This is a response from Health Minister Nelson Bascome to the opinion piece that ran in the The Royal Gazette yesterday:

The letter from the Opposition Shadow Minister for Health suggests that:

There is no plan for addressing the hospitals outstanding issues and health care in Bermuda generally;

Our health care system is in total disarray; and

The Government's statements are being made in light of the upcoming elections.

My comments are intended not so much as a rebuttal but as statements of fact. Although I have made these statements many times, I believe under these circumstances, they bear repeating so that the general public is not misled and looses sight of what has been achieved to date and where we are trying to go in our effort to rectify some of the problems in Bermuda's health care system.

Issues related to health care in Bermuda and the Hospital in particular have been well documented in both the Oughton and Arthur Andersen Report. The former government had not agreed or signed off on many of the recommendations in the Oughton Report which was completed in 1996. It is a fact that Arthur Andersen was commissioned by the previous government, to review and analyse the recommendations from the Oughton report and prioritise these recommendations for implantation according to a set criteria.

In particular, Arthur Andersen identified several serious concerns related to the health care system in Bermuda. In particular they focused on the problems related to:

How we pay for our health care;

Provision of services for seniors;

The high cost of prescription drugs; and

The establishment of standards and protocols for the management of specific diseases like diabetes, asthma, heart disease.

The Andersen report of 1997 provided a broad framework for implementation of several strategies. Detailed implementation plans remained to be developed and were not done before the end of 1998. More importantly, the most critical and difficult strategy related to changes that were needed to the reimbursement had not been addressed. The United Bermuda Party could not sign off on the recommendations from the Andersen report because it was not completed before the change in government.

When the Progressive Labour Party came into power, it continued the review of the health care system and worked with Arthur Andersen to complete the development of the implementation plans. The Cabinet Sub Committee on Health was actually appointed back in 2000 to support this effort, and was encouraged by the consultant because of the diversity of needs, i.e. Physicians, insurers, allied services, HIC, etc. The Cabinet Sub Committee has in effect streamlined the Cabinet approval process and provides input related to the revitalisation of Bermuda's health care system and guidance to providing services in this regard. This role has continued to date and will continue until such time as the revitalisation process is completed.

This is part of a plan strategy to address the whole healthcare system in Bermuda instead of using a piecemeal approach. At the end of this process, which will be arduous, Bermuda will have a coordinated healthcare system with services that comply with clinical and operational standards. We have also established partnerships with community organisations that we provide grants to insure not only the delivery of community services but also that these services move along in the same direction as our goal and mission. We can include such organisations as PALS, TB & Cancer, LCCA to note a few.

The Bermuda Hospitals Board is a critical part of the health care system. The Board has taken an aggressive approach to address a broad range of issues related to hospital care. There are several key processes that they have put in place to improve hospital services:

Established ongoing strategic planning to ensure continuous improvement of the facilities infrastructure and services;

Identified and prioritised the capital development needs which has not been done before and seized opportunities as they arise to addressing the needs this list

Identify alternate sources of revenue through creative thinking

Implemented a system of Bermudianisation for the senior posts at the Hospitals

Created a succession plan to insure that there would always be a Bermudian available to fill the post of Chief Executive Officer.

The Bermuda Hospitals' Board's efforts have been fruitful and have met with good success. I wish to just point out a few of their achievements since 1998:

The Financial Services Department - Institution of quarterly budget review

Bermuda Hospitals Board Accreditation 2002

Installation of a chiller at St. Brendan's Hospital and an air handling unit for KEMH Dietary Department

The employment of a full-time Chief of Staff and

The merging of Hyperbarics and Emergency Services

Improved salaries to nurses and allied health professionals

Radiology Information Systems/Teleradiography

Establishment of the Asthma Clinic

Diabetes Centre

Implementation of Hyperbaric Service for wound care

Implementation of Nursing Education Programme

Development of Hospital Reimbursement Initiative - costing service; development of Chargemaster and new fee structure

Establishment of the following:

i. Methadone Clinic

ii. Outpatient Surgical Clinic on 2nd Floor at KEMH

iii. Bone Density Services

iv. Wound Care Centre

v. MRI Services

vi. Risk Management Programme

vii. Home Healthcare Services

Refurbishment of the following:

i. Dietary Department

ii. Queen Elizabeth Nurses Home - Sisters Wing

iii. Cooper Ward

iv. Perry Ward

v. Cardiology Diagnostic Unit

vi. Inpatient detoxification

vii. Outpatient psychiatric clinic

viii. Wound-care Centre

Newborn Hearing Screening Programme started in June 2002.

Vascular Assessment Management Programme continues as our Dialysis census reaches a high of 81 clients.

Amalgamation of the Surgical Outpatient and Same Day Unit. Name changed to Pre-Operative Assessment Unit.

Identified all capital development needs and prioritised them.

The capital development needs of the hospital also encompass the refurbishment of the facilities which are buildings that have been in existence before my lifetime. The KEMH buildings and infrastructure with the exception of the new wing has deteriorated due to the lack of maintenance for over 20 years. The new wing was constructed on an aged infrastructure that houses the major electrical and plumbing for the hospital. The lack of maintenance has taken its toll. Additionally, we have had to rectify some problem related to poor planning. For example, the dietary kitchen was built on top of the emergency room. In May 2002, the hospital spent over $160,000, on extensive repairs to this kitchen to remove the floors and to stop leaks going into the emergency room.

There has never been a comprehensive plan to address the problems related to these ageing facilities and to systematically address their refurbishments until recently.

The Bermuda Hospitals Board has taken advantage of opportunities that are presented to address some of these needs. Since 1999 the Hospitals Board has completed the following Capital Projects with no cost overruns:

Cardiology Unit

1st Phase of the MRI

In-patient Detoxification Unit at St. Brendan's Hospital

The upcoming capital campaign is another strategy to address the major hospital projects. Capital campaigns are not a new approach for the Hospitals Board. In fact under the UBP government, the Bermuda Health Alliance asked the community for donations and funding, that has assisted the hospital.

I do not deny that there are problems in the health care system. However we have over the last four years made diligent efforts to implement plans to rectify these problems and to establish systems of accountability that will ensure long-term improvements in the health care system. This notwithstanding I need to go on record as saying that although we have problems, like any other country, our health care system is still one that we should be proud of.

Our citizens have access to quality health care services;

No citizen is denied hospital care;

Citizens with critical heath care needs can get assistance;

A range of specialised services are available on the Island; and

Our citizens as a whole enjoy good health.

We are not now or in the future intending to rest on our laurels. The PLP government will continue to press for improvements in the health care system to rectify shortcomings and ensure that everyone has an opportunity to achieve optimal health. As a step toward this goal I will be providing a status report on our efforts to establish an improved system for achieving monitoring and accountability of health care in Bermuda in Thursday's (yesterday's) press conference

Having said that about the healthcare system I also want to set the record straight on a few other statements made by Mr. Dunkley.

The consultancy vote in my Ministry is used to purchase a variety of services including staff training and evaluation and assessment services for clients here and overseas. It should be noted that as of December 2002, $1.2 million was spent on Bermuda consultancy services (Bermudians) and $360,000 was directed overseas for technical advice not available locally.