Who polices the Health Council? That is the question we should be asking as the standard health premium rises by another $39.24 a month. Last time the premium went up, the Council’s own fee was quietly tripled without legislation or debate. For a public regulator funded from a universal tax on health insurance, that should trouble us all.

Buried in the Council’s 2020–2022 annual report is a striking admission. The administrative fee that funds the Council “was approved to increase from $1 to $3.06 per insured person per month, however the change was not legislated”. Earlier increases were done the proper way: by amending the law. For 2021, the law wasn't changed and the Minister's September 2021 announcement did not mention it. Parliament never debated it; the public was never made aware.

At the same time, the Council has fallen behind on its own basic financial accountability. Its more recent annual reports and financial statements from 2023 onwards are absent. Meanwhile, its staffing has exploded from 8 in 2016 to 24 in 2026.

Where is that money going? The Council is designing a health provider and pharmacy inspection regime that would look more at home in a country of 60 million than 60,000. A checklist-driven framework that treats all health businesses the same, with extra demands on pharmacies.

Unlike other jurisdictions whose regimes are focused on outcomes, the Council's is overly prescriptive. Instead of asking “are patients safe, and are medicines being managed properly?”, it asks “have you filled out this evidence for this criterion in this format?”

The regulator does not set a solid example in its own practices yet proposes expansive oversight of others. It has no published complaints policy or complaints log but complaints handling is prominent in their proposed framework. Serious complaints about the medicine formulary decisions and market conduct have been met with noncommittal or delayed responses and promises of a “next phase” with no clear outcome.

Much of this regime looks more like a response to court challenges than a genuine attempt to improve outcomes and lower costs in healthcare. Meanwhile insurers and wholesalers are free to flaunt the rules and enter into deals giving them market dominance.

The Health Council has announced a temporary pause on "Phase II" of the Drug Formulary (including Ozempic) while it reviews market developments. An earlier e-mail had already confirmed Ozempic was on the regulated price list, so rebadging it as a Phase II issue looks like moving the goalposts. Again, the response is a vague “next phase” with no clear interim protection for patients or smaller providers.

The Supreme Court described their actions in the Dr Soares case as “the height of unfairness” for granting approval for existing providers while applying a more rigorous standard for others. The courts called it “not a level playing field by any stretch of the imagination”. It said the Council “acted irrationally and unreasonably” in making decisions “which no sensible person who had applied his mind to the question could have arrived at”.

In the My Pharmacy case, the Council's inspector arrived unannounced, refused to show credentials and was denied entry; My Pharmacy simply insisted on what the Pharmacy and Poisons Act requires. The Supreme Court then found that the Chief Medical Officer had no legal authority to run the annual inspection and “certificate” regime or to publish a list marking pharmacies as non-compliant.

The Chief Justice held that inspectors have “no greater authority to enter the premises of a registered pharmacy other than as set out in section 51(3) of the Act”, which only allows entry on “reasonable cause to believe that an offence … has been committed” and on production of credentials if required.

The Court noted that putting a pharmacy in the “no certificate” column can have “devastating economic impact” and granted orders quashing the list and requiring the entries against My Pharmacy to be removed.

These examples should have triggered reform: guidance, training, and consistent application of the rules. Instead we see the opposite. Those who challenged the regulators in court now sit under the heaviest lens; when complaints are lodged, the goalposts are moved. When a regulator bears down hardest on those who resist it and looks the other way when larger actors break the rules, confidence in its impartiality evaporates.

The Council circulated its draft pharmacy inspection regime with a confidentiality warning and two weeks for comment. A box-ticking exercise, not an honest effort to listen.

This matters because of funding. The Council is significantly funded from the Mutual Reinsurance Fund, the same pot that has just gone up by $40 a month. We deserve to know how much of the increase goes to the Council, how that money is being used, and whether the benefits justify the cost for 60,000 people.

The ask is not to abolish the Council; Bermuda needs a competent, fair health regulator. The Council has a difficult job.

The ask is to hold it to the same standards it imposes on others: transparent, properly legislated funding; up-to-date published accounts; clear, published policies for complaints and decisions; timely fair and consistent enforcement of rules, with published reasons when implementation changes; and learning from court rulings, not heavier scrutiny of those who have challenged it in court. Before we pay more, we are entitled to see whether the regulator we fund is well-led, responsive and effective. Right now, by its own criteria, it would be found wanting.

Denis Pitcher owns My Pharmacy LLC with his wife and is a former columnist for The Royal Gazette