Union reacts angrily to critical hospital report

A report on the management of Malta’s main public hospital has brought an angry reaction from healthcare unions. The report, commissioned by the Maltese Government and released at the end of November 2013, highlights a number of concerns. It claims levels of overtime pay at the hospital were excessive, the shift system was cumbersome, and there was a lack of control over the working time schedules of staff. The Malta Union for Midwives and Nurses has refuted all the allegations.


The Government of Malta commissioned former Health Minister John Dalli to compile a report on the management of the country’s main public hospital, Mater Dei, located in Msida. The report was published at the end of November 2013. Mr Dalli, a former EU Commissioner, was Minister of Health for a brief period from March 2008 to June 2009 under the previous administration led by the Partit Nazzjonalista (PN), now in opposition after its electoral defeat at the polls in March 2013.

Report content

The report highlights a number of concerns about the payment system and working practices at the hospital, including:

  • the high levels of overtime pay, amounting to €37 million;
  • levels of paid untaken leave and time-off allowances amounting to €30.7 million;
  • the large number of shift patterns;
  • delays to operations due to medical teams failing to turn up on time at the operating theatre;
  • the lack of a clocking in and out system for consultants, doctors and nurses.

The report states that management often felt ‘disarmed’ by excessive interference from politicians. It added that politicians were keen to avoid confrontation, and seemed to give in too easily to the demands of trade unions.

This view was supported by the former Chief Executive Officer at the hospital, Joseph Caruana. He complained about the intrusion of politicians in the running of the hospital. He claimed that very often this intrusion was instigated by the trade union, which was exercising too much power in the running of the hospital through its lobbying.

Mr Caruana also said management had been pushing for the introduction of a clocking in and out system for doctors and nurses.

Reaction of trade unions

The Medical Association of Malta (MAM) said it had no concerns about the report, as all doctors work on a one-shift basis. However, it called for more ‘time flexibility’, as 70% of the hospital doctors are women.

By contrast there was a furious and confrontational reaction from the Malta Union of Midwives and Nurses (MUMN). The union represents the majority of the hospital employees.

The union accused Mr Dalli of likening the running of a hospital to the management of a factory working on a conveyor belt system. MUMN ordered partial industrial action by nurses.

Paul Pace, MUMN President, said the peculiar shift system was due to the different levels of activity in the various hospital wards which meant they needed different staffing levels. He said there might be continuous round-the-clock activity in one ward while another might cope with a skeleton staff during the night.

The flexi-time system and the family-friendly shifts enhanced the retention rate of nurses, he said, with 75% of them being women, and 55% of them of child-bearing age. Uniformity of shifts would jeopardise the family-friendly environment which attracted a number of working mothers to the nursing profession.

The main reason for the high overtime levels, according to Mr Pace, was a shortage of full-time nurses and under-staffed wards.

With regard to delays in starting operations, Mr Pace said that although in many cases the full complement of three nurses, as required by medical standards, was lacking, those nurses at the operating theatre still went on to perform their duties.

Rather than enjoying a ‘free-for-all’, as the report seemed to be hinting, Mr Pace said nurses were performing work ‘beyond the call of duty’.

In response to the report, MUMN issued a directive instructing nurses not to take part in operations unless the safe complement of three nurses was available. It also instructed nurses not attend a call to any surgery after 17.00 as part of a safeguard against the stress induced by the day-to-day running of the operating theatre.


Mr Dalli stated that the union, rather than refuting the contents of the report, had simply tried to explain the reasons for the existing work practices. The Minster for Health, Godfrey Farrugia, in trying to play down the confrontation with the union, called for constructive dialogue and invited MUMN to be part of the working group that has been given the task of reviewing the report.

PN Spokesperson on Health, Claudio Grech, said the report was too confrontational and called for a more consensual approach. Although a conciliatory note did not seem to be forthcoming from the union, there appears to be agreement that a sustainable solution could be found.

Saviour Rizzo, Centre for Labour Studies

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