He claims to have inherited a broken system that he is adamant he can fix, but Health Minister Godfrey Farrugia tells Kurt Sansone this will take time.

One of the defining moments since you became minister was when you shed a tear for the patients you had to leave behind as a result of your appointment. Not everybody understood that emotional moment. How did you feel?

Karin Grech is supposed to be a rehabilitation hospital. It is not; it is a geriatric hospital that lacks best practice

After 28 years of continuous service as a family doctor with a catchment population of patients for whom you are not only a doctor but also a friend, it is obvious that separation hurts.

But I know that my country has called me for service and those same people have lent me to the state to serve in this ministry.

The pain is there but with self-discipline you have to stop serving them.

On that particular day all these thoughts crossed my mind, including the children I used to see, who are like my children.

Is it fair on your patients to suddenly stop seeing them?

It is definitely not fair on you. There are obligations and ethical considerations to make, but it does create an element of unfairness when you have to stop seeing those patients, most of whom would have given you the chance to serve in a political role by voting for you.

Were you prepared for a ministerial job because you could have remained an MP and still continued seeing patients?

I am prepared. Everybody has separation anxiety and adjustment disorder but this does not mean I have an identity crisis... that is all behind me now.

We are building a team and we are going to deliver.

We are working very hard and when I say we, I am referring to the 8,000 workers in the health sector. We have analysed the situation and we are now drawing up our plans and targets.

The Prime Minister gave your Cabinet colleague, Franco Mercieca, a waiver to continue practising his speciality. Is this fair when others like you have had to give up their profession?

The Prime Minister has the right to use his discretion. The degree of responsibility the Prime Minister has entrusted me with – from a financial perspective, from a human resource point of view and in terms of the service we want to deliver – can never be compared to the parliamentary secretariat for the elderly.

I believe the Prime Minister acted correctly in both decisions. I want to be totally focused on the holistic wellbeing of the health service.

One of your first decisions was to open a ministerial office at the accident and emergency department. What benefit did patients derive from this move?

I have always worked on the frontline as a family doctor. I have always been among the people. Having a big nice office like this one in Valletta is not enough.

Over here I am on a pedestal and I have never lived my life on a pedestal.

I wanted to hit the ground running by being there at the centre of one of the biggest problems at Mater Dei hospital.

But at the same time I opened my office there I also set up an action team involving employees from the various sectors of the emergency department.

The office is open at different times, I hold meetings and meet people over there... it has helped us draw up a plan to revamp the emergency service.

Is it your job to micro-manage the health service or should you leave health practitioners to do that?

I inherited a system that made no distinction between policy-making, regulators and operators.

This is a big problem and that is why I presented a Health Act in Parliament.

It is important for the minister to feel he is part of the team when action committees are set up because it is only by working together that we can ensure the service becomes more accountable.

Lack of space and human resources coupled with bad practices are the problems we face at the emergency department.

Overall, the health service has a problem of micro-efficiency. I inherited a system that was immoral and illegal.

Why?

If you paid me for a service by cheque, you would ensure that there is enough money in your bank account to cover the amount.

I inherited a system where, despite a debt of €63 million, I also had a shortfall of €101 million to operate with.

This means that over the past years, measures were being taken for which no money was voted for.

In some instances the capital expenditure would have been done but no money would be found for operative costs.

As a result I not only had to immediately stop the bleeding in the health service but resuscitate it.

To do so we have to work both at a micro and macro level.

You are in the driving seat today and people will hardly be satisfied by blaming the problems on your predecessor. They expect solutions from you.

I will not give you solutions after two months. The cancer unfortunately has deep roots and it will take a couple of months or years to solve the problems.

I inherited a system that did not have a director for human relations.

The system is confused: on the same payroll I have employees who are civil servants, staff members of the Foundation for Medical Services, self-employed, former shipyard and postal workers and even people with precarious jobs.

There are more than 1,000 different shifts and where some workers see no difference between rights and duties.

But how will you solve these problems?

Give me a chance and I will show you. I believe in team building. I have always been a team builder.

The first temptation is to get the people who worked for me at my clinic and bring them here but I can’t do that.

The first important thing is to have a clear picture of the situation and then have set targets.

We have to be decisive, transparent, and accountable and do things the right way.

At the same time, politics has to have a human face. I believe that with cautious spending we will be capable of offering more [services] at a faster pace with the same budget.

But to do this we have to be efficient at a micro level and have departmental budgets.

Having a sense of ownership and belonging is important; it is the trick that will help us resuscitate the system.

You speak of better management and improved micro efficiency but what concerns patients is the time they spend on waiting lists for operations. We have heard cases of patients who had their appointment rescheduled to next year. What solution are you giving these patients?

We are looking ahead. In October I will have the EU cross border directive coming into force. For the first time in the health sector I am drawing up costings of every measure and operation.

I am also working to have a charter of patient rights.

Patients will have a maximum transient time and if the maximum period is surpassed there will be an interim period during which hospital management will determine whether the medical intervention can be done anytime soon.

However, if it is not possible the intervention will have to be done elsewhere [with the cost borne by the Government].

This will cost public coffers a lot at a time when the EU is asking the country to curb health expenditure.

It can mean a higher expense for Government but we also have to resuscitate the system.

I believe that if things are run well and we act as one team, we will manage to deliver more with the same budget. We can become more cost-effective.

But you are only concentrating on secondary healthcare at Mater Dei when solutions have to incorporate primary healthcare and rehabilitation services.

Karin Grech is supposed to be a rehabilitation hospital. It is not; it is a geriatric hospital that lacks best practice.

At Mater Dei there are between 60 and 100 beds that are taken up by social cases. They should be in a rehabilitation hospital or in the community.

We have social case patients occupying a comfortable bed and others requiring medical treatment ending up on trolleys. This is not right.

There was no money allocated for the emergency service at Saint James hospital

The previous administration was in talks with the owner of St Philip’s hospital to lease the building for use as a rehabilitation hospital. What happened to those plans?

The St Philip’s deal is in abeyance.

What does that mean?

No decision has yet been taken in favour or against. The situation is the same as to how St Luke’s hospital should be used.

But is it a solution?

This is why we have left it in abeyance because we have to evaluate whether it can be part of the solution. But the first thing to do is reorganise what we already have.

If, from the 10 wards available at Karin Grech hospital, we are only using one, can it really be called a rehabilitation hospital?

We have to start from what we have. We have to consolidate and ensure we have robust structures without creating another haemorrhage.

Most of the public-private partnerships we had in health were a result of crisis intervention: we had a problem with long lists for cataract surgery and opted for a PPP, we had a problem in emergency and we outsourced it to the private sector.

But you stopped the emergency service at Saint James hospital. Why?

There was no money allocated for it. We owe millions to those people.

A Labour government has to find money to pay up because no money was earmarked for it by the previous administration.

Is it right to have a patient treated in the private sector at a cost that is higher than treatment in the state hospital?

I believe the private sector can be a catalyst for change and synergy is possible.

The health sector can create niche tourism and there is also a possibility for foreign investment.

I want the oncology hospital to be a European reference point and so I have to think of the upgrades that are necessary to make it so.

I cannot develop an oncology hospital without also developing human resources.

But no money was dedicated for the development of human resources.

Does this mean you will delay the opening of the oncology hospital?

No, it means that we have to prioritise expenditure. Its development cannot be looked at in isolation.

We have to look at the blood bank and see how to develop it further to offer haemo-immunology, tissue and cell transplants.

These are necessary when keeping in mind how oncology is developing. We have to create synergy with the bio-park being developed next to Mater Dei.

These are inter-related projects and this is why we have to look at the issues in a holistic manner. But these are issues that go beyond the problems at Mater Dei, where the emergency department is the biggest challenge.

When will patients start seeing any improvements?

There will be gradual improvements. There have been positive developments at emergency despite the staff shortage.

The implementation process will be announced later but I have to have the human resources.

People understand that they may not need to go to hospital’s emergency department but bad experiences at health centres have conditioned them to bypass the primary service. What is the solution?

We have to adopt best practice management. We have to introduce this culture. I believe this will happen when graduates specialised in family medicine join the service.

We have to empathise with patients who choose to go to health centres.

The centres must also be outreach facilities for specialised services.

In the past, rather than strengthening the services offered by health centres, we reduced them. Some were closed, services were cut and opening hours reduced.

Primary healthcare is the foundation on which any health service has to be built.

You are speaking of best practice and better management but you will depend on doctors, nurses and administrators. In the past there were instances when work conditions were changed and unions protested. Will you find cooperation?

Changes will also benefit workers and this will increase motivation. When this happens patients will also benefit.

It is useless for healthcare professionals to be offered better wage packets because what is needed is dedication.

We are speaking of a profession that cares. There are exemplary people in the health service and others have potential.

The health sector can create niche tourism and there is also a possibility for foreign investment

I am a union man myself because I was the Medical Association’s secretary for four years and I believe we can arrive by acting prudently and respecting the different opinions.

We can achieve standardisation and better management coordination.

The phenomenon of out of stock medicines is still with us. How will you solve it?

It is a major issue. The problems are two-fold: financial and lack of management.

The previous administration did not budget enough money.

They knew medicines cost €8 million per month, which equates to €96 million per year and yet they only voted €68 million.

This automatically creates a problem of out of stock medicine because there are no funds to buy it. This is another immoral situation.

From a management point of view the various entities dealing with medicines do not have compatible IT systems.

We cannot know in real time what our stock levels are because they have to be ascertained manually.

The hub is not at the centre of the whole chain. We inherited a lame system.

The analysis has been done and we are now looking at the best way to implement changes.

When will these come into effect?

It will take a couple of years to solve this problem because we have to restructure everything. I will not set a target but I cannot say I will solve it by 2014.

Will you consider a nominal fee for these free medicines?

No, it is not our policy to introduce any form of payment. We have to restructure the system in such a way so that medicines on the formulary are available.

PN REACTION

In a reaction, the PN said it seemed that the minister was trying to put across the message that he was facing major problems to maintain a comprehensive health service that is free and adequate for the people’s needs.

The party said the minister needed to face problems which would always exist as a result of an ageing population and thus increased pressures on health services and medical and technological advances which meant that costs would continue to rise.

The party said that under the PN government, health services remained free and services increased, including a sharp increase in operations.

The party also asked how Dr Farrugia had decided that Karin Grech Hospital lacked best practice.