Performance Audit: A strategic Overview of Mt. Carmel Hospital

The Auditor General today presented to the Speaker of the House of Representatives the National Audit Office (NAO) report entitled ‘A strategic Overview of Mt Carmel Hospital’ (MCH). This review sought to determine whether this hospital is operating efficiently while effectively addressing society’s mental health needs.

This audit has shown that MCH, and by implication mental health in Malta, are still considered a second priority to the rest of the local public health sector. While this Office commends Government’s recent stated pledge to invest some €30 million to carry out much needed and long-standing repairs to MCH’s physical premises, it however strongly opines that the hospital’s structural problems comprise but a portion of the shortcomings that MCH faces in its operations. Consequently, NAO contends that if an upward revision in the hospital’s recurrent financial allocation together with an overhaul of MCH’s operations do not accompany this capital investment, significant inefficiencies and ineffectiveness would still prevail.

Apart from a pronounced shortage in HR, particularly in the nursing grades, this Office also observed that relations between the hospital’s management and its staff are generally strained, which situation heavily impinges on the efficiency and effectiveness of the hospital’s operations. This Office also observed how MCH’s security arrangements are largely inadequate, with the deployed security complement not carrying out security functions involving the physical element (such as searches or restraint), as well as those relating to the monitoring of the hospital’s master keys. Some of these functions are instead carried out by nursing staff. The audit team further noted that security at the hospital’s main gate is lax, while the CCTV system in place leaves much to be desired.

This study also showed that MCH is partially serving as a place of last resort to a significant number of individuals who, though possibly in need of assistance and other targeted services, do not require hospitalisation in a mental health institution. This situation, NAO asserts, is putting further strain on the already stretched resources, and consequently, on the level of service offered to the mental health patients who do require hospitalisation. NAO however found that, while the way forward is to decentralise mental health treatment towards community-based services, MCH’s community clinics and day centres are generally understaffed and the required attention from management towards this function is on the whole lacking.

Finally, this Office observed how a comprehensive national strategy for mental health needs to be implemented and consequently urges the relevant authorities to give this matter its due priority. This initiative should ensure the effective overhaul of MCH and mitigate the prevalent negative stigma on mental health. In this regard, this Office feels it cannot emphasise enough the importance of having community services at the centre of any mental health strategy, as a strong community based system would ensure that hospitalisation in a mental health institution would become only a requirement for the most clinically acute cases. By implication, such a system would serve as a pressure valve for MCH and significantly reduce the impact on the national health bill, while ascertaining that, when possible, mental health patients remain integrated within the community and valuable contributors to society.

These issues, along with others, are comprehensively presented in the audit report in caption together with this Office’s recommendations.