The moment I discovered that Barts Medical School was coming to Malta (well, Gozo), I smelt a rat. I suspected that the desirable brand name would be used as a not-so-covert method of engineering the privatisation of Maltese healthcare. I fear I was right.
The arrival of Barts was never officially communicated to the University of Malta or the Malta Medical Students’ Association (MMSA) – who have long been at the forefront of Maltese Medical Education – instead it was sneakily slipped into a newspaper article (a quick Google search of ‘Barts Malta’ reveals that 12th February 2014 was the earliest public mention of the project).
So what's the big deal? Some might ask. Well, just a few things:
1. Lack of consultation
This is almost a cliché in Maltese politics (Żonqor, Paceville Masterplan, high rise in general, Marsaxlokk gas tanker…). Aside from this well-known medical brand potentially securing its name on the island for future healthcare privatisation, having a second medical school in Malta might be detrimental to the current medical school.
Mater Dei does not have unlimited patients, clinical or human resources for students to learn from – and so sharing it with another medical school might not be the best idea. It also costs €35,000 per year for students to attend the Barts school – which is a tough bill for the average Maltese medical student.
This private school will be using the same clinical resources as the public one, which are finite, and this threatens patients because they'll have fewer doctors in their public system. So it's selling clinical resources (patients, healthcare staff etc) to a profit-making organisation (Barts) to benefit a few wealthy people. And all this so that VGH agree to come to Malta.
2. No visible reaction
A year or so down the line, I realised that the government wasn’t joking about Barts coming to Malta so I decided it would be wise to do something about it. The MMSA, at the time, were reluctant to help, so I ran for election and was elected to the lofty position of ‘Student Representative’ on the Faculty of Medicine & Surgery’s Board. I then discovered, that in spite of Barts being an existential threat to the Faculty of Medicine & Surgery at the University of Malta – they too were reluctant to speak out publically against the secret dealings between the government, Barts, and a new entity, ‘Vital(i)s Global Healthcare’ (VGH).
Why do people remain silent? There is a fear factor, there is an element of apathy/hopelessness, and there is unfortunately an element of good old-fashioned mafia-style omerta. But none of these reasons are acceptable justifications for remaining silent in the face of unjust or harmful processes.
3. Lack of government transparency
Why should discussions about the future of our medical education or the fate of our public hospitals remain hidden from the Maltese public? Commercial sensitivity?
I grew up in the UK, where you have to pay £12,000 per year to attend University and where the stability of the healthcare system is constantly threatened by a government that doesn’t care too much for free-at-the-point-of-use healthcare. In short, I understand the perils of a reckless government who are more interested in economic growth, austerity, or personal profit, than they are in social justice or the health and wellbeing of the population that they are meant to serve.
As time went by, it became clearer and clearer that three Maltese hospitals (Karin Grech, St. Luke’s & Gozo General) would be transferred to a private company. The contracts between the private company and the government were totally withheld for the public up until very recently – they are now only partially withheld from the public, following the publication of heavily redacted versions.
"Why should discussions about the future of our medical education remain hidden from the Maltese public?"
4. It could lead to more privatisation
The secretive nature of this affair makes it difficult to comment on specific features of the agreement or the due diligence process and so it is no surprise that the Medical Association of Malta (MAM), Marlene Farrugia and the official opposition have been kicking up a fuss about the dubious nature of the VGH-government deal.
In my capacity as Student Representative (though more as a concerned citizen) I had meetings with the past and present Ministers of Health. My concerns about our current medical school were brushed aside. The Ministers mumbled something about “medical tourism” and how privatisation was the future.
Privatisation of healthcare is not a good idea, provided we are interested in a healthy society. I could write a book on this topic. Thankfully, Professor Sir Michael Marmot has already done this. His recent book ‘The Health Gap’ is primarily about Social Determinants of Health, but he also explores how private health care often leads to poorer health outcomes. He uses evidence from rigorous public health research: evidence > opinion. Unfortunately, there has been little to no public discussion about whether we would like our health services privatised in Malta.
"Privatisation of healthcare is not a good idea, provided we are interested in a healthy society"
5. No one's really that fussed
The fact that we don't question whether privatisation of hospitals is a good idea or not is troubling. The current situation is so bad that we don’t have time to talk about it – what with rampant lack of transparency and weekly revelations about how dodgy VGH’s director seems to be (see David Thake’s radio interview).
A few weeks ago it was revealed that VGH had not obtained the relevant licences needed to manage a hospital. VGH now manage three. I chuckle a little whenever the government tries to justify this. Are doctors allowed to practice medicine in an unlicensed institution? What happens in the case of a clinical incident? Does insurance cover healthcare professionals working in an unlicensed environment? I don’t know, and most probably neither do you. Troubling.
6. Apathy will see this project through
The truth is we are part of the problem. We are letting the government and their close friends (the people with the most lucrative lobbies) walk over us, and I believe that it has to stop. There is nothing to fear from speaking up for something you believe in, or against something you believe is wrong. I have done it, and I remain un-murdered. Sadly, I am insufficient on my own, and I will need your help.