[attach id=294342 size="medium" align="left"]Mater Dei chief executive Joseph Caruana. Photo: Darrin Zammit Lupi[/attach]

Political intrusion at Mater Dei Hospital has over the years weakened the management and rendered it ineffective, according to chief executive Joseph Caruana.

Breaking his silence after months of the management receiving flak for shortcomings at the hospital, Mr Caruana insists it has no say on strategic decisions because these have always been taken by the Health Ministry.

Interviewed yesterday in the wake of John Dalli’s critical hospital report, Mr Caruana speaks of his frustration with a system that repeatedly sees unions bypassing management to get what they want from politicians.

“Whenever I had clashes with unions under both governments and tried to stand my ground, especially on issues of patient safety, some of the unions bypassed Mater Dei management and went further up, be it the ministry, the minister or the Prime Minister until in some way they achieved what they wanted,” Mr Caruana says.

As an example he cites the introduction of a punch clock system for employees. Management has long been asking for it but no government has found the courage to confront unions on the matter.

But it is not only union issues where hospital management does not call the shots. Management has no say on key matters like human resources, finance, information technology and procurement.

These strategic areas are managed by the Health Ministry in Valletta and Mater Dei management is expected to implement decisions taken by people who are not on the ground in hospital, he adds.

“The people in the ministry... are often constrained to take decisions either in the dark or based on other parameters that do not fit the needs of hospital operations and patients. Sometimes decisions may be taken to keep industrial peace.”

Mr Caruana says blaming the problems flagged by the Dalli report on the current management team would be “unrealistic” because all the shortcomings were present even before Mater Dei started operating.

“Trying to find people to shoulder the responsibility may not be an easy task as most problems are system failures and not people failures,” he says when asked about the Prime Minister’s statement on Sunday that those responsible for the mess at the hospital should carry the can.

‘The buck does not stop with me’

In line with the Dalli recommendation for politicians to keep their hands off hospital management, Mr Caruana argues that the system of running Mater Dei from the ministry has to end.

He gives more examples of frustrating situations that are caused by the management’s inability to take even simple decisions like buying a laptop.

“What I can get overnight from a retail outlet at €700 comes to Mater Dei through Mita (the government IT agency) four to five months later at a typical cost of €2,600,” he says.

On a more serious level, Mr Caruana says Mater Dei has negligible control over the procurement of medicines and hospital supplies.

“This does not mean that we at Mater Dei should not have managed stocks better than we have done so far and I take responsibility for that. But the basic tool to manage stocks is a good IT system, which the hospital does not have... I had asked the ministry to invest in a different system but my request was turned down.”

And the list of frustrations goes on with management unable to recruit or lay off employees. If a nurse resigns, he says, it takes 13 months for a replacement to be recruited and the same applies for doctors and other professions.

Mr Caruana recalls an incident when a doctor had informed him eight months in advance that he will be on leave for three weeks. Although the ministry was asked for a replacement it was not forthcoming and this increased the patient waiting list.

“In July of 2011 I asked the ministry to recruit a communications manager and a theatres director, two critical roles, but these posts have not yet been filled to date,” Mr Caruana says, adding the hospital was still without a finance director 14 months after the previous one left.

He gives a crude assessment of the bureaucratic machinery of the civil service. “Systems in the civil service work at two speeds: slow and very slow.”

Mr Caruana says management has often raised awareness on the issues flagged by the Dalli report and notes that proposals were also made to the ministry on a list of areas where savings could be achieved.

“For example, the number of static security guards that pepper the hospital unnecessarily can be cut down, but neither the ministry under the previous government nor this one have so far taken the suggestion on board,” he says.

Mr Caruana reminisces on the day, two-and-a-half years ago, when he was appointed to the post and then minister Joe Cassar emphasised that the buck now stopped with him.

“Little did I know that in fact, most of the time, the buck does not stop with me and systems are designed so that it does not stop with me... this has been the most frustrating aspect of my job,” Mr Caruana says.

He praises his management team who despite the difficulties managed to achieve progress in those areas where no obligation of intervention from the ministry was necessary.

He says the output in operating theatres has increased, patient safety in theatres and the hospital has improved, a significant reduction in hospital born infections was achieved and theatre lists were taken from the hands of doctors to a central repository.

But he admits it is ridiculous for him not to be able to say where every cent of the salaries he pays is going and whether it is adding value. “What I can guarantee is that if the government takes up the reforms with the unions, all of Mater Dei management without exception will be behind it.”

ksansone@timesofmalta.com