Health Minister On Throne Speech Initiatives

Good morning members of the media,

Thank you all for coming today.

As stated by the Governor in last week’s Speech from the Throne, this Government’s operating vision is “to achieve social and economic equity for all Bermudians, leaving no one behind.”

It is in this vein that many of the initiatives which will be implemented in the coming months and years ahead, under the Ministry of Health and Seniors, were created.

Equity deserves to be and WILL BE a cross cutting theme for Bermuda’s health planning for the next five years. Communities have an ethical imperative to provide for those among them who, for circumstances beyond their control, cannot provide for themselves.

This is why the Ministry of Health and Seniors will put forward a Vulnerable Persons Act to protect the most vulnerable from predators and those who may do them harm.

This Government believes that every country has a moral responsibility to ensure that its vulnerable populations are given the greatest possible protection.

Children are protected under the Children Act 1998 and there is currently some protection for seniors under the Senior Abuse Register Act 2008…But there is little in the way of protection for persons who are between the ages of 19 years and 64 years and who may have cognitive or other disabilities which make them vulnerable to many forms of abuse.

For example, a legal definition to address the term ‘lacks capacity’ is required for all vulnerable persons including seniors. There is a need for clarity regarding when a person cannot make a decision for him or herself.

Additionally, it is the opinion of many of my technical officers within the Ministry that the statute should contain a directive similar to that set out in the UK Mental Capacity Act 2005 Chapter 9 Part 1 Best Interests as to how a person who lacks capacity should be treated.

In addition to the creation of this Act, the Ministry will strengthen the provisions of the Senior Abuse Register Act 2008 to provide greater protection for vulnerable seniors.

The Director of Public Prosecution has identified several short comings with the Senior Abuse Register Act 2008 as it is now and has proposed three amendments to correct the deficiencies…

Firstly, that consideration should be given to making the offence of Senior Abuse triable on indictment. At the moment, the offence of Senior Abuse is a Summary Only offence. This places unreasonable time limits on the investigators to complete an investigation and to present a file to the Director of Public Prosecutions for review. Such an amendment will remove time restraints; and will allow for more severe penalties in the most serious of cases.

Secondly, that consideration should be given to widening the powers of intervention under The Act. At the moment, the Bermuda Police Service have no statutory power to remove a Senior from a home unless very dire circumstances exist. An amendment along the lines of the “Significant Harm” provisions of the Children’s Act 1998 (sections 3 and 41) would allow the police to detain a Senior where they have reasonable and probable grounds to believe that a Senior is suffering or is likely to suffer significant harm.

And, thirdly, that consideration should be given to creating Secure Treatment Orders under The Act. At the moment, difficulty arises where a Senior is not competent to assist in the investigation, but we are able to adduce their medical records as evidence. This is of particular hindrance when the suspect is the caregiver/ relative of the Senior who won’t sign a medical waiver. An amendment along the lines of the provisions under section 39 of the Children’s Act 1998 would give the Court, on application, power to order the medical or psychiatric examination or other assessment of the senior.

Bermuda, like most other countries, has an ageing population. There are approximately 600 persons that reach 65 years each year.

While “Ageing in Place” is the Government’s policy, Bermuda will need additional long-term care beds for both the elderly and the disabled.

The Government will therefore produce a strategy for the care of the elderly and disabled who are no longer able to stay in their own homes.

Because long-term care is an expensive proposition, a long-term care plan must take into account the needs of the community, the ability of families to pay for care, and the role and financial capacity of the Government.

‘Long-term care’ (LTC) refers to a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time.

Long term care is not age dependent. Individuals across the life spectrum require long term care. It is common for long-term care to provide custodial and non-skilled care, such as assisting with normal daily tasks like dressing, bathing, and using the bathroom. Long term care can be provided at home, in the community, in assisted living or in nursing homes.

The proposed long term care strategy is intended to identify the issues associated with long term care and propose how these should be addressed.

It is recognised that long term care is not the responsibility of a single agency. Several government departments and agencies have some responsibility for the establishment of programmes and services for the delivery of care. It is hoped that a cohesive system will be developed following the release of the strategy.

Many needs have been identified in reports on aging, disability and mental health, but a strategic approach is required to develop a coordinated network of services to assure availability of appropriate institutional and community care through the private and public sectors…which is what we hope to achieve.

Another initiative coming out of this year’s Throne Speech for the Ministry of Health and Seniors are proposed amendments to the Bermuda Hospitals Board Act 1970 to provide legal protection, or “shield legislation”, for physicians and officers of the Bermuda Hospitals Board (BHB) involved in Quality Improvement and Peer Review activities performed on behalf of the BHB.

The practice of good medicine requires regular review and critique by peers, but without shield legislation this important step to ensure good quality care can be stifled. It is international best practice to complete these reviews.

When adverse events occur in health care, healthcare professionals have a responsibility to review the circumstances that led to the situation and perform what is commonly known as a “root cause analysis.” The purpose of a root cause analysis is to better understand what went wrong in order to minimize the chances of such an event taking place in the future.

Fear of retribution in the form of dismissal, litigation or some other form of public shame has been shown to inhibit frank conversations and truth finding. Thus, best practice in most jurisdictions in US at least, is to protect, or “shield” such important process improvement activities from direct discovery in the event that the adverse outcomes results in litigation and a claim of negligence.

Another announcement made last Friday was that The Bermuda Health Council Act 2004 and the Public Health Act 1949 will be amended to introduce controls on the entry of new, high-cost health technology, which has contributed to rising health care costs in Bermuda and globally.

In Bermuda’s health care system there is limited control over the introduction of new health technology. Consequently, Bermuda has very high rates of equipment per capita compared to other high-income countries. Excess capacity often leads to high utilization, as providers have an incentive to seek a return on their investment. The result is equipment use that is not always medically necessary and that increases overall health costs.

The introduction of a mechanism to control the entry of equipment to the Island should, in the long term, have a positive impact on the cost of healthcare while allowing for the importation of appropriate equipment to meet the health needs of our population.

The amendments will mean that providers seeking to import medical equipment will require a certificate of entry. Applications will be reviewed in collaboration by the Bermuda Health Council, the Department of Health and the Office of the Chief Medical Officer. Technologies posing minimal risk and or with minimal cost implications will be fast-tracked. High cost, high risk medical equipment will undergo a full review process to determine health system need. If approved, a certificate of entry will be issued and importation will be allowed. Requirements for registration and licensing per the Public Health Act will continue in force as now.

The Bermuda Health Council will lead on the review and approval process, but it will be done in close cooperation with DOH and OCMO. Regulation under the Public Health Act will continue as present.

It is important to note that the Health Technology Reviews will not have an impact on access to healthcare. Current capacity in the health system will not be affected by the HTR process.

The focus of the HTRs will be on the efficacy and value of technology in improving quality of care and healthcare outcomes.

Lastly I’d like to briefly touch on an issue that has gathered much attention in the media recently…The closure of the Lamb-Foggo Urgent Care Center in St. David’s.

It was with great sadness that I learned of BHB’s decision to close the clinic. However, it was a decision which had to be made.

Put frankly, the Lamb Foggo Urgent Care Center (UCC) was running at a loss. On average, only 14 people attended per day, which amounted to about 5,500 persons per year. This volume was simply not sufficient to cover the operating costs of the facility. The original business case in 2007 noted that 8,182 visits would be needed to make the UCC viable and this was an accurate assessment.

By ceasing the service BHB is able to save about $250,000 a year. The service itself cost at least $2.5 million to run.

This money can be better used to support other vital services that are needed nationally, such as Dialysis, Oncology, Diabetes and the Emergency Department.

Government and all Bermudians want to see a safe, high-quality, patient-centered Hospital continue to provide acute-care services for all. The BHB is the only entity with the mandate to do so.

Both the BHB and the Ministry recognize that while BHB cannot run a viable service from the facility with the current business model, another provider may be able to operate from the site at lower cost.

For example, primary care providers are not as expensive as Emergency Department personnel. For this reason I have been personally working with the BHB to review alternative uses of this facility.

I will keep the public posted in this regard as we move forward.

I will be reporting a full statement to Parliament on the UCC on Friday, giving full respect to the supremacy of Parliament and the process that we as the people’s representatives should follow.

Thank You.

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