Joe Caruana: “Sometimes we tend to think we live in a bubble immune from global economics”.

Free healthcare was unsustainable no matter how politicians tried to portray it and hospital services would continue to be stretched unless sacrifices were made, according to the former Mater Dei Hospital CEO.

“Irrespective of any way either political party portrays it, the real root issue is this: how can you provide value healthcare to society without emptying the country’s coffers and stunting growth in other important areas,” Joe Caruana said.

Mr Caruana conceded there was no magic solution and every country in the world was facing this challenge, but “small sensible sacrifices” would go a long way to free up finances for better treatment.

Most importantly this was a matter of economic and social justice, not a political one. However, he stressed, the change in mindset had to first be made by society, not politicians.

Mr Caruana’s reflections come of the back of news that patients with Hepatitis C were being deprived of crucial medication as it would cost authorities €75,000 per patient; totalling more than €90 million a year.

The Ombudsman had been requested to intervene by two Hep C patients, one of whom had contracted the disease after using contaminated products given to him by the Health Department some 30 years ago.

The Ombudsman had received expert opinion that about 20 per cent of these patients would develop liver failure or cancer if untreated.

Mr Caruana said he could not see where the political and human justice was for the State to give free anti-hyper tension pills – costing anything from €5 to €25 a packet – to all, but struggled, or failed, to find finances for thousands needing life-saving cancer treatment costing €900 a vial per patient. “Sometimes we tend to think we live in a bubble immune from global economics and emerging and developing cultural and social phenomena,” he said.

This is not the first time Mr Caruana waded into this controversial territory, which politicians steer clear from for fear of losing precious votes. In 2011, he veered from the government’s standpoint on this delicate subject and was criticised for saying that from a business standpoint free health services could not be sustained for much longer.

“Today, I’m even more convinced of this. It’s not just Malta’s problem. The last time I saw the statistics, all European countries, with the exception of Germany, were making huge financial losses in their healthcare systems,” he said.

How can you provide value healthcare to society without … stunting growth in other important areas?

“Issues like means-testing linked to free healthcare, private insurance benefits and clamping down on the misuse of the free services, including a link to the type of lifestyle that leads to health problems, come to mind… But maybe this is the reason why I’m not a politician.”

In his first interview since stepping down for health reasons in November 2014, Mr Caruana, an engineer by profession, told The Sunday Times of Malta he missed hospital work “every day”.

“Although I was asked to remain I chose to move on because I had other aspects of my life that required my full undivided attention to be handled properly,” he said, adding that he felt enriched by the experience and privileged to have met so many competent professionals.

His three-year tenure was not without glitches, but mostly they arose from frustration with the slow speed within the civil service that worked against patients’ best interests and occasional clashes over political interference.

At the end of 2013 he had made it clear that political interference at Mater Dei had over the years weakened the management and rendered it ineffective.

His comments had come in the wake of a damning report on the state of Mater Dei by former European health commissioner John Dalli, who had called for hospitals with more autonomy and urged politicians to keep their hands off their day-to-day running.

There was also a distinct difference of management styles during the time of then health minister Godfrey Farrugia, pushing Mr Caruana to ask not to be reconsidered for the post. He reversed his decision when Health Minister Konrad Mizzi and Parliamentary Secretary Chris Fearne took over.

Reflecting on the “unnecessarily turbulent” period immediately after Labour was elected to power, Mr Caruana pinned it down to mostly inexperience and overzealousness to make improvements.

Mostly, however, the interference tended to come from the people around the minister – under both administrations – but when he stood up against such interference in most cases he felt understood and respected.

Mr Caruana felt his successor, Ivan Falzon, was facing similar frustrations as few if any, of the important changes that made it easier to run a hospital more efficiently had been implemented so far.

“If the current CEO, and his senior team, has to spend the bulk of their time juggling to see how to give adequate bed space to patients when there is not sufficient space to do so… then he would have similar frustrations to mine,” he said.

The political will to change, he said, was there – and was always there under both administrations. Although from his vantage point as CEO, he never saw real concrete steps to execute the process of cutting Mater Dei out of the civil service mechanisms.

“I understand this is a very big political decision but our politicians have chosen to go into politics and have been placed there by the people, to take the big, difficult decisions the country needs.”