Do not participate in the distribution of meals to patients. Do not participate in washing patients. Do not participate in nappy changes. Do not inform relatives when patients are discharged.

These were only four out of more than 124 directives issued a few days ago by MUMN, the nursing union in the middle of a pandemic.

One particularly callous directive was, “To stop shrouding with immediate effect”.   It wasn’t the only one. When operating theatre time was drastically slashed as anaesthetic staff were diverted to the rising number of COVID ITU patients, MUMN directed that only four theatres could run concurrently.  The usual number of theatres is over 18.

When only life and limb-saving procedures are being performed, cutting access to operating theatres further inflicts serious harm to the sickest.

This time Paul Pace has taken it too far. The Ministry of Health could not stand by and watch. The sheer insensitivity and coldness of the directives triggered legal action.

A warrant of prohibitory injunction was requested and granted to halt the threat to seriously ill patients and to allow the health service to continue to provide essential care. The move by the Ministry of Health was courageous – and unprecedented.

Such a step has never been taken despite the unreasonable unrelenting pressure applied by a hyper-militant union. Since 9 August, while in the middle of a pandemic, MUMN has issued no less than eight rafts of industrial directives (9/8; 18/8; 19/8; 31/8; 22/9; 2/10; 25/10 and 24/11/2020), the most recent being the most vicious and harmful.

So what is getting Paul Pace’s goat now? On 22 November 2018, MUMN and the Ministry of Health jointly announced that a collective agreement had been reached after long months of intensive discussions.  Substantial improvements in work conditions were brought in when the agreement came into force on 1 January 2019.  The agreement was for five years. But that agreement was signed by the previous MUMN president Maria Cutajar. Where was Pace?

He had been given a top advisory role with the Ministry of Energy and Health in 2015 after he placed eighth in the MUMN election and resigned in a huff. He was MUMN president for years before that and felt entitled to that position.

When Konrad Mizzi’s Ministry was asked about Pace’s remuneration as an advisor, no information was provided.  A freedom of information request had to be lodged by a newspaper to try and extract some information.

In March 2019, the incumbent president did not stand for re-election and Pace returned.  After a period of industrial peace and quiet during his absence, Pace’s militancy was back to haunt the health service.

His most recent barrage of directives was triggered when another union representing allied healthcare professionals negotiated its own collective agreement. Pace felt the government had been far more generous with the allied healthcare professionals than it had been in 2018 with MUMN.

Although the current MUMN collective agreement does not expire for another few years, Pace was having none of it. He was determined to use industrial action in the middle of a pandemic crisis to force the government to reopen negotiations around its own collective agreement.

The extreme measures that Pace issued were aimed at grinding the whole health service to a halt. Nursing staff were instructed not to inform relatives of patients’ developments, even when visiting is strictly restricted.

They were instructed not to take blood tests or follow up results, including for COVID-19.  They were directed not to inform doctors of any investigations needing to be taken, not to participate in ward rounds, not to transfer patients between wards or to call porters to transfer patients for essential investigations or treatment.

In St Vincent de Paule, Mount Carmel, Karin Grech and Gozo General hospitals, staff were instructed not to wash patients and not to feed them. Only four operating theatres could be used.

The reckless disregard shown by the union for the welfare of vulnerable and seriously ill patients led to the government’s action which is commendable, if well overdue.

But Pace came out more bullish. This is, MUMN stated, “an act of arrogance and betrayal to the frontliners from (sic) the Prime Minister and Health Minister”.

No Mr Pace, this is justified action by the Health Minister to protect patients who should not be made to suffer because of inhumane union directives.

Even before these latest brutal directives were issued, Saviour Balzan commented in August 2020 that Pace “should leave patients out of it.  Punishing them in the name of industrial action would be simply criminal”. Pace didn’t seem to get the message. Balzan’s assessment that Pace appeared to have a “God-given right to play Russian roulette with patients’ lives” was spot on.

The continuous and persistent disruption of the service, the unrelenting interruption of provision of care and the uncompromising unreasonableness of the union is not reflective of its members.

The vast majority of nursing staff and other healthcare workers are dedicated, conscientious and selfless in their compassion and care. And they abhor the spokes in the wheels MUMN determinedly places.

One of those dedicated nurses, Bernard Gatt, could not help calling Pace out and accused him of “taking advantage of a delicate situation. How dare you?” Gatt addressed Pace directly: “I have worked with doctors and nurses of great skill and compassion that you so clearly lack”.

Of course, our dedicated nursing staff deserve the best working conditions and remuneration possible. No healthcare professional worthy of the name however would dream of jeopardising patients’ health, even if their own conditions did not improve.

Now is not the time for unreasonable demands; much less capricious and gratuitous cruelty to the most vulnerable.

Kevin Cassar is consultant vascular surgeon at Mater Dei Hospital and Professor of Surgery, University of Malta.