The Health Division never agreed with the final draft of a 2007 collective agreement signed with doctors but it acquiesced because of "orders from above", according to former Health Minister Louis Deguara.

He was reacting to comments by Health Minister Joe Cassar that the collective agreement with doctors signed in November 2007 was flawed because it gave rise to unfavourable work practices.

"The Health Division never agreed with the final agreement because we knew it was seriously flawed. As a department it never agreed to the final draft," Dr Degu­ara said when contacted yesterday.

Asked why the agreement was still signed despite concerns raised by the Health Division, Dr Deguara simply said: "Orders from above."

He refused to elaborate but sources close to the agreement at the time said that during negotiations the Health Division could not discuss certain working conditions because its hands were tied and the Health Ministry had no say in the matter.

The collective agreement, signed just four months before the general election, had been described as "a milestone" by Prime Minister Lawrence Gonzi.

Working practices enshrined by the agreement mean that a vast majority of consultants work until 1 p.m., earning Mater Dei Hospital the label of "a part-time hospital" by former Social Policy Minister John Dalli in 2008.

The issue arose again last week when the present Health Minister said the government was proposing that doctors and consultants would work afternoon shifts so that the Outpatients Department could remain open till 5.15 p.m.

Dr Cassar blamed the problem of bed shortages at Mater Dei on unsuitable work practices and the issue has become a bone of contention between the doctors' association and the union representing nurses.

The Medical Association of Malta has said the uptake of afternoon shifts by consultants – a possibility under the current agreement but which is mostly shunned because of private practice – could improve but asked the government to make it financially more attractive.

The suggestion to pay consultants better overtime rates for the afternoon shifts raised eyebrows among nurses, who insisted they should be treated the same way.

Nurses' president Paul Pace said consultants should be available until 6 p.m. but doubted whether Dr Cassar had "the stomach to battle consultants with a general election just round the corner".

He called on the political parties to jointly agree on new working conditions for hospital consultants.

The Labour Party's spokesman on health, Marie-Louise Coleiro Preca said the party was not averse to changing hospital work practices.

"The Labour Party agrees with every initiative taken to increase the hospital's efficiency so that it could work to its full capacity for the benefit of patients," she said.

But the main problem, she added, was the government's "piecemeal approach" to the issue of bed shortages that was causing unnecessary friction between stakeholders.

Ms Coleiro Preca noted that on various occasions the Health Minister had flagged different problems to explain the bed shortages.

"The problem was first blamed on social cases. Later, the excuse was that we had a harsh winter this year even if this did not explain why a bed shortage still occurred in 2011 when the winter was mild.

"We then had the minister saying the collective agreement reached before the last election was not right and now he is directly blaming work practices."

Lack of planning, she added, had brought the situation to a head and this was not healthy because it created an air of antagonism between nurses and doctors.

To solve the problem, the government had to approach the issue in a holistic way by seriously sitting down with all hospital stakeholders, she said.

Meanwhile, the tit-for-tat continued yesterday as MAM reiterated that industrial action by nurses last Saturday was only averted after Mater Dei management promised to exert pressure on doctors to reduce their operation lists.

Operations were lasting past 6 p.m. and many times up to 8 p.m., the doctors' union said, defending its members from charges of inflexibility.

"While consultants and medical staff remain intent not to cancel any operations, they recognise the need to support the demand for more nursing staff in dealing with the greatly increased workload," the association said.

MAM REACTION

Dr Martin Balzan, MAM president, in a reaction said he was surprised that former Minister Deguara 'associates himself with the deplorable statements made by MUMN president clearly aimed at inciting his members by appealing to professional jealousy'.

He said the the 2007 agreement with doctors had major benefits for patients.

"One major effect which cannot be overlooked, was that it stopped the 50% brain drain of doctors to the extent that more doctors are returning to Malta than are actually leaving.

"Besides hundreds of applications are received from abroad to work at Mater Dei.

"Since the 2007 agreement, there has been a consistent 10% increase in operations each year, while the number of outpatient visits per year has doubled to over 400,000 per year. This was only possible with operation lists continuing till late evening and a large number of afternoon outpatient sessions."

Dr Balzan said the MAM fully symphathises with Health Minister Joseph Cassar's efforts in expanding the infrastructure and investing in human manpower, particularly in implementing post graduate training, according to the 2007 agreement.

"MAM looks forward to the revision of the collective agreement not only to consolidate its positive points but also to improve it for the benefit of patients."