Minister Updates On National Health Plan

Mr. Speaker, I stand before the House of Assembly today to update my Honourable Colleagues and the public on the progress made to date on the National Health Plan.

Mr Speaker, you and this honourable House will recall that in February 2011 I unveiled the National Health Plan Consultation Paper. This was followed by four months of extensive public consultation during which we spoke to all sectors of our community, and received much feedback on the proposals.

In November, 2011 the final plan was published entitled, “National Health Plan: Bermuda Health System Reform Strategy”, and we set about rolling out the implementation process.

To be clear, the purpose of National Health Plan is to lay the foundation for a 21st century health system for Bermuda. It is the strategic plan to reform the healthcare system in our community, and it provides a high-level road map that sets the direction and lays out the core values and goals we want for Bermuda’s health system.

Mr Speaker, I know stakeholders, and the public, have understood that the core values of the National Health Plan are equity and sustainability; and that the mission of the plan is to ensure a healthier population. These are to be achieved through eleven Goals that focus on access, quality and efficiency.

Mr Speaker, I want to stress that not since the Oughton Report have we had such a comprehensive review of our health system. However, we know that reviews and reports are not enough to bring about change. Learning from past initiatives, we understand fully that for the Plan to succeed we need action and accountability; and it is precisely for this reason that I stand before the House today.

In addition, we are fully aware that for the plan to succeed it is essential that the stakeholders who will be affected by the reforms, be directly involved in the creation and implementation of the solutions for change.

Consequently, when the final Plan was published in November of 2011, we established six Task Groups to develop policy options to implement key goals in the Health Plan, and a Steering Committee to oversee developments.

There are over 70 members of our community represented on the Task Groups. They range from health professionals and insurers, to the business community, civil society and patient and public advocacy. All of Bermuda sits at the table to create a fairer health system for our community.

The Task Groups are responsible for developing viable solutions on how to achieve the Plan’s goals. They are tasked with producing multiple policy options so we can consider various ways of achieving the Health Plan goals.

However, all solutions or policy options proposed must uphold the core values of equity and sustainability; they must build upon the strengths of our existing health care system; and they must be developed with broad stakeholder consultation.

Mr. Speaker, the Steering Committee, chaired by the Permanent Secretary of Health, is responsible for providing coordination, guidance and oversight of the Task Groups and for making recommendations on which policy options should be selected.

Since November, the Committee has met monthly; initially establishing the Task Group deliverables and reporting structure and now monitoring and facilitating Task Group progress through bi-monthly reports. This oversight and coordination has proved invaluable because, while the Goals of the NHP are clear, determining how we reach them is far from simple.

For many Task Groups the scope is large; and for all, the development of viable solutions must take into account the complexity of our current health system. The broad range of stakeholders on the Task Groups ensure a diversity of expertise at the table.

Since November, all Task Groups have actively worked on some essential, initial steps, including:
1. Broadening members’ understanding of the various components they are addressing in the health system;
2. Reviewing past reports and initiatives to prevent a duplication of effort; and
3. Defining their objectives and the scope of their work into a clear project plan.

This ground work is necessary to ensure clear understanding of the context and scope, in order to meet the timeframes set out in the Plan.

Mr. Speaker, the Plan has an aggressive timeframe considering the depth and breadth of reforms required.

Each Task Group’s deadline for developing solutions is dependent on the overall timeframe for their specific Goal and their interdependency with other Groups.

Accordingly, the Benefit Design Task Group had the shortest timeframe to develop their first deliverable because others are dependent on their work.

The Benefit Design Task Group is chaired by Tawanna Wedderburn of the Bermuda Health Council. It was established to provide options to the Steering Committee on how to expand the minimum mandated package of insurance, the Standard Hospital Benefit, beyond hospitalization to include preventative and primary care.

I am pleased to say that this Task Group worked extremely hard over the last few months to meet their deadline, holding 11 meetings and a half day session to do so.

The Task Group drafted options for health benefit packages that recognize best practice and ensure patients receive the right care in the most cost effective setting. This is the first big step towards achieving a 21st Century health benefits package that can genuinely meet the essential health needs of our people.

These options must now be priced by the Finance and Reimbursement Task Group before further assessment and stakeholder consultation can occur.

Mr. Speaker, the Finance and Reimbursement Task Group is chaired by Jennifer Attride-Stirling of the Bermuda Health Council.

This Group is responsible for developing options on how to restructure the way our health system is financed and how healthcare providers are paid.

The new financing mechanisms must enable universal coverage and affordable contributions, as well as reimbursement mechanisms that promote financial sustainability.

The Bermuda Health Council conducted a full tender process to secure an actuary to do the financial modelling necessary for the redesign of our health system. In late February the contract was awarded to Morneau Shepell, who are now costing the benefit package options developed by the Benefit Design Task Group.

Currently, the Task Group is focused on identifying financing options, and considering reimbursement mechanisms appropriate for Bermuda’s context. A draft consultation report with costed financing options will be completed in the autumn, and the final report will be submitted to the Steering Committee by the end of the year.

Tied closely to the work of Finance and Reimbursement and Benefit Design is the Overseas Care Task Group, chaired by Michelle Jackson of Argus.

Mr. Speaker, this Group is charged with developing options on how to make more effective and efficient use of overseas care. This is essential as overseas care has been the area within our healthcare system with the greatest increase in expenditure each year.

The Task Group is currently collecting and reviewing claims data to determine trends in overseas care use for the development of policy options.

In addition, the Group has begun identifying the range of policy options available to meet the Goal. As their work is dependent on Benefit Design’s options and vital to the development of Finance and Reimbursement solutions, the Task Group will complete their work according to these Task Groups’ timelines.

Moving on, Mr. Speaker to the Task Groups with Goals that have longer implementation periods.

The Long Term Care Task Group is chaired by Mr John Payne of the National Office for Seniors and the Physically Challenged.

The Group is tasked with developing strategies to meet the healthcare needs of people with chronic illnesses, and physical, cognitive or mental disabilities – our population of vulnerable persons. To be clear, long term care is not exclusive to seniors. The Task Group is developing options that will address the needs of vulnerable children, young adults, adults and seniors.

To manage this large scope, and to ensure even broader stakeholder involvement, the Task Group created subcommittees to identify solutions for specific areas.

The subcommittees established to date focus on:
• care giver support;
• standards for care homes;
• mental health and dementia
• community rehabilitation services; and
• funding for home care.

Solutions will begin to be presented to the Steering Committee by the summer to shape a comprehensive strategy. Although there is a four year timeframe for the overall achievement of this goal, there will be a phased implementation of the solutions developed.

Mr. Speaker, the Health IT Task Group also has a longer time frame to realize its goal due to its specialized and complex undertaking, and it will also have a phased implementation.

This Task Group is chaired by Venetta Symonds of the Bermuda Hospitals Board, and it is responsible for developing options for an integrated health IT system that will increase quality care and efficiency through the creation of an electronic health record.

To develop viable solutions the Task Group has produced and is currently in the process of conducting a comprehensive IT assessment of key stakeholders via an online survey.

In addition, the BHB has recruited a Project Director, Dr William Flatman, to lead the development of BHB’s Electronic Medical/Patient Record initiative, a core component of the national health record.

With over twenty years of experience delivering similar systems in the U.K., Dr Flatman’s extensive expertise and experience will be a great asset to the Health IT Task Group.

Overall, this Group is on schedule and is producing a phased project plan to submit to the Steering Committee.

And lastly, but certainly not least, is the Prevention Task Group.

This Group is chaired by Virloy Lewin of the Department of Health, and it is unique in comparison to the others in that we already have a strategy underway to assure our health system is one that promotes health and wellness.

The Well Bermuda Strategy outlines an agenda for health promotion on the island.

This is a large strategy consisting of 18 goals with action groups dedicated to each goal. These groups are developing action plans that will achieve the outcomes detailed in Well Bermuda, which in turn will realize the NHP Goal.

As a result, the primary objective of the Task Group is to create a framework that will ensure the successful progress of the Well Bermuda Strategy.

To date, the Task Group has focused on strengthening its governance structure and developing a monitoring and evaluation framework to ensure the comprehensive and consistent assessment of progress towards the goals of Well Bermuda.

The Task Group’s framework will be presented to the Steering Committee by June of this year, and we know that action will continue to take place to promote health and wellness across Bermuda.

Mr. Speaker, from what I have said today, it is evident that the Task Groups are progressing in their work to ensure we achieve the National Health Plan’s mission of healthy people in healthy communities.

And the Ministry of Health is committed to regularly updating the public on this progress through our website and facebook page. I encourage everyone to visit www.nhp.bm and the facebook page titled: Bermuda’s National Health Plan to obtain the latest updates and information about the NHP and Task Groups.

Finally, Mr. Speaker, on behalf of the Ministry of Health, I would like to sincerely thank all the Task Group members who have committed their time and expertise to improving our health system; and in particular, I want to thank the Chairs who dedicate significant time, human, and financial resources to running the Task Groups and ensuring their success.

We still have a lot of work ahead of us but I am confident we are heading in the right direction to make the Goals of the National Health Plan a reality.

Thank you.

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