Financial Administration

Audited Management Accounts

Steward International’s accountable care model depends on professional, detailed management of its financial position.

Steward International has worked hard to transform the accounting standards of the Maltese business since it arrived, resulting today in fully complete management accounts for all years in which the company has run the concession. These accounts have been audited in Malta and reviewed by international firms and adhere to all relevant reporting standards.

In line with its ethos of transparency and accountability, Steward International believes that it is important for these accounts to be available to the public whose money has been spent on operating the three hospitals in the concession.

Under VGH Ownership
The management accounts for 2015 – 2017 have been painstakingly re-created by Steward Malta, then audited and reviewed by international firms. These were never filed under VGH ownership.
In Transition
Under Steward Ownership
2022 filings are in process and not yet available for publication
The consolidated financial position of the concession is as follows:

The Concession was underfunded from the beginning and accumulated significant deficits. Steward International managed to reduce the shortfalls but fundamentally, the concession remains underfunded and unbankable.


When Steward International took over the concession in 2018, we discovered a large number of unexpected liabilities relating to VGH’s prior ownership. These liabilities totalled €‎61,786,010.

As part of our commitment to accountability and transparency we analysed and managed these liabilities in the years following our arrival. Some of these were settled and some were contested. At all times we have sought to preserve value for the Maltese taxpayer and we have now resolved all of the outstanding issues, leaving the concession on a stable financial footing.

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Please note, certain entities have been redacted due to GDPR

Labour Supply Agreement

In the Labour Supply Agreement, part of Concession Agreements originally agreed with VGH, the Government of Malta agreed to provide 1,536 personnel required for the running of the hospital sites. In turn the concessionaire – first VGH, then Steward Malta – agreed to pay a charge for these personnel.

The personnel supplied by the Government never reached the agreed level of 1,536, with the actual number on average 300 (around 20%) short. The charge to Steward Malta was not adjusted and the Government continued to automatically deduct this charge from the payments due to Concession. As part of the healthcare service delivery, Steward Malta therefore had to fill in the gaps from its own purse with personnel hired directly or through contracted services, such as care workers, cleaners, clerical, and security staff.

The financial impact of the failure of the Government to provide promised staff to the concession resulted in the losses below. These figures have been calculated independently by a ‘Big 4’ accounting firm based in Malta.

Note: The Financial Impact calculation is for illustration purposes only. While it is intentionally not exact, it is close to the real values which have been calculated in detail with the help one of Malta’s biggest accounting firms and are in the process of negotiated settlements with GoM

Concession Revenues and Expenses

Concession company revenue and billing mechanism for services delivered to Government of Malta.

Budget Allocation

Under the Concession Agreements, the Concessionaire is entitled to charge a pre-agreed fee for the running of Gozo General, Karin Grech Rehabilitation, and St. Luke (Outpatient) hospitals. The fee had been originally negotiated between VGH and the Government as part of the tendering and negotiations process. It is intended to cover operations and routine maintenance, not to finance expenses for the construction at this point.

The nominal budget allocation (cost to Government and revenue to concessionaire) was set at €51 million for the budget year 2016. This revenue then increases by the annual healthcare budget for Malta (which is published and voted annually by parliament). As of year 2021, the year of the last audited accounts, this revenue was €73.6 million.

In addition to this budget allocation, the concessionaire is entitled to certain other revenues and reimbursements. This includes funds for the provision of Air Ambulance Service, Lease Revenue for the Medical School, and other services delivered at the request of Ministry for Health (e.g. new beds added in Gozo and Malta, Covid expenses incurred on behalf of the Government, etc.)


The Maltese Government deducts an amount (also pre-agreed with VGH) for the salaries of government employees that work at the hospitals. This is the so-called Labour Supply Agreement which is an integral part of the concession contracts. Essentially, the concession company never receives the full amount of the budget allocation because of the netting mechanism for sums due to (and due from) Government. Additionally, the Government deducts certain concession fees every quarter while the rents for the land and sites is being paid separately from the concessionaire.

The above items constitute cash revenue for Steward Malta. Several sample invoices have been provided for illustration purposes.

Other cash receipts from the Government have occurred in the past reflect continued negotiations, settlement disputes over overcharges and unpaid bills by the Government to concessionaire.

Billing Process

The Concession company bills in four instalments for the above budget allocation. All bills and supporting documentation are always sent to the Ministry of Health, which is charged with oversight and review and examination of the bills. The Ministry of Health assesses the documentation and requests further supporting evidence as needed. When the bills are found to be properly supported and due, instructions are sent by the Ministry of Health to Treasury to pay the outstanding amounts.

VGH management period invoices

Steward International management sample invoices

Note: The presentation of the supplemental financial information is not in accordance with the International Financial Reporting Standards. However, Steward International believes that this supplemental information provides useful information to the user of financials statements and is presenting for this purpose only. The numbers, in total, tie to the audited accounts.
Note: Total charges / expenses required to run the concession historically have exceeded revenues and have created a persistent deficit position. Of the €490.3 million receipts from GoM (in cash and benefits-in-kind) for the period 2015-2021, €500.4 million have been utilised for hospital operations (wages – 66%, supplies – 11%, other operating costs – 13%, project salvage costs and payments to GoM – 10%). The underfunding for the concession overall and the associated legacy salvage costs have left no funds available for capital improvements and investment.