Minister Deguara describes Migration plan - 2/2/2007

link to The Times

Migration to Mater Dei Hospital
Louis Deguara

Over the past few months the opposition has made quite an effort to look reasonable, suave, moderate and constructive, in short to present itself as a viable alternative government. The drawing up of various policy papers after some degree of consultation have played quite a part in its presumed redemption, until one bothers to scratch the surface, which, in today's rush, few have the luxury to do. The truth is that their driving force is an election victory whatever it costs, not its principles, which it has long lost, and the lack of which is exalted as pragmatism. No wonder the leader is hard-pressed to keep the party together. Not a few within the party continually still question his leadership credentials. Hardly a week passes by than some incident or other bears Labour's true nature, its peevishness, sometimes to the point of childishness, its propensity to destructive criticism, and its deep divisions.

Such is the incident regarding its secretary general. Such was the hounding of Gordon Cordina, to the extent that he felt he had to resign. Since, lately, statistics are heralding quite an economic recovery despite all the odds, and this could mean a veritable obstacle in Alfred Sant's efforts to salvage his political career, all is fair. Neither the national good nor the personal integrity of a competent and professional man count for anything if they stand in his way.

Nor have Dr Sant and his inner entourage any pity on the weakest members of society such as the sick. Much has been made in recent weeks about the opening of Mater Dei Hospital on July 1. For nearly two years since the signing of the agreement between the government and Skanska Malta JV on April 12, 2005, opposition spokesmen and media have been following events eager to spot the least falling behind. Now that it's daily becoming surer we will meet the target they are questioning the meaning of the opening date. The Opposition Leader is himself leading the charge claiming that this is going to be a mere ceremony and there will be no inpatients in the first week of July. Can anything be more peevish and amateurish? Doesn't he realise that July 1 is a mere six months away and he may remain with egg all over his face?

In fact the agreement, inter alia, stipulates a construction works programme allowing a hospital opening in July. We have every interest to move patients to Mater Dei as early as possible. But we have repeatedly made it clear we are not prepared to compromise on patients' safety. Indeed, the migration plan was developed around the central principle that no patient's health is put at risk. Not political expediency! The whole process from beginning to end will take about three months. Construction readiness is not the only constraint.

Migration means more than the mere transfer of patients and services. The migration plan proper has started a long time ago. We realised early that this is no easy task; this is not the simple closing down of a hotel and the opening of a new one. It is going to be a unique experience.

Hospitals are not built every day. Certainly not in Malta. That is why we needed foreign expertise. The issue is rendered more complex because we only have one acute hospital here. We can't stop taking in patients by directing them to other hospitals. Nor do we have other back-up services in case something goes wrong. The ideal would have been that only new patients are admitted at Mater Dei and patients at St Luke's Hospital are discharged home when cured instead of moved to Mater Dei. But the ideal is not always attainable. However, only acute patients will be transferred. Those who are due to leave in a mere day or two will not be transferred. Nor will patients undergoing rehabilitation and the so-labelled social cases move to Tal-Qroqq.

Another point one has to understand is that we are not transferring a product but a service or, rather, quite a number of sensitive services, delicate by their very nature and delivered to human beings at a weak point in their lives. It is a service we have to continue offering all the time. We can postpone elective interventions for a few days but not urgent treatment.

We are also transferring staff from one environment to another and from differing types of equipment requiring a learning curve. That is why we have been for a long time getting our staff, professional or otherwise, to familiarise themselves with their vastly-improved working environment, but new all the same. This is an essential facet of the migration process.

All key activities and milestones that hospital migration entails were identified and weighted especially against patient safety but also staff disruption. The plan has been built on the grounds of least risk, maximum acceptance by staff and financial efficiency, management, staffing and equipping of the new hospital. We early committed ourselves to double running, transitory services (and costs), as some departments will have to operate for a short period on a split site basis.

We have been working on what is called sequencing - no service is interrupted or, where unavoidable, the interruption is kept to the barest minimum.

Stand alone departments will be the first to be transferred. Pathology is a case in point. There is no direct contact with patients, nearly all the equipment is new and so you can stop testing at St Luke's and start immediately from the new premises. One can also revert to the old site in case not everything works like clockwork on the first day.

Medical records are another area which should present us with minimal problems once the IT issue is settled. Then it would be the turn of outpatients and later day surgery and a number of specialities. Adequate sections of support services staff, such as porters, telephone operators and domestic services, will transfer simultaneously.

During this period a transport link using various types of vehicles will be constantly available between St Luke's and Mater Dei.

Then comes the most critical phase, the transfer of those special departments where most attention is required. Paediatrics, obstetrics and gynaecology, orthopaedics, operating theatres and emergency services.

Every normal being hopes that the migration plan will succeed first and foremost in the interests of patients and, why not, in the interests of the prestige of our health system held in such esteem abroad.

Only the Labour opposition seems to be ready to rub its hands in glee if something goes awry. They hope that such mishaps will help catapult them to power. To achieve this goal they do not mind causing distress to patients, especially to those who read or listen to nothing but the MLP mouthpieces.

Dr Deguara is Minister of Health, the Elderly and Community Care.

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