Mater Dei Hospital will be freed of all outpatient services and instead focus on emergency and longer-term inpatient care, according to a plan the health minister presented to top officials on Thursday.

The plan, which is still in its early stages and has no specific timeframes, is to shift outpatient and day care services to the Guardamangia area housing Karin Grech and St Luke’s Hospitals.

Staff at those two hospitals, which currently provide rehabilitation and physiotherapy services, will be moved to an as-yet undefined location while the facilities are revamped to allow them to serve as a hub for outpatient services and day cases.

Health Minister Jo Etienne Abela is understood to be thinking of subcontracting rehabilitation services to the private sector while the Guardamangia area is being revamped. 

Doubling Mater Dei's emergency department

The minister’s vision is part of his broader plan to maximise clinical floor space at Mater Dei Hospital, which is now struggling to keep up with the demands of Malta’s larger population.

Moving outpatient and day care services out of Mater Dei will allow the hospital to grow its in-patient, emergency and tertiary-level care facilities.

There are plans, for instance, to more than double the size of the hospital’s emergency department, the minister told Times of Malta.

Mater Dei currently has 35 service cubicles within its emergency department. The plan is to increase it to 70 to 90 cubicles, both by extending the department into existing areas at the hospital and also physically enlarging its footprint.

A call for expressions of interest to develop that expanded capacity will be issued shortly, the minister said. 

While Abela has previously hinted at expanding emergency services and indicated the private sector might be involved, the plan to shift outpatient services away from Mater Dei was not known.

Neither of those two ideas featured in a seven-year national healthcare strategy published just weeks before Abela replaced his predecessor Chris Fearne as health minister. 

Abela's plan to refocus Mater Dei on inpatient services is especially significant, as it calls into question the government’s years-long plan to develop a massive new outpatient block on Mater Dei grounds. The block, spanning 16,000 square metres over five storeys, received planning approval in 2021.

Sources told Times of Malta “millions” were spent on designing the facility and carrying out geological studies at the site. But construction stalled due to a lack of funding and the project appears to have now been shelved.

Minister confirms plan

Abela confirmed his plan to shift outpatient services to Guardamangia when contacted by Times of Malta on Friday, but said it was still at a preliminary stage.

“I met with employees and officials to explain the plan and receive feedback. It’s still early days and discussions are still being held,” he said.

So far, hospital officials and unions seem receptive to the idea, he said.  

The minister also insisted that plans to build a new outpatient block at Mater Dei had already been shelved by the time he became Health Minister earlier this year.

Plans shared with Karin Grech staff

Staff at Karin Grech hospital have already been informed of the plan to eventually move them.  

In a memo seen by Times of Malta, Karin Grech Hospital CEO Stephen Zammit told staff he still does not know when that will happen, as the government has yet to decide where the hospital and its rehabilitation services will shift to.

“Eventually, rehab services will move into a new site (most probably within SVP grounds) and which will provide proper rehab services according to the needs of our population,” Zammit told staff. 

The ‘SVP’ mentioned in the memo appears to be a reference to St Vincent de Paul, the country’s largest state-run care home for the elderly, which is based in Luqa.

A change in healthcare strategy

The health minister has made no secret about his wish to turn the Gwardamangia area which houses St Luke’s and Karin Grech hospitals into a “health village” that can take some pressure off Mater Dei Hospital, which is struggling to keep up with demand.

When he first shared that plan, he said that he wanted to move all non-clinical services – such as administrative offices and the medical school - away from Mater Dei, to ensure every inch of floor space at the hospital is dedicated to clinical services.

The vision he shared with health officials on Thursday goes beyond that. If realised, it would shift the bulk of Mater Dei's daily visitors to the Guardamangia area. 

Well over 500,000 patients attend outpatient clinics at Mater Dei Hospital every year and those services, which cost tens of millions of euro a year to run, place significant strain on hospital infrastructure. 

To try to ease some of those pressures, plans for the now-shelved new outpatients block included provision for a 627-vehicle underground car park and construction of a new bus terminus.

A 2017 National Audit Office analysis of outpatient services at Mater Dei concluded that anything between 20 and 50 per cent of those patient visits could have been handled by regional healthcare services, rather than the state hospital.

One major problem flagged in that 2017 study was that of outpatient “queue jumpers”, with many Mater Dei clinicians using the public hospital’s services to schedule tests for their private practice patients.

As a result of that and other issues, the average person waited eight months for their first outpatient appointment.

While those figures date back to 2017, problems remain to this day.

In January, Jo Etienne Abela told parliament that more than 15,000 people were waiting for an MRI – nearly double the number on the waiting list six months prior.

One of the conclusions of the NAO’s 2017 probe was that Mater Dei must work with the private sector if waiting times are to be cut and outpatient services improve.

The health minister has previously said he is open to tying up deals with the private sector to improve public healthcare services, provided those services remain free for end users.

Abela told Times of Malta that he would like to rope in private sector operators to extend emergency room services across the country, beyond the capacity of state-run hospitals and healthcare centres. 

He also did not rule out involving the private sector in his plan to revamp outpatient services. "Several financing options" are being assessed, he said.