Minister Wilson On Changes To Health System

“Health system change is complex,” Minister of Health Kim Wilson said, adding that “we must achieve better health outcomes, particularly chronic disease management and mental wellbeing.”

Speaking in the House of Assembly on Friday [March 24] the Minister said, ”We must ensure the availability of essential health services residents can be confident they can afford when they need them. We must strive to be efficient and effective in delivering these services and eliminate waste and duplication in the health system.:

The Minister’s full statement follows below:

Mr Speaker and Honourable Members,

The first strategic principle of the Bermuda Health Strategy 2022-2027 is, “Promoting healthy living and preventative care”.

As we strive for a healthier Bermuda, living a healthy lifestyle and taking steps to prevent the onset of illness are essential actions in our personal journey towards better health and key to improving our population’s health.

Mr Speaker,

As I stated in this House last year, health system change is complex, but our goals are clear. It bears repeating that…

We must achieve better health outcomes, particularly chronic disease management and mental wellbeing. We must ensure the availability of essential health services residents can be confident they can afford when they need them. We must strive to be efficient and effective in delivering these services and eliminate waste and duplication in the health system.

Mr Speaker,

As we continue our multi-year journey to deliver on this Government’s promise to implement universal health coverage for all residents, I want to take this opportunity to focus on our individual roles in the health system transformation that lies ahead of us.

Many of us think of our health system as comprising the treatments we receive from doctors, dentists, nurses, physiotherapists, pharmacists and other allied health professionals, as well as the services provided at hospitals, health centres, clinics and laboratories. We think of our health as a product of these health system services, perhaps with an added measure of genetics. But our individual health is more than that.

Arguably, our health is largely created through actions outside the health sector. The conditions in which we are born, grow, live, work, and age are fundamentally connected to our physical and mental wellbeing. While we may not be able to control all of these conditions of life, we can make individual decisions which, collectively, foster health transformation – at a personal level and at a community level.

Mr Speaker,

What is required by the entire Bermuda community, though, is a paradigm shift in our thinking about health and wellbeing and, especially, our role in the change we want to see.

As I announced at the beginning of this month, the Department of Health is focused on promoting good health and will be spearheading the Commit to Change campaign this year. The campaign’s goal is to encourage residents to make small commitments toward healthy living. Change is tough, and failure can be demoralizing. So, we will be asking you to just make one change at a time. These changes do not need to be big, but they do need to be consistent. Small steps help us create valuable habits. Good habits create change.

Mr Speaker,

We all know a healthy diet and regular exercise are good habits. You do not need me to tell you that. When you Commit to Change, just drink a glass of water instead of a soda. That is a small step. Park your car or bike three streets away from the shop you plan to visit, and walk to it. That is another small step.

Other good habits include a good night’s sleep, making time to be mindful, learning something new and having breakfast.

When you notice a friend, family member or colleague making one small change, don’t tease them; instead, support them or, better yet, join them. These small steps matter, and they make a difference.

Another adjustment we can make in our lives is to ensure we get our annual physical and, for women, our yearly mammogram. Be pro-active about our health status. If we can prevent illness and injury in the first place, we can reduce costs in the health system. If we cannot prevent illness, at least we may receive treatment early enough to produce a good result and decrease, if not eliminate, complications later in life.

Mr Speaker,

A key change in our approach to health and wellbeing would be our use of the Emergency Department at KEMH. Many people view the care received from the dedicated staff at the Emergency Department as free. It is not free. It is paid for through a combination of our tax dollars and a portion of the health insurance premium of every insured person. As Honourable Members will be aware, Emergency Department treatment is one of the most expensive ways to receive medical care. Using it for regular care drives up costs in the health system for us all.

The change you can make is to stop and, first, ask yourself if your GP can help. Perhaps, you can wait until the next day to see your GP? If you are a GP, does your patient absolutely require the type of urgent medical care the Emergency team provides?

We recognise these can be difficult decisions, and particularly for those who are uninsured or underinsured, the Emergency Department can be viewed as a viable option. A revamp of our healthcare system is necessary to help all residents access care more appropriately; ensure we, as a community, make the best use of our vital hospital resources; and deliver better value care for all of us.

Mr Speaker,

Change is a developmental process. It occurs on a gradient ranging from incremental improvements to transformation.

We all have a role to play in the health system transformation, and each small step matters.

Universal health coverage, or UHC, is a vital part of the change we need to see, and this Government remains committed to its implementation.

Mr Speaker,

The Ministry of Health, along with key partners in the private and public sectors, has made progress with priority projects which are foundational for UHC.

On such project is Bermuda’s first Joint Strategic Needs Assessment [or JSNA]. To manage the island’s healthcare system transformation within our financial constraints, as a starting point, we need to know what our priority health needs are, including both physical and mental health.

Honourable Members will recall my Statement last November which spoke to a strategic principle of the Bermuda Health Strategy, “understanding our population’s health needs”. With the vital support and superb work of Public Registrars in training with the UK Health & Safety Agency, along with resources kindly provided by the Department of Statistics, Bermuda’s first JSNA is nearing completion, and I thank them for their incredible efforts. The JSNA will provide a baseline of information on our population’s health. It comprises a review of the following areas:

• 1. Bermuda’s population profile and the social determinants of health,

• 2. health behaviour and risk factors,

• 3. causes of ill-health and death,

• 4. vulnerable groups [including children, the elderly and people with disabilities], and,

• 5. healthcare services.

The JSNA’s key findings on Bermuda’s population profile and wider determinants of health, indicate the island’s population looks set to decrease size, increase in age, and continue to be characterised by multiple socio-economic inequalities. While this may not be new information, all these conditions will impact health and healthcare.

As stated in the Bermuda Health Strategy, healthcare strengthening has a 10-to-15-year horizon, and it is important to be able to measure our progress. We must know our starting point, as we can only manage what we can measure.

We expect completion of the JSNA in early April and look forward to publication shortly thereafter.

Mr Speaker,

Another strategic principle of the Bermuda Health Strategy is ‘harnessing healthcare technology’. As noted in that Strategy, technology can help improve access to physical and mental healthcare services. This can also improve how healthcare is delivered and how outcomes can be monitored.

In undertaking the exercise of developing the Bermuda’s National Digital Health Strategy, a project working group set up in October last year aimed to establish a system-wide vision and integrated digital healthcare strategy. Digital health innovation is more than electronic medical records. This form of health innovation has the potential to be a key enabler in the transformation of Bermuda’s healthcare system.

The working group comprising doctors, insurers, representatives of BHB and the Bermuda Health Council, as well as relevant government departments, has met bi-weekly, then weekly, since October. In that time, it has engaged Edinburgh Innovations and Interactive Health and collaborated with KPMG to produce a Digital Health Assessment of the workforce and a Digital Health Assessment of the community, respectively.

The aim is to complete the National Digital Health Strategy in April, with publication in due course after that.

I want to take this opportunity to thank all members of the National Digital Health Strategy working group for their very hard work in getting to this point.

In particular, the efforts of Kirsten Beasley, who Chairs the group, and Laure Marshall, Project Manager, have been invaluable in the progress made to date.

Mr Speaker,

The JSNA and National Digital Health Strategy are vital, foundational pieces of work that will guide decision-making into the future. I look forward to sharing their full findings and recommendation with this House.

Mr Speaker,

The UHC programme of work also includes an examination of our integrated care pathways, and that work is underway as well. The purpose is review and understand care needs and care provision so as to identify any potential improvements. With a deep understanding of a patient’s journey along a care pathway, it is possible to design a more integrated service model to improve the patient experience, clinical outcomes and operational performance.

The initial care pathways being examined are:

• the First 1,000 Days of Life, with Dr Sylvanus Nawab as the clinical lead,

• chronic kidney disease, and,

• adult acute mental health, with Dr Anna Nielson-Williams as the clinical lead.

The clinical lead for the kidney disease pathway is still to come.

These integrated care pathways reflect another strategic principle of the Bermuda Health Strategy, “partnerships and collaborative working”. As outlined in the Strategy, understanding and defining more integrated care pathways between providers and individuals will increase the quality, affordability and efficiency of care. It will also strengthen the health system by defining standards and promoting and disseminating best practices.

Finally, Mr Speaker,

I would like to provide Honourable Members with an update on the drug formulary.

Controlling the cost of pharmaceuticals is a crucial part of our health system’s financial reform. Our high cost of healthcare, an ageing population and an increasing incidence of chronic diseases such as diabetes all contribute to the burden felt by many in the community.

Science continues to give us new medications and treatments for managing our health, but it is clear people are concerned about the price they have to pay for these medicines.

Clinically, pharmaceuticals are medications which are the most effective non-behavioural intervention for non-communicable disease. Pharmaceutical intervention saves money and interrupts the costs and burden of disease progression but doing so with efficiency does require cost control.

The Pharmacy and Therapeutics Committee is up and running, and advises the Health Council on the drug formulary where prices will be regulated.

The purpose is not to control the price of every medication sold in Bermuda. Rather, the Bermuda Drug Formulary will comprise the list of common essential medications along with associated products and devices used in medical treatments, which are intended to be medically appropriate, cost-effective and sold at a regulated price.

So far, the Health Council has placed the two Covid antiviral drugs on the Formulary and they are priced at $30.

Additionally, the Committee met this week and approved four diabetes medications to be added to the formulary. The Committee will deliberate on two more diabetes medications very shortly. The Health Council anticipates publication of the group of diabetes medications by the end of next week.

The next group to be considered is insulin, followed by cardiovascular medications. The public is invited to check the Bermuda Health Council’s website for updates as they happen.

Mr Speaker,

As we seek to answer the question, “What does it take to be healthy and stay healthy, not just get healthy?”, we strongly encourage everyone to execute on those small steps and small changes which are within your control and create good habits. That is within our ability, and that is our personal responsibility.

The paradigm shift in our thinking about things like our use of hospital resources, frankly, is necessary. Bermuda must revamp its healthcare system, and we all have a role to play.

The Ministry’s commitment to providing the support that we can through our public health services is unwavering. This Government’s commitment to healthcare transformation is resolute.

Thank you, Mr Speaker.

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