The Bermuda Hospitals Board could be in debt by $200 million within five years if nothing is done to curb healthcare costs, according to the board’s chairman.Speaking at a meeting of the Hamilton Rotary Club, Jonathan Brewin issued fresh warnings that the scale of the financial problem facing the board “should concern us all” and that changes to the healthcare system are “necessary and unavoidable”.Mr Brewin began his presentation by outlining a series of increased costs that the BHB was facing, including the withdrawal of a Government subsidy to pay for the $14 million-a-year Continuing Care Unit, construction costs for a soon-to-be-completed acute care wing, an increased cost base because of higher patient demand for services, and a new $650,000-a-year administrative bill to pay for work permit applications.“More money will be going out and, as the Board discovered in the month it was appointed, even less money was going to be coming in,” Mr Brewin said.“Accepting the status quo is like sitting down in a leaky boat and not realising that we don’t have long before we go under. We will sink if we do not swim.”Painting a grim picture of the state of health funding on the Island, Mr Brewin acknowledged that “the road ahead looks hard, steep and painful”, and that “we have a tough challenge”.But he also stressed that solutions could be found, and that the BHB was working in partnership with the wider community “to assist in developing a financial sustainability plan”.“We certainly are standing at a moment in history,” Mr Brewin said. “Change is necessary and unavoidable, and our challenge is to ensure we work with community and overseas providers, the Ministry, insurers and the people who use and pay for our services to make healthcare more affordable and effective.“We have a tough challenge, but it is widely recognised that the rising cost of healthcare is unsustainable and liable to damage our country, our businesses and residents if we do not address it.“This brings many more people to the table, looking for solutions and seeking to cooperate and coexist, rather than compete, in order to ensure people in Bermuda can continue to access the right services at the right time at a price they can afford.”Mr Brewin added that a Financial Sustainability Steering Committee, comprising board members, community members and hospital leadership is already meeting, and subcommittees focusing on strategic, operational and structural sustainability are being established.“We are working hard to establish a new dialogue with all our partners in healthcare — community physicians, overseas affiliates, patients, insurers, the Ministry of Health and Seniors and the Bermuda Health Council — to ensure collaboration as we proceed to address urgently needed change in the overall healthcare system.“Our aspiration is to build a safe, high quality healthcare system that always puts the patient, those who are less fortunate than ourselves, at its heart.“If we want new hotels, new tourism services and new international business partners to regard Bermuda as a good place to conduct business, we need to address healthcare.Mr Brewin was joined by BHB chief executive officer Venetta Symonds, who reiterated the need for reform, but pointed out that patients and doctors could help bring down costs.“The chairman has spoken about involvement in BHB governance and strategic planning, but this must also take place at the bedside, and in the doctor’s office,” she said.“People in the community also need to get more involved in their care and educate themselves on healthcare practices that are high quality and safe.“However, we are absolutely clear on one thing — even though our most pressing challenge is financial, our most important and non-negotiable focus is on the integrity, safety and quality of healthcare services, and we will work with all our stakeholders, all the community, to achieve this.”