Mental health consultants’ private practice left unchecked despite contract restrictions

Malta’s mental health services still lack an independent mechanism to verify whether government consultants contractually barred from private practice are complying with the restriction, despite the National Audit Office flagging the issue.

The NAO found that management within the Health Ministry had effectively rejected a recommendation to introduce additional safeguards, arguing that changes would require negotiations with the doctors’ union and could lead to counterdemands.

The issue concerns consultants employed under what is known as “Contract A”, which restricts private practice.

In its original audit, the NAO acknowledged that monitoring consultants’ private work could be difficult and time-consuming. Nevertheless, it recommended that consultants should at least be required to sign an annual declaration confirming that they were not engaging in private practice.

Any suspected breach could then be investigated and action taken where necessary.

Not even this recommendation was accepted by the government.

Mental Health Services, led by Rosanne Camilleri — who was found to have been “professionally incompetent” in her previous health ministry role – told auditors that changes to the applicable sectoral agreement would have to be negotiated with the signatory union.

Management argued that reopening the agreement could result in counterdemands from the union and therefore did not recommend pursuing the NAO’s proposal.

The latest audit confirms that Mental Health Services “still does not have a direct monitoring mechanism” to independently determine whether consultants engaged under “Contract A” are carrying out private work.

Instead, compliance continues to depend on the consultants’ contractual obligations and their own declarations.

Management told the NAO that no breaches of contract involving employees were reported or identified during 2025.

The unresolved issue forms part of the NAO’s follow-up of weaknesses previously identified within Malta’s mental health services.

Overall, auditors found considerably more progress in this sector than in several other government entities examined in the same report.

Of the seven recommendations reviewed, two were fully implemented and significant progress was recorded on another three. One registered insignificant progress, while the recommendation concerning consultants and private practice was not accepted. This gave Mental Health Services an overall implementation/progress rate of 71%.

However, the NAO said further action was still required in other areas, particularly concerning approvals and documentation for services provided by Mental Health Services employees to other government departments or entities, and the use of time off in lieu to benefit from overtime rates.

While acknowledging the “considerable efforts” to address weaknesses identified in its original investigation, the NAO made clear that shortcomings remain.