The debate about the privatisation of three State hospitals that ought to have occurred prior to the privatisation is only happening now. Not so much happening as raging.

Chris Fearne attempted to sidestep the protestations by stating on the eve of last week’s doctors’ strike that the debate cannot be re-opened. The problem is that a debate never took place.

The privatisation was spun as a done deal with much pomp during the campaign for the European Parliament elections of 2014. Details were scanty, and only when sumptuously named Vitals Global Healthcare unraveled did the contours of the deal began to take shape before our eyes.

Only now can we appreciate the insidiousness of the privatisation to our health service – that’s why the doctors irrupted into the fray now. The deal looks so awry that the widespread suspicion that it’s the bastard child of corruption is understandable, but I shall suspend that suspicion and discuss the misguided­ness of this privatisation.

And I am going to focus solely on the privatisation of Gozo’s general hospital – as well as two other skewed privatisations in Gozo – because privatising Gozo’s only hospital is particularly treacherous for the durability of free, quality healthcare in Gozo.

Of course, no one disputes that some form of privatisation – a public-private partnership (PPP) – could put healthcare on a more sustainable footing. The question is how and to what extent; that question is all the more tricky in the context of a single general hospital in a region geographically cut off from the mainland (or main island).

Precaution calls for this to be privatisation lite. That means the government retaining strategic ownership and leadership of the hospital, and creating ad hoc structures to stimulate specific investments and improve the operational running of the hospital. Management of the hospital would be best assigned to trust.

But the deal that’s been struck has handed over strategic control and virtual ownership (it would be costly, and legally tricky, for the State to wrest back ownership) to a foreign company. And while that is likely to stimulate service improvements and investments in the short term, as contractually stipulated (once and if Stewart take over), in the medium and long term it is unwise to allow a foreign company virtual monopoly over Gozo’s only hospital.

Health provision in Gozo could incrementally be held to ransom by a foreign company whose sole interest is to make a profit from people’s health

Difficulties can arise, for example, as advances in health science compel the hospital to introduce new machines and procedures. A fee-per-use payable by the government would have to be negotiated in every instance, and there’s little doubt about who’s going to wield the greater negotiating leverage given the monopolistic situation. The company would seek to exact an operating profit and a return on investment on the procurement of (expensive) equipment.

As these developments play out, particularly if the volume of medical tourism falls short of projections, health provision in Gozo could incrementally be held to ransom by a foreign company whose sole interest is to make a profit from people’s health.

Something of equal public disservice seems to be in the offing in the case of the indoor heated swimming pool in Gozo. Long promised by the government as a public-service project – to serve aquatic sports people, water-based physiotherapy and those who swim for fitness in the winter – this government decided to get the pool done via a PPP, trading public land in return for a package of limited free hours of use and other minor concessions.

But the tricky part for the bidding company is return on investment. It will cost millions to build the pool, running costs are considerable (especially to keep the pool heated), and to ensure sufficient return on investment and operating profit requires user fees that may put off many potential customers. So the figures don’t add up whichever way this is stretched, and that’s what may have given rise to the idea to add a hotel-of-sorts to the complex, which in turn led to bad press and grumblings among hoteliers.

So this PPP is faulty at the concept stage. The viable approach would be for the government to build the pool and then enter into a management agreement. An agreement could be devised to ensure that fees remain reasonable, that the operator rakes in a profit if operationally efficient, and that the government gets a percentage off the fees to fund maintenance and upgrades in the long term. (The government has just spent €6 million on a shooting range, ser­ving a machismo sport; isn’t a swimming pool for holistic health more of a priority?)

The same principle could have been applied at the Ta’ Maġġi Industrial Park, where a private company has been leased public land to build workshops and warehouses which it is selling. The government could have constructed the units itself, then simply thrashed out an agreement for the operational running of the site with a private company.

The problem with these three PPPs as conceived is that the government has handed over strategic control of public ser­vices to private companies, allowing these companies to profit or profiteer, and leaving the people in the lurch. The nature of the deals also opens the door to corruption.

Yet the good news is that in at least two of the three instances – the swimming pool and the hospital – it’s not too late for the government to rethink and redesign, or at least tweak and renegotiate.