Every day, as I walk into work at one of our hospitals, I am struck by the unique position that our healthcare facilities have in the islands’ communities – places where me­di­cal science meets the extremes of human emotion. Joy, relief, pain, grief – all are experienced every day, to some degree or other, by patients and staff at Gozo General, Karin Grech and St Luke’s hospitals.

As I often tell our teams, patients may forget our name, yet they will never forget how we make them feel and we always do our best to ensure that the care we provide leaves patients feeling valued and respected.

I am incredibly proud of the staff of Steward Malta, this tight-knit, cohesive team that works quietly yet passionately to improve patient care across Gozo, Karin Grech and St Luke’s hospitals. I am proud of their commitment in the face of the many adversities that we have together overcome to bring quality people and healthcare facilities together to serve the communities we live in.

Things have never been easy. Everyone on the island has an opinion about Steward’s entry to Malta and its operations since the company agreed to step in, in good faith, to steer what was left of the doomed Vitals Global Healthcare (VGH) concession.

But, as someone who has led our opera­tions for the last three years – and as a medical doctor and a public health consultant myself – I don’t recognise the unfair image of Steward that is too often trotted out for political point-scoring, forgetting the many competent, talented and unique professionals that make up Steward Malta and who, day in, day out, care for our families, friends and neighbours.

The difficulties were evident from the start. Steward was approached by the Maltese government to take over the concession, which, at the time in 2018, was in a state of dire emergency. It is no secret that VGH, under the tight control of its owners, had not delivered on its obligations, nor had the government demanded they do so.

Not only that, there were also no funds left for the salaries of medical and non-medical staff working at the hospitals. This was unknown to VGH’s own management teams at the time, who were not allowed any visibility of the financial situation by the owners.

The government gave Steward a mere two weeks to agree to take on the responsibilities of the concession and ensure doctors, nurses, cleaners and everyone else whose livelihoods depended on VGH could get their salaries paid. This came with a commitment, to Steward and to the wider community (including the European Commission), that the terms of the deal would be renegotiated to make the concession viable.

Things were actually worse than most people realise. Everyone knows about the failings of the concession itself. The National Audit Office has been clear in its two reports, and, particularly, the second one, of the inherent problems with the original agreement and the actions of those linked to it while even the EU has lambasted the terms of the concession, calling it “unbankable”.

On taking over VGH’s operations, Steward discovered that there were no management accounts at all- Nadine Delicata

This ill-thought-out concession agreement was made even worse by the actions of VGH’s owners. VGH had created a raft of companies, shifting assets between them and burning through funds. On taking over VGH’s operations, Steward also discovered that there were no management accounts at all, and that – shockingly – there had never been so much as an attempt at an audit of the company by the relevant authorities. VGH’s owners had been left, unattended, with a massive amount of taxpayer money, with no one checking up on how they were delivering on their commitments.

Steward was confronted with a complex situation and left to deal with this alone. The priority was and remains always the provision of healthcare to our communities, yet on top of this we had to build from scratch a functioning healthcare company: bringing funds and assets back into the business, shutting down unnecessary satellite firms and cleaning up the ugly mess left by the owners of VGH.

When discrepancies were found, Steward was not rewarded but punished. We uncovered a staggering amount of VAT that not only had not been paid by VGH  but which the authorities had failed to detect, a likely mistake if no audit had ever been carried out. It was Steward which, transparently and openly, reported this issue to the tax authorities, only to be told that it was liable to pay for the negligence of VGH’s owners.

And what of the renegotiations of the terms promised when Steward took on the fiasco left by VGH’s principals? Three times during the last three years, Steward has finalised negotiations with the government to agree to terms that would make the concession viable; three times the government has pulled out of signing at the very last minute.

This is critical for us and our promises to taxpayers. Only new terms will allow banks to lend to us to finance the construction of hospitals and other commitments, something they won’t do under the deal’s original terms.

Despite these setbacks, we have made significant investments, even as COVID-19 placed a heavy burden on all of us. Hospitals have been made safer, with investments in infrastructure and plant and with new equipment sourced through our international network. We delivered the Barts Medical School in a record 18 months, a cutting-edge construction that has been hailed as one of the best medical schools in the Meditteranean, firmly establishing the Gozo hospital as a teaching campus.

Quality metrics and key performance indicators were introduced, ensuring clinical services were aligned to patients’ needs and providing regular monitoring and reporting to the government. Our staff remains dedicated to the job, working harder than ever throughout the pandemic to keep our communities safe.

When the takeover took place in February 2018, there was a feeling of optimism that Steward would be able to turn the concession round. Four years later, I remain convinced that we can deliver top-rate hospitals to Malta and its people, on time and on budget, relying on Steward’s international expertise and realising architectural plans we finalised and gave to the government way back in 2019.

Emotions may continue to run high both inside the hospitals and outside but Steward continues to maintain its focus on our number one priority: our patients.

Nadine Delicata, president of Steward Health Care Malta

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