Miriam Dalli would be the ideal next health minister, specifically because she is not a health professional, according to the Malta Union of Midwives and Nurses (MUMN) president.

Paul Pace claimed the best health ministers in the country’s history were people who were detached from the healthcare profession, because they had no pressures to help their own colleagues when taking decisions.

“I believe it’s time we have a woman minister and someone who will not be influenced by doctors, nurses or consultants,” Pace told Times of Malta.

“It’s the prime minister’s prerogative, of course, but in my view, the ideal replacement would be Miriam Dalli. I don’t see anyone as efficient and as capable as her to tackle the system’s problems.”

He said three of the best health ministers were Louis Galea, Konrad Mizzi and John Dalli, and they were not health professionals.

“I understand Mizzi and Dalli were eventually embroiled in several scandals, but before that happened, as health ministers they were doing a good job,” he insisted.

Questioned about his views that Mizzi went on to sell three hospitals to a foreign company that had never worked in healthcare before, Pace insists that save for that scandal, the former minister did a very good job to eliminate out-of-stock medicines and starting the construction of much-needed new wards, for instance.

Pace has been at the helm of the MUMN for 12 years and is one of the most fiery and controversial trade unionists, known to dish out harsh industrial actions for his members, often disrupting large portions of the healthcare system.

He said he has a love-hate relationship with Chris Fearne, who he says is doing a fine job overall. But he insists that if Fearne had to be appointed European Commissioner, his job should not go to a doctor or surgeon again.

Surgeon and cabinet newcomer Jo Etienne Abela, who serves as Active Ageing Minister, has sometimes been touted to take Fearne’s job in that case, but Pace insists Abela has so far disappointed nurses and is yet to prove himself as a worthy minister.

The Carmelo Fino case

Pace and Abela have been at each other’s throats since the beginning of summer, when 83-year-old dementia patient Carmelo Fino walked out of St Vincent de Paul residence in the dead of night and got lost, only to be found dead two weeks later.

Abela had ordered an independent inquiry into the disappearance, which found that four security guards, two carers and a nurse failed to do their job properly that night.

All seven were suspended from their job, causing Pace to lash out at the minister for framing what was “clearly a system failure” on a young, reliever nurse who was unjustly left in charge of a ward with 37 patients.

Pace admits the nurse probably failed to notice the elderly man leaving the ward, not through negligence, though, but because of the circumstances.

He might have been attending to another patient at that moment, he said, and being a reliever nurse, he could not know all the patients and their conditions.

Even if the nurse had seen Fino walking out of the ward, he would not have stopped him, Pace argued, because it was an open ward – meaning patients walked in and out freely whenever they felt like it.

Doctors had diagnosed Fino with dementia, so they should have also shouldered at least some responsibility for not recommending his transfer to one of eight other closed wards in the residence, Pace said in defence of the nurse.

“We had long been warning that St Vincent de Paul is a time bomb. The nurse shortage added to these circumstances meant a big mistake like this one was bound to happen,” he said.

This inquiry was targeted to blame the nurse and exonerate the authorities

“The system failure is so real that since Fino disappeared, the government spent an extra €1 million to beef up security. Also, patients were reassessed and 60 of them were assigned a constant watch – meaning a carer to keep an eye on them all day long.

“So, there was, indeed, a system failure.”

The MUMN’s industrial actions forced nurses in state care homes to stop doing some duties, namely head counts and incident reports. But the most detrimental was a bed-blocking directive – forcing all homes to stop admitting new patients.

As the cold winter months crawled up on the health authorities, the beds at St Vincent de Paul grew emptier and those at Mater Dei became increasingly occupied by elderly patients who did not need to be there but could not be transferred to the home.

Panic and fears that the healthcare system might become paralysed triggered the government to take MUMN to court over the directive, with the court forcing the union to suspend the directive.

But the controversy around the Fino case ensues.

The inquiry also found that Fino had already been wandering in the streets for 15 hours before authorities began to search for him outside the care home.

It underlines how staff at the home only realised the man was missing five hours after he had left the hospital and then spent an entire morning looking for him inside the premises and in the home’s grounds because night shift officials, including the nurse, had given false statements about when they had seen him last.

In an e-mail, the nurse told his superiors that he had last seen Fino at 5.45am, when in fact, CCTV footage shows Fino had been missing since 3am. The inquiry found that the statement misled the search, causing a huge delay that might have been detrimental to find Fino.

But Pace argues that does not mean the nurse was lying. He could have genuinely thought Fino was in bed when he checked at 5.45am, or he may have mistaken someone else for him. Moreover, the nurse sent the email in the evening of the following day, meaning he could not have misled the search with that email in the morning.

“This inquiry was targeted to blame the nurse and exonerate the authorities,” he said, adding that the nurse was not even questioned for the inquiry.

‘A broken system’

Pace insists the healthcare system is broken, not patient-centred enough, waiting times at the accident and emergency department and at healthcare centres are swelling and no government has managed to fix it yet.

And on top of that, the system is suffering a nurse haemorrhage because of dire working conditions.

“Nurses run the hospitals, and aside from taking care of patients, they are expected to fix bed shortage, find ways to get medication when it’s out of stock, worry about toilet paper running out in the bathrooms and everything in between,” Pace said.

“Some of them don’t take leave, work 12-hour shifts with no breaks, and they are now threatened with suspension and prosecution if something goes wrong. No wonder scores of nurses are leaving the public health service.”

A future in politics?

Pace knows a thing or two about playing political chess, but he would not consider a life in politics.

However, he said if he were minister, he would have the power to bring about the much-needed change he believes in, of course, but it is far harder than he wishes it would be.

“I can’t stand clientelism. To have a successful political career in this country you must tow the party lines all the time, and I am not obedient like that.

“Being minister comes with a lot of constraints. At the end of the day you always have a lot of swords and knives over your head.”

Pace did get closer to political power in 2015, when he accepted a government consultancy contract with the health ministry. He served as a government adviser for a few years, during which, he admitted, he made €80,000 a year.

But despite being offered a contract renewal, he decided to quit consultancy and run for the MUMN top job again, returning as union president in 2019.