Last updated at 3.35pm with Civil Society Network's reaction - The doctors' union said on Tuesday the strike it had ordered over the privatisation of hospitals was a success with almost all its members obeying its directives.

MAM general secretary Martin Balzan told Times of Malta that he was aware of two or three doctors who had not obeyed the strike directive.

Doctors have been ordered to strike for a day in outpatients' departments and a number of health centres. 

Dr Balzan said the only doctors working at Mater Dei Hospital were those  exempted from the directives. Among them were those at the Outpatients Department dealing with oncology and maternity and some who needed to help in fracture cases.

MAM secretary Martin Balzan with Accident and Emergency doctors who were exempt from the strike directive but showed support for the union.MAM secretary Martin Balzan with Accident and Emergency doctors who were exempt from the strike directive but showed support for the union.

Dr Balzan said Accident and Emergency doctors, who were exempted from the directives, this morning expressed their full support for MAM (See picture).

The directive, he said, was also a success in health centres.

Dr Balzan thanked patients for understanding the situation and said the hospital management was arranging new appointments for the near future.  

POLITICAL PARTIES' REACTION

At a press conference, the shadow minister for health, Stephen Spiteri said the strike by doctors was proof that the contract for the running of the three hospitals had raised concerns among everyone, not just the Opposition. The doctors were not on strike to cause trouble but because they had their patients’ interests at heart.

He said Vitals had not observed its contractual obligations, and this, therefore, was an opportunity for the government to rescind the contract and take back the running of the hospitals.

Vitals, he said, had not increased the number of beds, it did not build Bart’s medical school and did not refurbish the Gozo hospital.

Patients, doctors and all Maltese citizens were in the dark as to what will happen to the hospitals.

The government has a clear opportunity to take back the hospitals, he insisted.

"We should revisit the contract. Why should the government pay a million euro for an air ambulance? Why should the government pay extra costs for unused beds?"

He expressed solidarity with the doctors, workers and patients, who were ultimately the ones suffering.

Asked whether the Nationalist Party was optimistic that the doctors and the government would come to an agreement at a meeting due tomorrow,  PN MP Mario Galea, who was also at the press conference, argued that Health Minister had made it clear already that the government would not be stopping the hospital transfers deal.

In a reaction, the Labour Party said the PN was clearly against private sector investment but they could say nothing against Steward Healthcare, who were taking over from Vitals.

Steward would in the coming years be investing far more than the government could, while the health service would remain free of charge and workers' conditions would not be affected.  

CIVIL SOCIETY NETWORK'S REACTION

The Civil Society Network expressed its support with MAM and said the patient would suffer the most from bad decisions taken by the government.

The fact that the government did not respect its obligations in respect of MAM was of grave concern and raised very serious doubts as to in whose interest decisions in the health sector were being taken.

"It is unacceptable and indeed shocking that the government imposed on the Maltese people the obligation to pay €100 million and all the investor’s liabilities in the event that any future Maltese government decides to take back into its hands the said hospitals.

"This is a burden on future generations and explains why the details of the government’s agreement with Vitals have been maintained secret."

REASONS FOR THE STRIKE

The strike was ordered in protest over the way St Luke's, Karin Grech and Gozo hospitals are being transferred to Steward Healthcare, in what, the MAM says, is a breach of the doctors' collective agreement. The agreement says the union should be given six weeks notice so that meetings on the transfer could take place.

Read: MAM still in the dark on hospitals’ transfer to Steward Healthcare

The UĦM Voice of the Workers has declared its support to the doctors' union. The union has ordered nursing aides at Mater Dei Hospital not to inform patients about new appointments.

Phlebotomists were told not to draw blood.

The directives were issued not only in support of the MAM but also to protest against the privatisation of three State hospitals, UĦM chief executive Josef Vella said. 

Tuesday's industrial action has impacted hundreds of patients, who have seen their outpatients' appointments postponed after waiting weeks

Tuesday's industrial action has impacted hundreds of patients, who have seen their outpatients' appointments postponed after waiting weeks, sometimes months, for them.

Health Minister Chris Fearne told Times of Malta on Monday that some 3,000 patients would be impacted. 

Read: Doctors' strike: 3,000 patients to be impacted as UĦM adds to directives

The strike went ahead after a meeting between the MAM and Mr Fearne on Monday failed to make progress. 

Vitals Global healthcare took the 30-year concession for the hospitals in 2015 but has sold it to Steward just 21 months into its operation. MAM is calling on the government to retract its consent for the transfer and consult with it first, in line with a collective agreement.

Dr Balzan said the MAM agreed in principle with a public-private partnership for state hospitals, management and leadership should remain in the hands of the government. 

It appeared, he said, that the government agreed with the union on this principle. Still, no progress was made at the meeting. 

[attach id="627882" size="large" align="left"]The Cospicua health centre. [/attach]

THE DIRECTIVES:

The MAM ordered doctors to strike in hospital outpatients' departments. The directive also affects health centres and bereg, and only three health centres in Malta - Paola, Floriana and Mosta - and one in Gozo - Victoria - have doctors' services.

Ward doctors at Mater Dei Hospital are on a work-to-rule directive. Doctors in administrative duties are not answering phone calls or e-mails.

At health centres, all scheduled non-urgent appointments shall be rescheduled, and routine repeat prescriptions shall be postponed to other dates. 

All walk in cases needing emergency care will still be seen to. 

Services for house calls will be limited to one doctor per health centre using the usual protocol to determine which cases need to be seen.

At hospital, no sickness certificates will be issued for discharged patients after 2.30pm. No discharge letters, prescriptions or any paper work are to be issued
from the discharge lounge. Foundation doctors will only fill in this paper work, if patients are in a normal ward.

After 2.30pm only prescriptions for a three-day supply of medicine will be filled.

From 2.30pm to 8am foundation doctors are only to deal with all urgent matters of a clinical nature and Limit their paper work. 

The directives do not apply to clinics at Sir Anthony Mamo and maternity clinics. 

There shall be no directives affecting the accident and emergency department, or any of the acute wards.

"The outcome of this dispute may have implications for the next 30 years
so please carefully consider the importance of this moment. As more privatisation looms on the horizon, it is essential that everyone is prepared, and follows the directives to the letter," the MAM members were told on Monday. 

Health Minister Chris Fearne.Health Minister Chris Fearne.

Minister says he's open for talks

When contacted, Mr Fearne said he had offered to show MAM all the contracts linked to the hospitals deal.

He acknowledged that despite progress on a few other issues - including the wages of certain doctors at health centres - the government and MAM failed to agree on the way forward for the concession agreement involving Vitals.

"Back in May we had agreed with MAM that any future PPP arrangements will ensure the government retained full control but the VGH agreement cannot be re-opened. The VGH agreement is what it is and it makes no sense to re-open that debate. We simply can't go back to 2013," Mr Fearne said.

Admitting that VGH were behind schedule in certain aspects, which prompted the new deal with Steward, Mr Fearne said he remained open to discussions.

"We need to safeguard the interests of the patient. It's in everyone's interest to resolve this," the minister said. 

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