Paediatric surgeon Chris Fearne has had to give up his career after being appointed Parliamentary Secretary for Health. Two days into the job he speaks to Kurt Sansone about the challenges ahead, including handling the unions.
When Chris Fearne left Girgenti palace after meeting the Prime Minister he immediately phoned three people: his wife, his mother and nurses’ union head Paul Pace.
It is no coincidence that the phone call to Mr Pace ranked high on Mr Fearne’s list of priorities soon after receiving the news that he will be Parliamentary Secretary for Health.
The paediatric surgeon knows that the Malta Union of Midwives and Nurses headed by Mr Pace can be a major headache for any politician as the last two health ministers – Godfrey Farrugia and Joe Cassar – can attest.
“I want to have strong unions because I want workers in the health sector to have good conditions... my approach is to work with all stakeholders,” he says, when asked how he will deal with the MUMN.
It is a conciliatory tone towards a union that only recently insisted that Dr Farrugia, the former health minister, was “not up to it”.
But Mr Fearne does not flinch at the suggestion that health sector unions wield too much power on hospital management. This was noted in both the Johns Hopkins and John Dalli reports that analysed the workings of Mater Dei Hospital.
Unions have a defined role to improve the working conditions of their members, he says. “The Labour movement has always been at the forefront of the fight to improve workers’ rights and we have to ensure the conditions employees enjoy are the best.”
Mr Fearne insists that he wants to work with all stakeholders, including the Opposition, to address the problems that afflict the health service.
“Our enemy is disease, not each other,” he says in almost poetic terms.
I meet Mr Fearne at the Health Secretariat in Merchant Street, Valletta, just two days after taking his oath of office.
With no political experience, Mr Fearne actively joined the Labour Party after Joseph Muscat became leader and was elected to Parliament last year at his first attempt.
But now, at the pinnacle of his medical career, he is giving up his profession to take on a Cabinet role that puts him in the driving seat of health reforms.
“I feel I can contribute to the health sector in a different way,” he says with no hint of regret at having to end a career during which he was appointed chairman of surgery at Mater Dei Hospital.
I want to have strong unions because I want workers in the health sector to have good conditions
Conscious of the controversy that surrounded last year’s appointment of ophthalmologist Franco Mercieca to Cabinet – he had been given a waiver to continue seeing patients in breach of the code of ethics – Mr Fearne points out that the second round of phone calls after leaving Girgenti was to the private clinics where he offered a service.
“I instructed them to cancel all my appointments and remove my name from the list of doctors offering a service at the clinic,” he says.
He then explains that he only kept four patients at Mater Dei he had just operated on. “Three of these are no longer in my care because they left hospital and my only patient is a baby who is recovering from surgery.”
Sitting across the boardroom table and accompanied by two of his staff, Mr Fearne refutes any suggestion that professional jealousy from his medical peers could get in the way.
“I do not anticipate this problem and knowing the commitment my colleagues in the profession have towards improving the lives of patients, I believe I will forge good relations with them,” he says.
But now in his political role will he be able to control the behaviour of consultants, that elite body he formed part of for years?
He smiles at my use of the word elite. It is something of “a myth”, he says, adding that the vast majority of consultants are dedicated people.
Mr Fearne argues that the biggest problem he experienced as chairman of the surgery department was the fact that consultants wanted to perform more operations but could not because the resources were lacking.
But he insists his role is not to control any section of the health sector workforce.
“Politicians are there to give direction, not micro manage the sector. I have to ensure taxpayers are getting value for money. My role is to facilitate the job of health workers by ensuring they have the opportunities to grow.”
Mr Fearne acknowledges there may be decisions that will not go down well with some in the medical professions but pledges to discuss and consult at every step.
“We will not be arrogant, but if decisions have to be taken I will take them and shoulder political responsibility for them,” he says, insisting the government’s priority is to put patients first and address their concerns.
Mater Dei CEO Joe Caruana had urged politicians to keep their hands off hospital management. He gave examples of frustrating situations caused by the management’s inability to take even simple decisions like buying a laptop.
It is a situation Mr Fearne is aware of and he pledges to provide management with the necessary structure to be able to do their work efficiently.
He says that his predecessor’s policy to revamp the management structure by creating strategic business units – giving individual hospital departments a measure of autonomy – will be discussed with all stakeholders.
The MUMN had come down heavily on the proposal to adopt this management structure at the new oncology hospital, claiming to have learnt about it through the media.
“At this point no final decision has been taken on the creation of strategic business units and everything is up for discussion. I will approach the discussion with an open mind,” he says, in an attempt to reach out to the unions.
But apart from the internal union politics, Mr Fearne realises there are more pertinent patient-related problems that require solutions.
He identifies three areas that have been a constant headache: out of stock medicines, lengthy waiting times at the emergency department and the lack of acute beds at Mater Dei.
The situation with medicines had started being tackled by his predecessor in the form of a White Paper to reform the Pharmacy of Your Choice system including the procurement of medicines.
Mr Fearne says he already had a meeting with Health Minister Konrad Mizzi on the outcome of the POYC consultation process and in the coming weeks they will publish the recommendations to reform the system.
He refrains from giving details of the final plan, insisting it may be a hybrid of the three ideas outlined in the White Paper that included roping in the private sector.
The problems may be more complex when dealing with the situation at accident and emergency.
It is an urgent matter but one that is not easy to tackle, he says. “It hurts me to see patients waiting for so long to receive treatment but the solution requires additional manpower and structural changes.”
He says the problems are compounded by the fact that health centres were starved from any meaningful investment over the past 25 years, a situation that has led to almost 70 per cent of patients turning up at Mater Dei’s emergency department without a referral.
“What can be treated in the community should be handled by family doctors and health centres to ease the pressure on the hospital. In this way we have to empower family doctors and help them set up group practices while beefing up health centres.”
One of the benefits of having group practices is that patients can benefit from access to a family doctor on all days, easing the pressure on the public health system over the weekend when private doctors are less likely to be available.
I have to ensure taxpayers are getting value for money
But when I point out that the setting up of group practices has long been touted as part of the solution with very limited success, Mr Fearne smiles and insists it will be implemented.
However, he is aware that this is only a long term vision that will not deliver immediate results.
The short-term solution is to increase the human resources at the accident and emergency department and create more space for treatment areas.
“Konrad and I are in the process of setting up project teams tasked with finding and implementing solutions to tackle specific problems, including the situation at accident and emergency,” he says, adding the teams will be managed by technical people.
However, one of the problems identified by the Health Ombudsman last year was that patients were never discharged on Sundays because consultants do not work on that day. This blocks an amount of beds in the wards on a day when admissions through the accident and emergency department are high.
“Sunday is normally an off-day for consultants and I think they are entitled to a day off like anybody else. I am aware of the Ombudsman’s observations although the discharge rate is not so radically different from weekdays.”
A possible solution, he says, is to change the requirement that patients can only be discharged from hospital by the consultant.
Lack of bed space at Mater Dei is another major issue, which also has no straightforward solution.
The hospital was built with fewer beds than its predecessor St Luke’s Hospital and an ageing population has only made matters worse.
Mr Fearne says the solution to this problem may have to explore options “outside Mater Dei” but insists it is premature to say whether St Luke’s Hospital should be used.
The St Luke’s option was used by his predecessor who last week opened a ward at the former hospital in Pieta, much to everyone’s surprise.
And with the Prime Minister having gone on record last year saying that he was resisting suggestions for the government to re-open St Luke’s Hospital, finding a solution has never seemed so precarious.
Mr Fearne admits that 10 days ago Mater Dei was facing “a crisis” with the number of patients being treated in corridors as a result of the bed shortage.
We will not be arrogant but if decisions have to be taken I will take them and shoulder political responsibility for them
“Administrators felt they had to use all resources at their disposal, which included transferring some patients to the former hospital. I gave instructions for the number of patients at St Luke’s to be reduced as quickly as possible and by today [Friday] the number has been halved.”
Mr Fearne says the project team that will be working on the bed shortage problem will start implementing solutions before the onset of winter when patients surge as a result of seasonal influenza.
It is finding solutions to these immediate problems that the Health Ministry will be focusing on before dedicating its energy to drawing up long term plans, he says.
He steers clear from making commitments on whether the government will reconsider the leasing out of St Philip’s Hospital, a private hospital that is not operational, as a rehabilitation facility.
“I have only been here two days but I do not want to undermine the work of the project teams,” he says.
But there are other issues at stake. Opposition health spokesman Claudio Grech last week described the new patient-management IT system at hospital as possibly this administration’s major flaw.
Does this worry him?
Mr Fearne acknowledges the concerns.It is obvious that people are concerned when an IT system that was going to cost some €25 million was re-commissioned from elsewhere at the cost of somebody’s wage, he adds.
“To this end I will commission IT experts to analyse the new system. I have assurances from the hospital CEO that it is working well but I will not only be taking his word,” Mr Fearne says.
Another issue unrelated to patient care is the appointment of former Nationalist finance minister and EU health commissioner John Dalli by the government last year to draw up a report on Mater Dei.
Mr Dalli’s critical report on the hospital’s failings sent unions on a warpath, to the extent that the former health minister had to distance himself from the findings.
What role will Mr Dalli play now?
“I thank John Dalli for his work and we are analysing his findings but he is not my consultant,” Mr Fearne says emphatically.
He will be working in tandem with Dr Mizzi, whose appointment as Health Minister alongside the energy portfolio was a major surprise in the Cabinet reshuffle.
But on a more curious level, Mr Fearne and Dr Mizzi were elected from the same electoral district. Pundits have speculated that this can be a source of political animosity between the two as they compete for voters’ attention.
Mr Fearne looks at me in a puzzled way. “People say this to me but... coming from the same district can paradoxically be an asset.”
He argues they are both results-driven and full of energy. Mr Fearne says he got to know Dr Mizzi better during the election campaign. “We did not campaign together but we struck a good note,” he says.
How will this curious tandem work?
“I know what needs to be done in health and Konrad knows how to get there.”
The actions of these two men will be closely watched. Unlike other areas of government operation their results and failures will be visible for all to see.
While finding immediate solutions to lingering problems is a necessity to alleviate the burden from patients and healthcare workers, much will depend on the long term strategy to get out of the firefighting mode every recent health minister has found himself in.
Two days into the job may be too short a time to get a clear picture. It will take Mr Fearne a lot of hard work to turn things around but, in his words, hard work is not something he shies away from.
ksansone@timesofmalta.com