First we need to identify the bottlenecks and determine the best policies to reduce waiting times. To do this, I propose the following. Autonomy: Mater Dei Hospital must be turned into an autonomous institution - like the University, like Zammit Clapp and other hospitals. Autonomy will reduce the bureaucracy which exists in the present system.
The government should steer not row: A new "clinical supremo" should be appointed. He should have powers to employ doctors, nurses and paramedics on definite contracts. His decision should be final and he should be answerable directly and only to the Minister. The Minister should set the policy and the director implements the policy on the principle that governments should steer and not row.
This new director should be appointed from outside the present NHS structure so as to bring fresh ideas to tackle old problems - which the present management has clearly been unable to solve. He should not be hampered in any way by any NHS director not even by the director general.
The Health Department should act as an authority to maintain standards in government as well as in private hospitals, but should not interfere in the running of hospitals - we have seen the result of that.
Employ more full-time doctors and nurses: In any publicly funded system which permits doctors to practise privately in parallel with the NHS, there is a financial incentive for surgeons to maintain a waiting list. (A principal reason people opt for private care is to avoid excessive waiting). Therefore full-time employment of more doctors and nurses, on a definite contract basis, should be encouraged.
Centralise and update: Waiting lists should not remain fragmented as at present, by different departments. There should be one centralised waiting list. Some patients have died while waiting for treatment, some patients have been treated for their condition as it developed into an emergency, while some patients have given up waiting and have had the operation done privately - by all accounts several hundred patients are no longer on the waiting list!
Establish a one-stop shop: For the patient, waiting time starts from the first visit to the GP. From this moment on, there may be a long series of queues before the patient eventually receives the required surgery. For instance someone in need of a knee replacement may join one queue for an outpatient appointment followed by another queue for an X-ray, then back to outpatient clinic before joining a long list for the knee replacement.
A "one-stop shop", where patients are seen in outpatients and tests performed on the same day, with an immediate decision whether to put the patient on the waiting list, will increase efficiency.
Rank patients: Patients waiting for elective surgery should be ranked. Ranking must be based on a set of defined clinical and social criteria, such as progress of disease, disability, dependence on others, age, loss of ability to work - and certainly not influenced by who you know. Urgency related groups (URGS) should be established and each group should be associated with a maximum recommended treatment time (Urgency is the speed required to intervene in order to obtain the best clinical outcome).
Prioritise: A "priority score" for each patient should be established that is an admission index to determine the order by which patients receive treatment - each according to his/her needs (Priority is the relative position on a surgical waiting list).
Finally clinical outputs and outcomes should be kept under constant review - and appropriate measures taken.
Only when maximal efficiency with the present state resources is achieved should we form a public private partnership. Needless to say, there will be those who would not like these changes - as it would affect their comfortable lifestyles.
Many would be keen to change things. I am certain I could make it work.
Dr Portelli is the director of St Philip's Hospital.