Government’s health strategy must be clear

The ongoing Parliamentary debate about the private-public partnership  (PPP) with Vitals Global Healthcare, to own and operate three hospitals in Malta and Gozo, should give rise to a broader debate about Malta’s entire policy direction regarding health.

To use a medical analogy: a patient must be diagnosed before he or she can be cured. Likewise, a problem must first be identified, before it can be solved. And while problems seem to exist aplenty concerning the contract itself... unless the issue is viewed within its proper context, there is a danger of losing sight of the ultimate objective in this debate: i.e., to ensure, as both sides of the House are committed, that the national health service remains free, and of the highest possible standard.

That is no small task (indeed, in most other countries the objective itself would be considered contradictory). Nonetheless, medical professionals argue that – in a small country such as Malta, with its own idiosyncrasies – the health service can indeed be kept both ‘excellent’ and ‘free’... even at a time when people are living considerably longer than ever before; and when the cost of providing this service – the medicines, the equipment, the new technologies, etc. – has never been higher.

This newspaper shares that optimism: we believe it is both desirable and logistically possible – albeit at great cost – to maintain a free national health service, for all persons regardless of circumstances, ‘from the cradle to the grave’.

But we must also be realistic about the enormity of this ambition. Above all, we must also be professional and clinical in our approach. The only way to ensure the future sustainability of the system, is to draw up a comprehensive, long-term plan which envisions exactly how this system will be financed and maintained; and above all by whom.

It was, in fact, to address the impending healthcare sustainability time-bomb that the government had resorted to a PPP in the first place. From the outset – long before the current controversies arose – this was itself ominous. The profit-motive is by definition incompatible with our country’s declared health policy
objective: to provide a free social service for everyone.  And this raises an important point: even before debating the intricacies of the VGH, we should have debated the policy direction itself.

Given the extent of what is at stake, it is clearly insufficient for a single party in government – no matter how large its electoral majority – to unilaterally commit future generations to a health strategy, without first opening that strategy up to debate. This applies to any strategy... even more to one as patently flawed as the VGH deal in question.

Meanwhile, the apparent collapse of this deal suggests that – while the intention may have been well-meaning (and this too is debatable) – the strategy itself has manifestly failed... as similar strategies have in fact failed elsewhere. From this perspective, we must question the government’s wisdom in placing so much trust in a single PPP, with a view to attracting paying medical tourists from abroad. More than a policy direction, the government’s approach was piece-meal and short-sighted. And matters can only be
exacerbated by the many apparent flaws in the deal itself.

If the government’s intention, through this agreement, was to refurbish St Luke’s, Karin Grech and the Gozo hospital, so that parts could be used for medical tourism purposes... then the way it went about matters raises many serious questions. Why sell off all three hospitals? Those were national assets, and represented considerable governmental investment running into millions of euros. The same objectives could easily have been reached through an agreement allowing Malta to retain ownership. Instead, we sold those properties, and inserted a clause that permits the buyer to extend the terms of the contract from 30 to 90 years; and also a buyback option, whereby government would have to spend 80 million euro to reacquire what was its own property to begin with.

To make matters worse, the concessionaire has apparently failed to meet its financial commitments – which were projected as a 200 million euro investment – and is now trying to sell off its acquisition to third parties.

As is perhaps to be expected, given what appears to be a fiasco of a deal for Malta, the Opposition has seized the opportunity of the Parliamentary debate to implicate large-scale corruption in proceedings. And at a glance, there is much about this agreement that raises suspicion: not least, the obscure ownership structure of the VGH group. Be that the case or not – government certainly has a lot of answering to do – at least part of the debacle can be attributed to the lack of a properly thought-through national vision for healthcare.

It was, at best, naive to place so much trust in the notion that a single PPP – even without the many flaws in the set-up – could be the answer to Malta’s healthcare headaches. As it transpires, the VGH group could not even guarantee its own sustainability... let alone the future sustainability of our free health service.

In a sense, this was predictable:  having no clear government policy/vision is bound to lead to confusion down the line.