In Malta, we were recently blitzed with news about developments in health care including the Barts medical school in Gozo, new private investments at St Luke’s Hospital and at Gozo General Hospital as well as private hospitals in Bulebel and Smart City and the purchase of St James Hospital by American investors.

A few days ago, the government announced that it received three bids for public private partnerships for Gozo, Karin Grech and St Luke’s hospitals and that these will now be assessed by Projects Malta.

The Medical Association of Malta has discussed these initiatives with the authorities and we have expressed our concerns about the details of the upcoming negotiations and their impact on the standards of patient care and health workers’ conditions of work.

We are particularly concerned about the implications of privatisation on equal access to healthcare for all and on the continuation of care on the basis of clinical need.

Will expensive treatments be restricted to save money? How will specialists be trained in private hospitals? Will clinical decisions be dictated by accountants?

Privatisation of parts of the NHS in Britain led to financial disasters and we must not repeat the same mistakes in Malta.

The government should discuss the proposed changes in the context of an overall national health strategy. Privatisation of the Maltese NHS will introduce radical changes in healthcare and these changes are causing anxiety to healthcare workers.

They must be thoroughly discussed with all stakeholders, before irreversible decisions are made.

Gordon Caruana Dingli is president of the Medical Association of Malta.