Malta today article - 11th December article - 20/12/2004
Matthew Vella

The secretary-general of the Medical Association of Malta, Martin Balzan, has reacted vehemently to the proposals outlined in the forthcoming health reforms for new working conditions, the details of which were first published in
MaltaToday in November, describing the reforms as “either the work of a sick mind, or of somebody who has a heavy axe to grind against the medical profession.”
“Various members during the MAM meeting had very colourful adjectives to apply to this document, but in summary the answer is ‘no, thank you’,” a clearly caustic Balzan told this newspaper.
The confidential report, circulated only to medical associations and medial staff unions, highlights various proposals for a “radical updating and adjournment of work practices”, which will include a three-tier system of management led by the Ministry, the Health Division and ‘Agencies’, the hospitals themselves.
Balzan said the document had not identified the shortcomings of poor management, instead giving the impression “that all is wrong because of lack of discipline and private interest. Not a word of praise for the high quality, high-intensity work which the medical profession provides.”

The government report, entitled ‘Proposals for New Working Conditions’, clearly states that the new health sector administrative set-up contemplates changes in employment and positions at various levels, including managerial levels. A clear devolution of power is outlined, as well as stricter audits, “accountable practices” for a rationalisation of primary, secondary and tertiary care, and the issuing of new internal and external calls for applications in a redeployment exercise.
“In spite of such weak and ineffective management, WHO and UNICEF have shown Maltese health standards to be high, and the service to be of high quality and extremely efficient. Studies of client satisfaction continue to give very high rates, the highest in Europe in fact.
“There is one main reason for this: the dedication and competence of the medical staff who give these first class results against a background of rather ineffective management,” the MAM Secretary General said, lambasting the ‘government propaganda machine’ for stigmatising doctors as only interested in doing private practice.
The health reforms clearly state that all employees have to declare any private practice whilst senior management will be precluded outright from the right to practice privately.
“Who is seeing these patients, and who is performing these operations? Ghosts, perhaps?” Balzan said of St Luke’s Hospitals workforce, which every year sees a total of 25,000 operations, coupled with 250,000 outpatients and 110,000 acute emergencies annually, and over 30,000 resident patients.
“To add insult to injury, the document proposes only negative measures and a completely autocratic management which deprives employees of any rights, and opens great opportunities for those who have any sort of patronage to play ball as they please. Who needs things like the public service commission, the Ombudsman, trade unions, or indeed collective agreements? All we need is a management which gets autocratic powers of hire-and-fire without any form of checks and balances,” a sardonic Balzan remarked.
The report states that staff will have to undertake new training where necessary, otherwise they shall not be considered to assume new responsibilities. A re-grading exercise will also be undertaken where required and all management positions will be on a three- to five-year performance contract. Staff will be expected to undertake undergraduate and postgraduate teaching as required, but will not be remunerated specifically for teaching. Such academic activities will however not be considered to have satisfied working hours obligations, and staff will have to make good on such time. The new reforms also include the introduction of audit initiatives which will establish performance management and quality assurance programmes which staff are expected to participate in as part of their contractual obligations as well as being taken into account for the purposes of their career advancement.
“To date the government has decided to unleash the Tax Compliance Unit uniquely on the medical profession,” Balzan told this newspaper. “While many doctors speculate why thousands of businesses and businessmen are left untouched, the government unleashed this profoundly negative document. Why is the government again targeting the country’s most prestigious and highly productive profession? The best brains are at work but still no one can find any logic.”

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