Social Policy Minister John Dalli is still considering a proposal by the Royal College of Surgeons of Ireland (RCSI) to set up a private medical school in Malta, over two years since it was first submitted.
In September 2007, former Education and Health ministers Louis Galea and Louis Deguara had signed a one-year memorandum of understanding (MoU) with the RCSI to set up the school. By contrast, an RCSI medical school was set up in Bahrain within a year of signing a similar memorandum (vide www.rcsi-mub.com/about).
There is some doubt as to whether the RCSI memorandum with the Maltese government is still valid as it has not been formally terminated or extended.
The RCSI proposal is understood to involve an investment of €48 million over 10 years. Moreover, the RCSI did not ask for any state subsidies and is prepared to pay the government to gain access to Mater Dei Hospital and other public and private health facilities. It also offered postgraduate training opportunities and access to much-needed funds for research and development.
The RCSI was interested to offer, among other medical programmes, a four-year graduate-entry medical education programme starting as early as September 2008. The course would be fee-based, aimed mainly at attracting international students who already have an undergraduate degree but wish to change career and become a doctor.
However, in order to provide clinical training to the students the proposed medical school needs to have guaranteed access to patients and health facilities, mainly at Mater Dei Hospital.
The RCSI is prepared to pay government for this access, which the medical school of the University of Malta (UoM) currently uses free of charge, even for medial programmes it offers to Maltese and EU students for free but to non-EU nationals against payment of fees.
The RCSI’s willingness to pay the government to be allowed access to Mater Dei Hospital for its fee-based programmes has cast a question mark over whether the government can continue granting the University free access to Mater Dei for its own fee-based programmes.
The RCSI’s proposal was discussed at length by a joint RCSI-government steering committee set up immediately following the signing of the MoU. One issue in particular that the committee discussed was establishing the maximum number of students that could be trained at Mater Dei.
The committee had estimated that, using modern methods of teaching, the hospital could accommodate between 250 and 300 medical students per year.
Another subject that the committee had to discuss was the issue of the charges and conditions for the use of Mater Dei’s facilities by the students and staff of the proposed RCSI medical school.
A moot point is whether the goverment is in favour of granting the RCSI and/or the UoM exclusive use of Mater Dei’s facilities for their proposed fee-based medical programmes.
In its so-called Vision 2015 strategy, the government had pronounced itself in favour of promoting centres of excellence in Malta, including in the health and education sectors. It is, therefore, interesting to see how the government is planning to ensure an equitable playing ground for the use of Mater Dei for the training of medical students of the University and the RCSI, and indeed of any other private medical schools that may wish to set up in Malta.
In March 2008, at the RCSI’s 10th overseas meeting which was held in Malta, Mr Dalli, who had in the meantime taken over the health porfolio, was reported to have said that “it is in our interest that these negotiations be concluded positively in the shortest time possible”. He had also said that the RCSI’s proposal in line with Malta’s plans to become a centre of excellence in education and health services.
However, negotiations with the RCSI appear to have ground to a halt due to the University’s plans to expand its own fee-based medical education programmes.
In February 2008, the University signed an MoU with St George’s, University of London, (SGUL) with a view to launch a joint four-year international graduate entry medical education programme similar to that proposed by the RCSI. Prof. Godfrey Laferla, dean of the University’s Faculty of Medicine and Surgery, had said the proposed joint venture “would be a true partnership between two equals where the responsibilities and benefits would be shared, unlike the franchises other institutions have previously proposed”.
The University’s intentions were further confirmed last April when it entered into an agreement with the Kuwaiti government to accept up to 65 Kuwaiti scholarship students per year for the next five years, mainly in its medical courses, including medicine, dentistry and pharmacy.
These are the University’s most expensive courses. The fee for students from Kuwait who started the five-year Doctor of Medicine and Surgery course this October is €24,000 per year. In October 2011, it will go up to €25,000 per year.
In view of the competing RCSI and UoM proposals, the social policy ministry issued a ‘Call for proposals regarding medical schools in Malta’ on October 8, 2008, and sent it to the RCSI and the UoM, inviting them to submit a budgeted proposal by October 31. It also set up an adjudication committee, chaired by Mimcol chairman Ivan Falzon, to evaluate the two proposals.
During a meeting with the committee, the RCSI proposal received the support of a number of high-profile local medical professionals including Frederick Fenech, Alex Manchè, Stephen Brincat, Albert Fenech, Paul Soler, Yves Muscat Baron, Joseph Pace, and Paul Pace of the Malta Union of Midwives and Nurses, among others.
The committee’s report was submitted to Mr Dalli on June 5, 2009, and it is understood that it found the RCSI’s proposal to be preferable to that of the University. However, the RCSI’s repeated requests to receive a copy of the report have been turned down.
A series of questions sent by The Sunday Times to the Social Policy Ministry were left unanswered. In a terse, one-line reply, the ministry communications coordinator said “The ministry is still being briefed on the best option”. It is not known by whom the ministry is being briefed, or indeed whether the adjudication committee’s report has been discussed at Cabinet level.
Local supporters of the RCSI project are perplexed and dismayed at the way the government has moved away from its initial welcoming of the proposed RCSI medical school to delaying its decision on the issue for over two years.
This despite the adjudication committee’s positive recommendation to what is, in effect, a proposed foreign investment that is, in Mr Dalli’s own words, “in line with Malta’s plans”.
Moreover, a legal adviser pointed out to The Sunday Times that such a delay may also be interpreted as contrary to the principle of the free flow of capital and services across the EU, and as such, the RCSI could, as a last resort, launch a legal case against the government.
The same legal adviser also queried the government’s refusal to release the committee’s report, pointing out that the RCSI’s request is in line with the principle of transparency and good administrative behaviour, which is enshrined in Malta’s Freedom of Information Act, and Article 41 of the EU’s Charter of Fundamental Rights.