March 1, 2023

Members, we are now at the point
where we start the Orders of the Day.
As everyone knows, and again for our listening audience, we are in the annual budget session.
Today, as always, there are eight hours allotted for
the debate on the respective ministries and depar t576 1 March 2023 Official Hansard Report

Bermuda House of Assembly ments. We will start this morning with the Ministry of
Health. They have five hours and the remaining three
hours will be on the Ministry of Social Development
and Seniors.
Again, for the listening audience, when we go
into the Committee of Supply , or Committee, the
Speaker is out of the Chair . So, for the next eight
hours the House will be in the hands of chairmen,
once the Deputy moves us into Committee. I believe
the first Chairm an this morning will be MP Pearman
(am I correct?) .
Deputy [Premier ].

Hon. Walter H. Roban: Good morning, Mr. Speaker.
Good morning listening public and Members of the
Legislature.

Good morning Honourable Member s
and members of the listening public. We are now in
the Committee of Supply for further consideration of the Estimates of Revenue and Expenditure for the
years 2023/24. Today we have the Ministry of Health,
Heads 21, 22, 24 and 91, which I believe are all four
heads of the Ministry. They are now to be debated and I call on the Minister in charge, the Honourable
and Learned Kim Wilson to proceed.
Minister, you have the floor.

Hon. Kim N. Wilson: Thank you, Mr. Chairman.

It is now 10:27, which I believe
means we finish at around 4:57 or thereabouts. Thank
you.
Hon. Kim N. Wilson: Thank you. Good morning, Mr .
Chairman.
I move that the following Heads: Head 21,
Ministry of Health Headquarters; Head 22, Depar tment of Health; Head 24, Hospitals; and Head 91, Health Insurance to be now taken under consider ation. The Ministry of Health Budget is found on pages
148 to 169 of the Estimates of Revenue and Expend iture.
I am here today with great pleasure to present
the budget for the Ministry of Health overall, starting
with Head 21, the Ministry of Health Headquarters,
found on pages 149 to 153 of the Budget Book.

HEAD 21 —MINISTRY OF HEALTH
HEADQUARTERS

Hon. Kim N. Wilson: Mr. Chairman, the mandate of
the Ministry Headquarters is “to make Bermuda
healthier” .

Expenditure Overview

Hon. Kim N. Wilson: Mr. Chairman, a total of
$10,309,000 has been allocated for Head 21 Headquarters for 2023 /24, which represents a decrease of
$5,581,000, or 35 per cent , over the original budget of
2022 /23.
Much of the change is due to the lifting of the
public health emergency in November of last year.
This means the Ministry is no l onger required to pr ovide the services and manage the mitigation
measures needed to control and contain the COVID -
19 virus. The pandemic response unit has been largely stood down, and the Ministry is re- engaging with the
community, focusing on its numerous public health
services and activities.
Mr. Chairman, although COVID -19 remains a
global health emergency, according to the World
Health Organisation —and is a highly infectious di sease in our community —in Bermuda we have taken
advantage of our impressive v accination rate to r esume our lives. However, we remain vigilant and
aware of the potential impact of COVID -19 on our vulnerable populations as we move to this new normal.
I will now speak on each of the programmes
and business units under this particular head, Mr.
Chairman.

General

Hon. Kim N. Wilson: Mr. Chairman, t he programme
2101 (General ) comprises 12 FTEs [full- time equiv alents] and a budget largely dedicated to grants admi nistration, the implementation of universal health co verage, health disaster [coordination] and accounting
services.
The programme’s total budget on page B -149
of the Budget Book is $9,185,000. Of that, $4,328,000
is set aside to support the implementation of universal
health coverage and cover expenses associated with the day -to-day operations of the Ministry, including the
Accounts section. Mr. Chairman, $4,161,0 00 is for
grants and $158,000 is for health disaster coordinaBermuda House of Assembly tion, which is a legacy of the Ministry’s national health
emergency function. The balance of $538,000 supports the Ministry’s Corporate Services policy directorate.

General Administration

Hon. Kim N. Wilson: Mr. Chairman, under business
unit 31000 General Administration, the Government is
committed to strengthening our health system to bring
about healthy people in healthy communities , which is
a multi -year journey towards delivering universal
health coverage (UHC) for necessary health care services. The aim is to ensure that all residents of Bermuda have access to essential quality health services when they need them without suffering financial har dship.
With a focus on integrating health services
across the continuum of care that is public health,
mental health, acute and post -acute care, and community services, the implementation of UHC will seek
to contain health care costs, as well as employ pr evention and health promotion strategies, to produce better health outcomes.
This transformation to UHC requires the str ategic planning of upcoming projects and ongoing e ngagement with key stakeholders to ensure deci sions
and actions impacting UHC are patient -focused and
timely. For this, there is an allocation in the Ministry’s Headquarters budget in the amount of $1,463,000 to
establish a programme management office (and her einafter I will refer to it as the PMO ) for delivery of UHC
and a further $900,000 for consultants. This is in addition to an allocation of approximately $534,000 for
health promotion and wellness in the Department of
Health’s budget.
Mr. Chairman, the PMO will manage the c oordination, implementation, execution and integration of all projects associated with the workstreams in
2023/24, and beyond, to accelerate changes towards
UHC. The PMO will also support the transitional go vernance structure whose purpose is to facilitate the
engagement of the many and wide- ranging health
system participants through stakeholder working
groups and forums. The PMO will comprise a p rogramme director, communications coordinator, project
managers and business analysts, with funding set
aside for subject matter expert s as necessary. The
Ministry currently has two project managers assisting with UHC implementation and will seek to build further
capacity within the public service via knowledge sharing and hands -on experience managing UHC related
projects.
Mr. Chairman, the UHC Steering Committee,
which was established in 2021, is presently focused
on three building blocks of overall health system strengthening: stewardship and governance, health
care service delivery and health care financing. The
Steering Committee com prises representatives of several government departments, as well as the Bermuda Health Council, Bermuda Hospitals Board, the
Bermuda Medical Doctors’ Association, BermudaFirst
and patient representatives.
The Steering Committee confirmed the follo wing foundational projects for 2022/23:
• establishment of a National Digital Health
Strategy ;
• agree our starting points ( with the assistance
of the Joint Strategic Needs Assessment) ;
• integrated essential care pathway mapping
(which is the First 1,000 Days as well as the
chronic kidney disease) ;
• build a new pan- system governance model ;
and,
• options for consolidating the government
health insurance funds.
Mr. Chairman, w ork has commenced on these
projects with some close to being completed, either in
whole or in part . The overall purpose of the PMO is to
deliver support, communication and coordination for
all UHC projects and workstreams to more rapidly ad-vance health system change.
Mr. Chairman, in the 2023/24 budget year,
working with the UHC Steering Committee and the
stakeholder working groups and forums, the Ministry
of Health will look to build on the progress made in the
current year and, in the process, we will
• identify and prioritise opportunities to improve
care provisions and access along the care
pathways already mapped and work on add itional care pathways, including a mental
health care pathway, to ensure equitable access to needed health services ;
• identify and prioritise opportunities for health
system cost savings out of the care pathways
already mapped;
• identify opportunities to improve the gover nment’s health insurance funds ;
• identify alternative funding models which can
be used to shift away from a fee- for-service
payment model and towards an incentivised
outcomes -based model ;
• build on the anticipated outputs of the National Digital Health Strategy, to formulate the i mplementation plan for the procurement of an
infrastructure build of the integrated care rec-ords system ; and,
• leverage the results of the Joint Strategic
Needs Assessment, determining the appropriate metrics to start tracking in order to best monitor and measure performance on our
population health needs and developing an
implementation plan to address data gaps.
Mr. Chairman, the Ministry is aware that certain projects, such as updated national health ac-counts, are needed to progress components of UHC,
578 1 March 2023 Official Hansard Report

Bermuda House of Assembly and we will work closely with and support the relevant
agencies.
The overall aim remains to create a more eff icient and value- driven health system where our res idents enjoy better health outcomes. We must all
commit to doing what we can to live a healthier life.
Living healthier lives reduces the burden on Berm uda’s health system and produces economic benefits.
Mr. Chairman, the Ministry of Health cannot
achieve health system transformation alone. For that
reason, in the upcoming budget year the Ministry will complete the set -up of the transitional governance
framework envisioned by the 2021 UHC roadmap. It
provides a structure for collaboration and engagement
with the wider Bermuda communi ty—beyond the
Steering Committee—through a broad stakeholder
group comprising nurses and the allied health professionals, the I sland's private insurers, the Chamber of
Commerce, local and international businesses and
third sector organisations. This struct ure includes the
following working groups and forums for stakeholders:
the Clinical Senate, Health Financing, Health Insurers,
Health Advocacy and Service Providers. The Clinical
Senate began to meet in January, and the Ministry
anticipates inviting stakeholders to join the remaining
groups in the coming weeks.
This ends my presentation on 31000 General
Administration.

Grants Administration

Hon. Kim N. Wilson: Mr. Chairman, regarding bus iness unit 31015 Grants Administration . I would invite
you to turn to page C -18 which lists the Ministry of
Health grants to several agencies providing essential
front-line services to aid public health and social assistance and, also, a grant for health education. The
total budget for the business unit is $4,161,000. These
grant funds are allocated as follows:
• $3,000,000 for the Lady Cubitt Compassionate Association (LCCA) to cover overseas
medical care for uninsured and underinsured
persons;
• $1,000,000 for the Bermuda Health Council;
• $6,000 for the Sexual Assault Respons e
Team [SART ] which, combined with $55,000
for additional nursing services, will result in a
total grant of $61,000 for SART ; and,
• $100,000 for the Dr. Barbara Ball Scholarship.
Mr. Chairman, please note the final approved
Estimate Book will reflect a total of $61,000 for SART under Grants , page C -18, which currently shows a
grant of $6,000. Accordingly, the Grants t otal on that
page will be amended from $4,106,000 to $4,161,000.
This change will fix an entry by the Ministry that incorrectly included $55,0 00 for nursing services within
Headquarters salaries , although there is no FTE associated with these services. Page B -150 will be
amended accordingly . Charities and other key agencies provide the
Ministry of Health with supporting services that are
vital to the community and complement the Ministry’s
mandates. The LCCA, the Bermuda Health Council and the Sexual Assault Response Team are all critical services and are fundamental to the success of the
Ministry. The Bermuda Nursing and Midwifery Council
is being transferred to the Bermuda Health Council
and, as such, is no longer included in the Grants budget.
The LCCA as an organisation has been a part
of the Bermuda community since 1932. In the 1950s ,
the LCCA began assisting residents who needed to
travel abroad for medical treatment not available in
Bermuda. Today, the LCCA administers the Patient
Overseas Financial Aid Programme, working with residents with limited or no ability to pay, to find the right solution.
The 2023/24 year will see an increase in funding for the LCCA from $2,500,000 to $3,000,000. And
this is to cover the costs associated, particularly, with
exceptional cases . And that is, cases involving medical treatment where the costs are greater than $50,000.
In 2021/22, exceptional cases cost
$3,070,000 and in the current year they are forecast to cost $3,024,000. The increase in funding of
$500,000 will better ensure the LCCA is able to cover necessary costs in fulfilling its mission to assist those
with insufficient health insurance.
Mr. Chairman, also, included in the Grants
budget for 2023/24 is $100,000 in funding for the Dr.
Barbara Ball Scholarship. The Ministry of Health will
once again award the Dr . Barbara Ball Public Health
Scholarship, annually, to Bermudian students with proven financial need seeking careers or professional
development in public health. The scholarship is offered in honour of Dr .
Barbara Bertha Ball who was the firstborn Bermudian
woman to practice medicine in Bermuda and a tireless champion for people’s rig hts. The Dr . Barbara Ball
Scholarship is offered for a range of health care fields
of study that benefit public health directly and which are a priority for public health needs in Bermuda. This
scholarship was last awarded in 2020 but was inter-rupted due to the demands of the pandemic.
The scholarship is an important facilitator to
encourage and support the young people of Bermuda to join the health care workforce. The awarding of this
scholarship is in direct alignment with the current Bermuda Health Stra tegy's strategic principle that
states, “Strengthening our Health Care Workforce. ”
As never before we need to encourage our
young people with careers in the health and care sec-tor because the pandemic has underlined the i mportance of attracting and retain ing health care professionals. In addition, Bermuda has an ageing popu-lation with associated health care needs including a
high burden of non- communicable chronic diseases


Bermuda House of Assembly that we are seeking to prevent and treat. Furthermore,
participants in the s ignature schools’ Health and Social Care Pathway to be offered at the Berkeley Inst itute will benefit from assistance in accessing higher
education.
Another grant recipient is the Bermuda Health
Council.

Bermuda Health Council

Hon. Kim N. Wilson: Mr. Chairman, I want to highlight the work of the Bermuda Health Council, which is
a quango under the Ministry of Health. The Council
receives operational funds in part from the Ministry
grant and is positioned to continue to advise and
make recommendations to the Minis try of Health system matters.
Mr. Chairman, the Bermuda Health Council’s
mandate is to regulate, coordinate and enhance the
delivery of health services. The grant for Bermuda
Health Council can be found on page C -18, cost ce ntre 6895, under Ministry of Health.
In 2023/24 the Health Council’s grant will be
$1,000,000, which is the same support level as the
previous two years. The Council has been continuously involved in critical initiatives in support of health
system improvement. During the coming year , the
Health Council will play an essential role in progres sing Bermuda’s u niversal health coverage goals including strategic initiatives around digital health, procur ement, and health system financing. These projects are
in addition to their regulatory activi ties related to
health professionals, health businesses, and health
insurers. The Health Council will also be systematically working on major projects towards improving the
National Drug Formulary, social determinants of
health, long- term care, kidney transplantation, popul ation health education and health workforce capacity.
The Health Council’s grant is primarily su pplemented by a transfer from the Mutual Reinsurance
Fund (MRF), licensing fees paid by health insurers,
and licensing and registration fees paid by regulated
facilities and health professionals for a total budget of
$4,300,000 [for 2023/ 24.]
Mr. Chairman, in 2022/23 the work of the
Health Council centred on four strategic areas: regul ation, quality and standards, and finance and economics, w ith oversight by audit and governance. I will ou tline some of the year’s achievements now.

Regulation
Hon. Kim N. Wilson: Mr. Chairman, as the primary
regulator and registrar of the health system, the
Council facilitated the administrative functions of m ost
health professional bodies and health professional
conduct committees, and managed licensing functions
in respect of select health facilities, namely diagnostic imaging facilities, laboratories, hospitals, nursing
homes and residential care homes.
The Health Council enhanced its paperless
process for the registration of over 650 non- physician
non-nursing health professionals by adding online
payment to its resource toolkit. This continuous modernisation of processes and the change management
required t o be effective has its challenges as any pr ocess transformation would have. However, these i nterventions do align with the Health Council’s objective to reduce the administrative burden of statutory board members so that they have increased ban dwidth to st rategically enhance their speciali sed fields
towards the improvement of population health in Ber-muda. In early fiscal year 2024, the Health Council is
planning to introduce a change of registration pr ocessing by transitioning to a blockchain- enabled pla tform. The aim is to reduce the processing time of
health professional renewal registration applications
from six to eight weeks down to seven days.
Mr. Chairman, modernisation of regulatory
processes continued in 2022/23 with the digiti sation of
the care home inspection process and reporting tools.
Now, instead of paper scoring, inspections are occur-ring on tablets with electronic scoring tools thus reducing human error and bias in the scoring methodology.
The Health Council understands how important long-term care is to this country and is continuing to put in
place a stronger foundation that will not only support
the sector but ensure that there is adequate accountability entrenched in its operations. This foundation
includes collaborating with Age Concern t o support
long-term care leaders in forming a Long- Term Care
Administrators Association. This professional associ ation is intended to assist in regulating and setting quality standards in relation to the provision of services
within this market. The Health Council also co mmenced a financial review of the operations and f inances of care homes.
In addition, in respect of long- term care regulatory activities, the Health Council continues to work
collaboratively on streamlining the complaints repor ting and handling processes, which involves partnering
with the teams at Ageing and Disability Services under the Ministry for Social Development and Seniors, and the Bermuda Nursing and Midwifery Council
[BMNC] .
Mr. Chairman, in response to concerns about
the affordability of prescription medication, the Bermuda Government provided the Health Council with
the mandate to implement the Bermuda Drug Form ulary. The goal of this work is to ultimately create a
more cost -effective prescription medication market by
setting th e prices of select medications, monitoring
compliance with regulated pricing, and negotiating the price at which medications are imported. An example
of this is the formulary including oral antivirals for COVID -19 and setting a maximum price for consu mers to pay for these therapies. With price regulation,
580 1 March 2023 Official Hansard Report

Bermuda House of Assembly we are avoiding what some countries have seen as
intentional price gouging related to COVID -19 pro ducts and services.
The Health Council continues to review the
medication list with the Pharmacy and Therapeutics
Committee to identify opportunities to improve the
prescription medication offerings of Bermuda. It continues to be imperative that we stay ahead of the
curve when it comes to having an efficient prescription
medication marketplace.

Quality and S tandards

Hon. Kim N. Wilson: Mr. Chairman, within its goal to
enhance the integrity and thus use of local health sy stem data, in fiscal year 2022/23 the Health Council
finalised the development of unique patient identifiers
for individuals and national pr ovider identifiers for
health care businesses and professionals. While the
initial intent was to integrate the unique patient identifiers into the Bermuda Hospital s Board’s PEARL system prior to launch, the Health Council is working with BHB to integrate t hese identifiers into the next phase
of development and, subsequently, to require its use
in the processing of health insurance claims and
transactions.
Mr. Chairman, as the transition towards
greater standardisation is still evolving, this modern isation of data will lead to a much better understanding
of our population’s health needs in the future. This is a
key element that continues to be discussed in the N ational Digital Health Strategy project working groups
as part of UHC and is an area where the Hea lth
Council is continuing to play a lead role.
During the upcoming fiscal year, the Health
Council will build on its other recently implemented
information technology systems for case management, health data analytics, and online payments by
working with other health system stakeholders to:
build a more comprehensive health care business directory and social services network platform; roll out
digital inspection applications; and provide more
transparency for its health data. The goal being for consumers to be able to delve into anonymised data
to understand better how the local system runs and where there may be room for improvements and ev idence- based innovations.
The Health Council also manages the pr ogramme which supports Kidney Transplant Coordin ation. Through this programme, education on kidney
transplants is being conducted and comprehensive coordination is provided to those who have been des-ignated to receive a new organ. Through this pr ogramme we have seen the highest rate of kidney
transplants occ urring in the country’s history. Right
now, dialysis costs approximately $135,000 per patient per year, and, collectively, for our 200 patients,
close to $30,000,000 a year. Each transplant that is
done is estimated to save as much as $700,000 over a 10- year period for each of those patients receiving a
kidney transplant. In the current fiscal year, the pr ogramme saw six individuals transplanted resulting in
an anticipated health system savings of more than
$4,000,000 from this year’s cohort alone. This is the
type of savings that can be reinvested in public health
programmes leading to improvement of Bermuda’s
disease profile and better age ing of the population
over time.
Mr. Chairman, a big part of the efforts of the
team have been to streamline the abili ty of persons to
serve as live organ donors. Like many countries, there
is a long way to go to increase the likelihood of individuals donating organs to family and friends, but the
work is being put in to boost this using best practices
from multiple other countries. In concert with the work
of improving organ donation, I am pleased to report
that the Health Council is investigating the expansion
of global partners that will be cost -effective in delivering these surgical procedures, as well as the possibi lity of such services being delivered here on I sland.
The Health Council recognises the larger goal
to improve the quality of life of the residents of this
country. As such, budget allocation being spent on
programmes, staff and other resources is strictly for
the purpose of creating opportunities for saving the
health system money or improving the lives of the
population in a cost -effective way. Under that premise,
the Ministry is working with the Health Council to u pdate legislation that would make those s hort- and
long-terms goals more achievable within today's modern health care climate.

Financing and Economics

Hon. Kim N. Wilson: Mr. Chairman, the Health
Council continues to enhance its National Health A ccounts Reports process. These reports detail tot al
health system expenditure during each year.
As the standards change around how finances should be accounted for within a health system, the Health Council is working with internal and external
stakeholders to make sure that our numerical comparisons ar e in line with the rest of the world.
During the year , the Health Council continued
to regulate the prices of Standard Health Benefit ser-vices. The pricing of these services continues to be
guided by the r esource- based relative value scale or
RBRVS struct ure. The prices are kept up to date on
an every -three- month process with releases to community providers happening every six months. This
RBRVS structure is also used in guiding fair rei mbursement practices for insurers and fair pricing practices for provi ders. The intent in the future is to stab ilise this methodology in practice, and then more t owards stabilising and regulating how copayments are
charged within the delivery of services. The current issue with copayments is that the optics of high c opayment s are linked to individuals delaying their care


Bermuda House of Assembly and thereby leading to longer term health complic ations and avoidable costs to the health care system.
The intent is to ensure access to the right care at the
right time for all people without the introductio n of
health care disparities.
Understanding the spend that takes place
within our health system is an important variable in
understanding where there are opportunities to be
more efficient or opportunities to take on new innov ations and progressive challenges. The Health Council has a structure for reviewing such opportunities through its health technology assessment process.
This process includes a scrutiny of peer review r esearch and market literature from around the world,
an analysis of local utilisation and demand data, and a discussion by local experts on potential advantages
and disadvantages of change. The Health Council has
worked closely with the Pan American Health Organ ization on a health technology assessment process
and is also in the process of adding the calculation of
quality -adjusted life years to its cost assessment por tfolio. The Health Council in 2023/24 will continue to
refine this process so that there is more evidence-based decision making involved in the financing of
local healthcare.
Mr. Chairman, in 2022/23 the Health Council
has advocated for legislative changes necessary to
finalise the standardisation of the medical and dental
charges, to update the BHB Fee Regulations and
make changes to the Standard Health Benefits Regulations to allow them to work better for the broader
health system in a modern context. In addition, the
Health Council continued to work on updates to legi slation for more significant penalties and accountability
factor facility licensing requirements .
Mr. Chair man, I am pleased to report with resources no longer focused on the public health emer-gency the Ministry is working with the Health Council
to advance these priorities in 2023/24. There is a lot of
work to be done as the health system faces an uncertain future of global headwinds but updates to existing
legislation will allow for a much better opportunity to
steer through the pending challenges of an ageing population, an unstable global economy, a heavy burden of chronic illness and an increasing demand for
acute care services due to violence and accidents.
Mr. Chairman, turning now to Audit and Governance: The Health Council has a track record of
timely financial transparency , and through working in
close collaboration with the Auditor General have year over year tabled on time and unqualified audited f inancial statements. The Health Council’s annual r eports and financial statements are completed through
fiscal year 2021 and the ones for fiscal year 2022 are
in progress. The Health Council looks forward to completing this financial audit and then preparing for the
audit for fiscal year 2023 to commence once this fiscal
year ends in March 2023. The Health Council’s team of 19 staff conti nues to have a successful paperless office, with most
of its information shared via electronic means. The
Council also continues to review and enhance its i nformation technology tools so that it can progress to become more efficient and thus be a more cost -
effective resource to both the Government and the
health system alike.
Mr. Chairman, turning to the future: Looking
forward to 2023/24, the Health Council will continue
with its wide remit of performing functions that i mprove the health system. As the population and its
health needs evolve, it is important for the Health
Council to maintain agility in how it accomplishes its
mandate. As it continues to promote community i nvolvement and solution generation through the inno-vation programme, the Health Council also looks to
support the next generation of health professionals
through education, mentorship and exposure pr ogrammes.
This past year, the Health Council hosted five
interns to support its work and give them opportunity
for skill development and exposure to possible career
paths. Of note, Mr. Chairman, for 2023/24, the Health
Council will carry on its work to create more structure
and planning for long- term care support frameworks
that are effective in reducing risk and preventing di sease, identifying ways to better manage healthcare financing, listen to the concerns of the public, and ensure that patients, providers and businesses are afforded fairness, privacy, and protection in their dea lings.
This ends my presentation, Mr. Chairman, on
business unit 31015, Grants and Administration.

Corporate Services and National Heal th Emergency

Hon. Kim N. Wilson: Turning now to Corporate Services and National Health Emergency, located at
business unit 31020 Corporate Services, and 31997
National Health Emergency. Mr. Chairman, the est imated budget for Head 21, Corporate Services Un it, is
$538,000. This unit comprises the Ministry’s Policy Directorate and the staff that work closely with me, as
Minister, as well as the senior management team to undertake research and assist with the development
of policy and regulations. As with other sections in the
Ministry, the resources have now shifted from the
pandemic to the more regular business of the Ministry
and we have planned a very busy legislative agenda
for 2023/24.
The budget allocation for what was known as
the National Health Emergency is $158,000. This unit
undertakes critical health disaster coordination for the
Ministry and is a legacy of our pandemic experience
which highlighted the need for planning and preparedness. In 2022/23 the Ministry improved its standing with respect to the Pan American Health Organiz ation’s plan of action for Disaster Risk Reduction mov582 1 March 2023 Official Hansard Report

Bermuda House of Assembly ing from satisfying one out of six indicators, to satisf ying four out of six indicators. In 2023/24, one of the
work streams is to successfully accomplish the r emaining indicators and thus be better positioned to manage the public health risk associated with disas-ters and extreme weather emergencies.
This completes my presentation of 31020
Corporate Services and 31997 National Health Emer-gency. This also completes my remar ks on all the
business units under the programme entitled General.
The second programme under Head 21, Mi nistry Headquarters, is the Office of the Chief Medical
Officer.

Chief Medical Officer

Hon. Kim N. Wilson: Mr. Chairman, I invite you to
look at pages B -149 to B -153 of the Estimates of
Revenue and Expenditure which specifically speaks to the Office of the Chief Medical Officer.
Programme 2102 under Head 21 is the Office
of the Chief Medical Officer (OCMO), found at page B -
149 of the Budget Book. Its total budget for fiscal year
2023/24 is $1,124,000, which funds two business
units, namely, 31030 Healthcare Registration and
Regulation, and 31040 Epidemiology and Surveillance
Unit. The office ordinarily consists of eight FTEs (full -
time equivalents), and one part -time consultant pharmacy inspector.
With the lifting of the public health emergency
last November, most of the staff assigned to work with
the Office of the Chief Medical Officer have returned
to their substantive roles. The instant command struc-ture is working to document the lessons learned during the pandemic. Examples of good practice are now
being embedded into the day -to-day practices across
the health economy.
The remit of the Office of the Chief Medical
Officer consists of five primary duties: (1) registration
and regulation of healthcare professionals; (2) pharmaceutical drug control; (3) epidemiology and
surveillance; and (4) statutory public health respons ibilities; and (5) health emergency planning, resilience
and response. Over the past eight years, the Office of the CMO has undergone significant reorganisation of
its structures in order to facilitate optimal efficiencies and to ensure delivery of an effective and robust
statutory service.
Previously, the OCMO registered all
healthcar e professionals besides the nurses and ps ychologists, as well as registering healthcare facilities
namely, hospitals, pharmacies, clinical laboratories and diagnostic imaging facilities. From 2020, the
OCMO transferred most of its registration and regul atory functions relative to healthcare professionals and
facilities to the Bermuda Health Council.
The Office of the CMO currently manages the
registration and re- registration of medical practitioners
as well as the registration and regulation of pharm a-cies. The OCMO also provides administrative support
to the Bermuda Medical Council , and the CMO is an
executive officer of the Bermuda Medical Council. The
office retains functions relevant to medical practitio ners and pharmacy regulation. This includes oversight
of the registration processes, the management of patient concerns, and ensuring best practice clinical
standards are in place and maintained to protect and
support the delivery of ongoing high- quality medical
and pharmaceutical care in Bermuda. In additi on, this
office manages the administration for the Professional Conduct Committee for medical practitioners on I sland.
Mr. Chairman, the OCMO’s pharmaceutical
drugs control responsibilities include ensuring that
annual inspections of pharmacies are conduc ted and
monitoring the importation of prescription drugs. This
includes ongoing checks of controlled or banned
drugs to ensure these items are kept safe and are
only received by appropriate responsible healthcare
businesses and individuals. Additionally, t he office
ensures that Bermuda stays within the assigned qu otas of controlled drugs and reports on controlled drug importation to the International Narcotics Control
Board (INCB), in Vienna, Austria. The INCB monitors
compliance with the United Nations Int ernational Drug
Control Conventions. This office also ensures that medications imported to the Island are in keeping with the provisions of the Pharmacies and Poisons Act.
Health protection and community health assessment are two essential public health functions carried out by the Office of the CMO’s Epidemiology and Surveillance Unit (ESU). The ESU monitors the
occurrence of diseases on the Island, both infectious
diseases and select chronic non- communicable di seases, to help prevent and control their spr ead and
impact. The ESU receives reports from individual
healthcare providers and laboratories and will invest igate unusual disease occurrences. The provision of
contact tracing and case management functions and
services are integral to preventing and/or m itigating
any future outbreaks of disease.
Periodic community health surveys are conducted to monitor and document the health of Berm uda’s population. The STEPS to a Well Bermuda sur -
vey, which is planned for 2023/24, is just one exam-ple. Data from community health surveys provide
population health information which is essential to setting health system priorities and for planning.
Mr. Chairman, additional functions of the O ffice of the CMO are to facilitate legislative functions, advise government departm ents on health matters
and to support the essential regulatory work of stat utory boards and councils. The Office also serves as Bermuda’s public health focal point for communic ations with regional and international authorities such as the World Health Organization [WHO], the Pan American Health Organization [PAHO], and the Caribbean Public Health Agency (CARPHA). Essential


Bermuda House of Assembly collaboration with these partners provides Bermuda
with access to facilities to develop and train our public
health professionals and to support and implement
strategic plans and technical assistance for the pr evention, mitigation and management of public health emergencies, including preparedness for disaster
management and extreme weather events.
Mr. Chairman, the Office of the CMO is deve loping health emergency plans. In the past year this team provided services to care for oxygen- dependent
patients who required uninterrupted power supply during the hurricane, as well as developing and executing
a polio outbreak plan. This was well recei ved and positions Bermuda to be able to deal with outbreaks like
this in the future. The Office works closely with the Health Disaster Coordination Unit.
In 2022/23 the Office of the CMO led the development of Bermuda’s first Joint Strategic Needs
Assessm ent. This is a critical part of our progress t owards universal health coverage as it helps to set out
our starting point. This work brought together all parts of Bermuda’s health system and included a focus on
the social determinants of health and was supported
by the UK Health Security Agency. The result of this
assessment will help understand the priorities for action and form the baseline for improvement over the
coming years. And, Mr. Chairman, I will be providing further information to Honourable Members in due
course concerning the Joint Strategic Needs Asses sment and the findings of that.
Mr. Chairman, in the Office of the CMO a
budget of $645,000 is allocated to healthcare registr ation and regulation. Over the past year the section has
ensured the administration of a variety of professional
services relevant to more than 200 registered medical
practitioner professionals, processed over 130 r equests for controlled pharmaceutical drug licence r equests, and completed 54 pharmacy inspections.
The Registr ation Section continues to meet its
performance targets by publishing accurate healthcare professional registers and supporting the
professional statutory boards in their registration and
complaints -handling responsibilities, duties and efforts.
For fiscal year 2023/24, $479,000 is budgeted
for the work of the Epidemiology and Surveillance Unit [ESU]. Capacity building in public health has been
supported by CARPHA, PAHO and Public Health
England since 2020, and has assisted the staff of the
ESU, as well as the staff in the Department of Health
to meet the challenges of preventing and controlling
emerging diseases such as the novel coronavirus pandemic, and in managing outbreaks of vaccinepreventable diseases such as whooping cough. These
organisations have also supported us in the management of non- communicable diseases, such as diabetes and cardiovascular diseases through the Hearts Initiative. Through the tireless work of the Public Health
Emergency Response Team (PHERT), and the Surveillance Assessment Response Team , the Office of
the CMO coordinates and collaborates with a broad range of health and other community stakeholders Island wide to prevent and mitigate public health
threats. The relationships established and maintained
via PHERT or the Surveilla nce Assessment Response
Team have proven to be priceless for the efforts of
mitigating the COVID -19 virus during this past two
years plus.
To date, there have been over 18,000 cases
of COVID -19 identified in Bermuda and, sadly, 158
deaths. This pandemic has impacted the lives of all
Bermudians and has also had a profound impact on
our economy and the fabric of our society. It is fair to
say that without the dedication and expertise of the OCMO, the Epidemiology and Surveillance Unit and
the entire Ministry of Health team that Bermuda could
have fared so much worse. The Office of the CMO’s entire work force has dedicated their lives to the r esponse to the COVID -19 pandemic, which has spread
around the entire world and has spared no country.
Mr. Chairman, the trend of lower reported
cases of communicable diseases other than COVID -
19 has been reversed in 2022. This may be related to
the lifting of the mandatory public health measures
implemented to control the COVID -19 pandemic, such
as physical distancing, and mask wearing. We now
have more reported cases of influenza, RSV and strep
throat infections, like many other countries in the
world.
The ESU has managed 225 individual case
reports of communicable diseases in addition to man-aging COVID -19 in 2022.
Mr. Chairman, the OCMO has continued to
provide critical support to the vaccination programme
to ensure that all eligible residents of Bermuda are
vaccinated and protected from the COVID -19 virus.
Working with colleagues in the Foreign Commonwealth and Development Office and the Government
House, OCMO worked tirelessly to secure vaccines
for all the residents of Bermuda. We must also
acknowledge the incredible efforts of both Gover nment House and the UK to assist us with the supply of
these critical vaccines at t his most challenging of
times.
In all, Mr. Chairman, by the 31
st of January
2023, our vaccination teams have administered over 200,000 vaccinations. Impressively, our mass -
vaccination campaign ended with 75.0 per cent of the
general population immunised wi th two doses and this
rises to 85.6 per cent when you consider just our res idents over the age of 65. Additionally, 68.8 per cent of
the eligible population has received their first booster with many people going on to receive second and
third boosters. The more recent vaccines have been
administered through collaboration with doctors’ offi c584 1 March 2023 Official Hansard Report

Bermuda House of Assembly es, community pharmacies and third sector organis ations.
Mr. Chairman, if I could, I would stand here
today and use the entire five hours allocated to this
Ministry to applaud and salute the tireless efforts and
contributions of the entire health team across the I sland, including our volunteers and all of our partners in
the private and public sectors. Not only have we held
our own against this powerful foe, but we have also
managed, at the same time, to sustain delivery of es-sential medical services across the board.
This historic pandemic threat that has held our
small nation to ransom has only been managed due to
the dedicated and tireless efforts, devotion, and col -
laboration of every single sector and person in our
community. Our nation has, once again, shown how
our camaraderie and community spirit has allowed us
to triumph over adversity and we are going to require
the same ongoing dedication and effort to overcome
the long- term impacts of the pandemic in the future.
Mr. Chairman, finally, the development of the
important Chronic Disease Register continues to
evolve and be refined. We are rebooting efforts at establishing a chronic renal disease register that was
stalled by the onset of the pandemic. This is going on
in partnership with the Bermuda Hospitals Board’s
Tumour Registry. We expect this to be up and running within the coming year and provide valuable insight
into this disease which is the source of suffering and
high cost to Bermuda.
Mr. Chairman, this ends my presentation on
business unit 2102, Office of the Chief Medical O fficer. In addition, Mr. Chairman, this concludes my remarks with respect to Head 21, the Ministry of
Health Headquarters.

The Chairm an: Thank you, Honourable Minister, if
this is a convenient moment just to pause for a second, Honourable Members and members of the liste ning public, we are in the Committee of Supply for fur-ther consideration of the Estimates of Revenue and
Expenditure f or the year 2023/24. This is the debate
on the Ministry of Health with four heads. Honourable
Minister Kim Wilson has just concluded Ministry of Health Headquarters. This is a five- hour debate, en ding at 4:57 pm. We are approximately one hour into
the first . . . we have almost finished the first hour of a
five-hour debate.
Minister, when you are ready, please continue
with, I believe Head 22.

Hon. Kim N. Wilson: Yes, Mr. Chairman, that is correct. Head 22, the Department of Health.

HEAD 22 —DEPARTMENT OF HEALTH
Hon. Kim N. Wilson: Mr. Chairman, I invite you to
turn to pages B -154 to B -164 of the Budget Book, which speaks specifically to Head 22, again, the D epartment of Health.
Mr. Chairman, it gives me great pleasure to
present the budget for Head 22 , the Department of
Health, which again can be located at pages B -154 to
B-164 of the Budget Book. The total current expend iture is estimated to be $30,429,000 for 2023/24. This
represents an increase of $1,739,000 compared with
the original 2022/23 budget .
Vision and Mission: Mr. Chairman, the D epartment of Health’s vision is Healthy People and Healthy Communities. The Department’s mission is to
promote and protect optimal health and well -being in
Bermuda. The 290 Department of Health officers,
which is fo und at page B -157, work in 25 programmes
represented as 31 discreet business units in the Budget Book. This is all designed to assure the health and well -being of the general population.
Mr. Chairman, the Department of Health, section 2205, Administration, comprises the business
units of Administration, Health Promotion, Compr ehensive School Health and Childcare Regulations. Under unit 32230 Administration, the 2023/24 budget
estimate for business unit 32230 is listed on page B -
155 and is $429,000.
Mr. Chai rman, public health services are more
important now than ever, given the toll that the
COVID -19 pandemic has taken on our community.
The Department of Health’s efforts are focusing again
on prevention of non- communicable chronic disease
and mental health. It is fair to say, Mr. Chairman, that
the post pandemic period is proving challenging. Not
unlike jurisdictions around the world, healthcare wor kers are experiencing burnout and the decreasing of resources. Added to that , as the House will well be
aware , are issues with the physical plant of the Hami lton Health Centre, also known as the Victoria Street
Clinic.
The Department of Health Offices are highly
engaged in work towards the Universal Health Cover-age and the first 1,000 days integrated pathway care
work project with the health system and the wider s ociety, which was a Throne Speech initiative. They will
also collaborate with the Ministry of Education’s Si gnature School Learning Pathways as far as reasonably practicable as these are meaningful and impactful
projects for public health and equity.
Business line 32240, Health Promotion. Mr.
Chairman, the 2023/24 budget estimate for the Health Promotion and Wellness business unit of the Depar tment of the Health listed at cost centre 32240 on page
B-155 is $534,000. Mr. Chairman, the Health Prom otion and Wellness Programme develops and impl ements policies, programmes and products that will promote health and wellness in the community in co llaboration with public health partners.
Health Promotion annually sponsors two D epartment of Health initiatives, namely, Public Health
Week, and Celebrating Wellness. The theme of Public


Bermuda House of Assembly Health Week 2022 was “ Public Health Begins with
You.” Events during the week focused on health equ ity, mental health, public health careers and the public
health award. The multi -stakeholder panel discussion
was on the topic “Health Equity in Bermuda—Build
Back Better.” According to the Robert Wood Johnson
Foundation, and I quote, “Health equity means that
everyone has a fair and just oppor tunity to be as
healthy as possible. This requires removing obstacles
to health such as poverty, discrimination, and their
consequences, including powerlessness and lack of access to good jobs with fair pay, quality education
and housing, safe environments , and health care.”
The COVID -19 pandemic has severe and far -
reaching repercussions for health systems economies
and societies. As people grapple with these health,
social and economic impacts, mental health has been
widely affected. Recognising this, heal th promotion
offered through Dr. Jana Outerbridge, the bespoke
session “What’s your mental health story? An Explor ation of Self -hood and Steps Forward.” Participants
were encouraged to increase their understanding of
their thoughts, behaviours, bodily sens ations and
emotions and explored mental health and how early
experiences may set the trajectory for their current
lives.
The other highlights included careers in public
health and the public health award. Public health pr ofessionals are involved in everyth ing from identifying
diseases to creating public policy. Now more than e ver, most of the world has witnessed first-hand a public
health crisis and there will be no shortage or demand
for well -trained public health professionals. The c areer
in public health fair goal was to allow the public to find
out more about the potential opportun ities there are in
public health. Every programme in the Depar tment of
Health was represented and staff pr ovided interactive
and informational booths to educate at tendees.
The public health awards ceremony reco gnized individuals and organisations whose contributions played a significant role during the COVID -19
pandemic. The winning organisation was the Bermuda
Red Cross, and the winning individual was Sakina
Usher. She is the s upervisor of the Clinical Lab at the
Department of Health. We are thankful for the ded icated hard work of all those who serve in any capacity in the fight against COVID -19.
Mr. Chairman, a journey of a thousand miles
begins with a single step. And in 2023/24 a portion of the increase in funding for the Department of Health is
earmarked for health promotion and wellness initi atives. The Commit to Change brand will be used for
an intensive social media campaign that will feature
testimonials from Bermuda residents who will share
their lived experiences with mental illness and/or challenges from non-communicable diseases encouraging
the audience to commit to a specific change, just one
thing that is important to good health. The Commit to Change campaign goa l is to
encourage residents to make commitments towards healthy living. These changes do not need to be big,
but they need to be consistent. Small steps help us
create valuable habits, which help us to achieve big goals. Instead of undertaking a huge makeover, you
might be able to improve your health with a series of
small changes. This approach may take longer, but it
could also motivate you to make some big changes.
Small, intentional steps that people can make are as
follows:
• Choosing water: Cutting out just one sugar -
sweetened soda can easily save you 100 or more calories a day, and over a year that can
translate into a 10- pound weight loss.
• Eating more vegetables: Start by eating one
extra vegetable each day. And you can add
them to a smoothie or combin e them with ot her foods to boost your meal. The best choice when choosing between frozen, fresh or
canned vegetables is what works best for you,
your routine and your family so that you can simply consume more vegetables.
• Exercising daily: (and I’m looking over at the
Whip who I know is a regular exercise geek ) If
you don’t exercise at all, start with a 10minute walk and increase the minutes as you
get stronger. To make sure you stick to it, pick a physical activity that you enjoy and match
your ability.
• Balance your mental well -being by reducing
stress (which is critically important): Try
breathing slowly and deeply for a few minutes
a day. It can help you relax. Slow, deep
breathing may also help to lower your blood pressure.
Mr. Chairman, stigma hinders mental health
help- seeking behaviours. Considering the small size
of Bermuda’s community it is hard for some with mental illness or a mental disorder to seek help. It is ther efore imperative to develop strategies in our communities to destigmatise menta l health. According to the
World Health Organization, one in seven 10- to 19year-olds experience a mental disorder, depression,
anxiety and behaviour al disorders which are among
the leader causes of illness and disability among adolescents. And again, Mr. Chairman, that can be located at the World Health Organization and that was a
2021 study.
Mr. Chairman in 2023/24, the Community A dolescent Mental Health Training programme will train school -based health professionals, including school
nurses, allied hea lth professionals, which include
speech pathologists, occupational therapists and physiotherapists, the Healthy Schools Coordinator,
the Ministry of Education’s Counselling Services and
sporting organisations. Participants in the programme
will learn about the stigma, complete the youth mental
health first aid course to learn about adolescent de586 1 March 2023 Official Hansard Report

Bermuda House of Assembly velopment, signs and symptoms of common disabling
mental health problems and crisis situations, learn
when and how to refer students and to promote and
anti-stigma i n the schools and sports club’s environment.
As a result of the training, it is anticipated that
participants will be instrumental in changing the cu lture around mental health, increase help- seeking b ehaviour and destigmatising mental well -being. This
target audience will help to address the health issue
from an early education and developmental perspective and provide a safe and supportive environment
for student mental well -being.
Mr. Chairman, HEARTS in the Americas. This
is the Pan American Health Organization’s flagship
initiative for improving high blood pressure control and
heart disease risk management in doctors’ offices using a standardised treatment protocol. HEARTS has
been implemented in 24 countries in the Americas. In
Bermuda, funding will be made available in 2023/24
for the Department of Health and a number of collabo-rating primary care physicians to demonstrate that the
HEARTS protocol can get improved results locally and
to harvest the learning before the protocol is eventually rolled out and made available to the entire health
system.
The HEARTS protocol is a simple, practical,
and easy -to-follow treatment protocol that can vastly
improve the control of high blood pressure. The
HEARTS protocol features specific drugs and specific
doses to control blood pressure in a format that is
easy to understand and implement in Bermuda’s
health system to save lives. Other countries that have adopted HEARTS are seeing faster sustainable control with consistent actions being followed by phys icians, cl ients and their relatives. In addition to medic ation, HEARTS includes counselling and support for
lifestyle change and diet which, added to reducing
high blood pressure, can reduce obesity and the risk
of heart attack and stroke.
The COVID -19 pandemic demonstrated how
the burden of non- communicable diseases in Berm uda with an ageing population creates serious vulner abilities in our population generally and also with r espect to infectious diseases. The HEARTS protocol is
in direct alignment with the Bermuda Health Strategy’s 2022 –2027 namely, Promoting Healthy Living and
Preventative Care.
Mr. Chairman, C elebrating Wellness was back
as an in- person event last year. This annual event is
geared towards increasing awareness and promoting measures to address t he epidemic of noncommunicable diseases, or NCDs , which continue to
severely impact the health, economy and development of Bermuda. The focus was “Celebrating Wel lness, Carnival Ready Health Extravaganza.” When
preparing to participate in a carnival, you must pr epare to be ready for the road. Maintaining a healthy lifestyle should be your number one priority in the months leading up to the event. In order to combat
NCDs we need to make commitments to live a healthy
lifestyle, moving more every day, choosin g water, eating more vegetables, and protecting our mental well -
being.
It is important to note that we must work t ogether as a community if we are going to tackle the
chronic diseases and the non- communicable diseases
like diabetes, heart disease and cancer. The goal of
the Department of Health is to reduce the number of
Bermuda residents who have or are at risk for chronic disease.
The Health Promotion Team raised awar eness of the Department of Health’s programmes through regular use of radio PSAs, soci al media posts
(namely, Facebook, Twitter and Instagram), the Health Promotions Calendar, and online directory of helping services. And of note, the awareness level of
specific programmes, for example, epidemiology and
surveillance unit, significantly incr eased due to more
interaction with these programmes during the pa ndemic.
Last year, the Government of Bermuda E mployee Wellness Committee, a collaboration between the Departments of Employees and Organisational
Development, Health and Communications focused
on mental health and well -being under the theme
“Nurturing the whole Self.”
The whole self encompasses mental health,
physical health, social health and emotional health.
When we stop and take the time to care for our whole
selves, mentally, physically, socially and emotionally,
we reduce our stress levels and boost our self -esteem
which generally makes us feel better and happier. When we take better care of our whole self, we can
perform better and help the people we love.
The Virgin Pulse Go, or VPGO, programme
provided employees with a holistic health and well -
being journey at work and beyond by empowering,
inspiring and engaging them to make small achievable
changes in their regular routine. Over 600 government
employees accessed the evidence- based t ools and
resources that support their health and well -being.
Employees made substantive gains in the areas of
physical activity, nutrition and well -being. The 2023/24
budget estimate for the Nutrition Services business
unit 32110 on page B -154, is $202,000.
Nutrition Services is both a sub- programme of
Community Health and a sub- programme of the
Health Promotion and Wellness unit because there is
both a clinical component, namely infants that are fai ling to thrive, and a population- based component. N utrition Services is committed to providing sustainable
nutrition community programmes to connect, engage and strengthen the community’s awareness of strat egies to improve healthier lifestyles and healthier eat-ing.
In 2022/23 Nutrition Services was incorp orated wholly into the Health Promotion unit with just


Bermuda House of Assembly one nutritionist/dietician. In 2023/24 this sub -
programme will be refortified with two officers reflec ting the Ministry’s renewed emphasis on health prom otion and prevention. This accounts for part of the department’s increase in funding for the upcoming fiscal year.
This year Nutrition Services partnered with the
Grow, Eat, $ave workshop, Department of Parks, local judges, non- governmental agencies and sponsors to
present the Bermuda Parish Gardening Compet ition.
The project aimed to encourage gardening in each parish inclusive of any skill level, garden size or ind ividual or group submissions. Engagement in this
competition celebrated the excellence of gardening,
recognised the passion of growing food, and works
toward sustainability. Sixty -four persons entered the
competition with 34 successfully completing submi ssions for awards. Participants included submissions
from all nine parishes and 13 schools.
The Grow, Eat, $ave programme continues in
partnership with facilitator Chaplain Santucci, the
Bermuda Agriculture Group, community volunteers and sponsors. Participation remains high as members
of the community seek sustainable food opportunities
and alternatives to feed themselves and their families.
In 202 2 the Grow, Eat, $ave programme had
48 graduates who completed eight weeks of virtual
classes and participated in five months of practice
planting sessions to gain practical experience and
skills. The original number of registrants was 98 persons showing t he ongoing demand for this pr ogramme and the desire to gain knowledge and skills
to successfully cultivate affordable nutritious food.
Performance measures indicate 68 per cent
increased consumption of five servings of fruits and
vegetables, the minimal s ervings known to reduce
certain health risks by participants. Growing your own foods means healthier diets. The gardening extension
class had 63 persons register in the first three months
of virtual classes on gardening topics put in place to
support graduates. The February 2023 class currently
has 45 persons registered for the Grow, Eat, $ave
gardening sessions to be completed in April. The Grow, Eat, $ave programme and the Bermuda Parish
Gardening Competition will feature again in 2023/24.
Another Health Promotion and Wellness acti vity is the Complete Health Improvement Programme
(or CHIP). The first session held in June 2022 had 11
graduates from 17 persons enrolled. The second session in October 2022 had 13 graduates out of the 19
enrolled. For the second session, group improv ements included weight loss, waistline inches lost, decreased blood sugar and decreased cholesterol. Performance measures indicate 100 per cent increased
consumption of five servings of fruit and vegetables
for all participants.
The Nutrition sub- programme is partnering
with the Department of Statistics . . . the Department
of Financial Assistance in updating the food cost est i-mates for the lifespan of infancy to adulthood inclusive
of pregnancy. Nutritionists have been attending the supply chain meetings under the leadership of Mr.
Dean Rubai ne for consultation regarding any risk of
food shortages. Recommendations from these food
security meetings highlights the need for local sustainable food strategies supportive of a contingency
plan as global issues continue to impact quality, qua ntity, availability and affordability of the imported food
supply.

Comprehensive School Health

Hon. Kim N. Wilson: Mr. Chairman, the 2023/24
budget estimate for the Comprehensive School Health, aka Heal thy Schools business unit, is located
at page B -155, business unit 32265, and it represents
a $124,000 budget. This budget figure reflects the decision to have Healthy Schools as a separate bus iness unit rather than as part of the business units of the Department of Health, and accounts for the funding line item in the Budget Book.
Healthy Schools promotes health in schools
through such government departments as Education,
the National Drug Control and Mirrors, community
health partners including the Bermuda Diabetes A ssociation, the Bermuda Cancer and Health, the Ber-muda Underwater Exploration Institute, and the D epartment of Health school -based programmes such as
child and school health, nutrition services, oral health,
community rehabilitation services, and environmental
health. Healthy Schools has 10 components of health and has been adopted by 31 of the 33 public and pr ivate schools since 2007.
In compliance with the school nutrition policy,
the Healthy Schools team is working more closely with
the Department of Education to limit all fast -food deliveries to schools for any reason and food- focused
fundraisers to no more than once per month in
schools. Healthy Schools has provided schools with
recommendations for non- food fundraisers. All but
one public school has a bottle- filling station, making
fresh, clean water the easiest choice. All private schools have filtered water systems and/or bottlefilling stations.
Healthy Schools promotes a healthy lifestyle
assembly in as many schools and camps as possible
that includes discussions about the importance of
adopting and maintaining healthy habits. In 2023/24
Healthy Schools will continue to work with the D epartment of Education’s curriculum officer for Physical
Education and Health to improve the completion of the
fitness ground assessments for P5 to S4 students in
terms 1 and 3. The purpose is to help students understand their own health- related fitness.
Healthy Schools and the Department of Education’s Facilities Manager, along with Environmental Health, will carry on working closely with school custodians and cleaning companies that clean schools to
588 1 March 2023 Official Hansard Report

Bermuda House of Assembly raise schools’ environmental cleansing standards
through frequent cleanliness inspections. In addition,
since 2020 Healthy Schools has been working with
publi c and private schools to ensure optimum env ironmental health in schools by having schools reduce
clutter in classrooms and other schools areas and i mprove compliance with the Bermuda School Asthma
Policy.
Finally, Mr. Chairman, Healthy Schools has
been coordinating out -of-school camps during all
school breaks and after school programmes through
the school year since the summer of 2021, providing
public health updates and visiting camps to conduct
surveillance and monitor safety and health standards
in camps.

Child Health Regulations

Hon. Kim N. Wilson: Mr. Chairman, under business
line 32290, Child Health Regulations, the 2023/24 budget estimate is found on page B -255, and that
budget provided for this unit will be $308,000.
Over the last fiscal year all eligible child care
providers (or CCPs), those caring for a maximum of
three children in a home setting, underwent the
STARS inspection. The results were posted on the
government website to educate the public and to i ncrease transparency. The majority of child care pr oviders met or exceeded the minimal standard recei ving three stars, which is satisfactory, four stars is very
good, and five stars is excellent.
Day care centres, that is, nursery schools, Mr.
Chairman, also underwent their pilot STARS inspection in preparation for their full STARS inspection
which will take place in 2022 [sic] again the majority of
day care centres met or exceeded the minimal stand-ard. Day care centres and child care providers that did
not meet the minimal standard were given additional
monitoring and support or placed on a provisional l icence if warranted. While some centres have readily
made the needed improvements, a small number of
day care centres remain provisionally licensed and
are displaying provisional licences in th eir premises
until matters are fully remedied. This STARS inspection tool is comprehensive and allows the officers to
evaluate aspects of child care while providing support and guidance throughout the process.
To support the child care providers as well as
the day care centres, quarterly meetings are held to strengthen the lines of communication and provide
updates and support related to the inspection process.
These meetings also afford the providers the opportunity to offer feedback and make recommendati ons
related to the inspection process. In fact, one of those
meetings took place last evening, Mr. Chairman.
There is ongoing collaboration between the
Child Care Regulation education officer, the Bermuda College and the Department of Education to reintr oduce the child care certificate in the year ahead. Until such time as the course becomes available on Island,
the education officer has researched and shared vi able online options for those seeking education in the
field. In addition, the education officer provided pr ofessional development opportunities and training to
providers. And this ends my remarks with respect to
section 2205 Administration.

Community Health

Hon. Kim N. Wilson: Turning now to Community
Health. Mr. Chairman, the Department of Healt h section 2201, Community Health, found on page B -154 of
the Budget Book comprises 13 business units and has a 2023/24 estimated budget of $22,282,000.
Line item 23010, Child Health. Mr. Chairman,
the 2023/24 budget estimate for Child Health, listed, again, at line item 32030 on page B -154 is
$2,927,000. The Child Health budget in 2023/24 will
increase by $263,000. The largest contributors to this
increase are rising costs of shipping and medical supplies and vaccines, which represents $145,000. Funds have also been allocated for contractors at $91,000
who are working to digiti se paper -based immunisation
records and helping to enhance school surveillance, which is a beneficial legacy from the COVID -19 pa ndemic.
Mr. Chairman, the Child Health unit consists
of four sections: Immunisation, Child Health, School
Health, including Asthma Education, and Travel
Health. These sections provide preventive and cur ative health services for infants, children, adolescents,
adults, seniors and the traveling public. These ar e
conducted through various clinics, schools and com-munity settings. Services include health and developmental assessments, screenings, referrals, treatment
of minor ailments, health education, health promotion, anticipatory guidance, adult and seniors’ im munis ations and travel consultation for travel to high- risk ar eas.
Bermuda’s expanded programme of immunisation plans for the needs of vaccines in the child and
adult schedules. So, again, Mr. Chairman, expanded
programme of immunisation which is EPI.
EPI procures most of its vaccines through the
Pan American Health Organization’s revolving fund. This process assures safe, effective and quality vaccines. Universal access for many of the vaccines is
provided through the public and private sectors.
Mr. Chai rman, all of the sections in Child
Health, 32030, were impacted by [human] resource
reallocation in response to the COVID -19 pandemic.
However, due to the relaxation of the COVID -19 pr otections and the expiration of the public health emer-gency order, most of the reassigned members have
returned or transitioned back to their previous roles
with some taking up leadership positions.
The focus of all team members within all sectors is to re- engage with their clients and recommence


Bermuda House of Assembly services with an emphasis on m ental health and s ocial well- being. Some staff continued to support poor
health and long- term care to strengthen the gaps that
had been identified during COVID -19.
Data on immunisation coverage shows a level
of 86 per cent for two- year olds, a decrease of 2 per
cent from the previous year. Despite challenges with
the physical structure at the Hamilton Health Clinic,
the team continues to provide adequate services to
our clients and the community.
Vaccine hesitancy remains a challenge and
the Child Health team is working on strategies to pr ovide the community with education relating to vaccine
preventable diseases. Persons continue to question
the administration of all routine vaccines. In 2023/24 the vaccine hesitancy strategy of 2022– 26 will be r eigniting activities along with launching the Healthy
Bermuda BDA app, tentatively set for April 2023 during the vaccination week of the American celebr ations. The staff continues to work diligently with clients
on catch- up immunisations for their children.
Expanded programmes and immunisation, or
EPI: Mr. Chairman, EPI training is conducted annually
by healthcare professionals in the public, private and
institutional settings and allied partners. Data from the
2022 a nnual flu express indicated that 1,340 doses of
the flu vaccine were administered from the eastern,
central and western areas of the Island. Cl ients were
able to register and make online payments. So this was essentially a paperless initiative in colla boration
with the Information and Digital Technology Team.
The flu vaccine was administered in all of our clinics with a distribution to long- term care facilities and the
private sector.
During our Flu Express collaboration was pr ovided from various sectors of the community. The
Bermuda Immunisation Information System continues
to convert historical and current paper childhood i mmunisation records into digital form. Electronic I mmunisation Registration continues to be used for the
documentation of all vaccines in our clinics and in
long-term care facilities.
Mr. Chairman, the health visitors working in
the Child Health unit have completed contact with
90 per cent of all parents of newborns and 85 per cent
of new mothers were screened for maternal well -being
at six weeks. These were done primarily via telephone
due to the high- risk COVID -19 restrictions and limited
staff availability due to reassignment. As of September 2022, 60 per cent of health visitors are working
within the unit and have restarted home visits for all targeted services, including six weeks .
The department’s health visitors play a critical
role in providing services for all families with children
under five years of age. They are considered key
stakeholders in providing input into Care Pathways for the First 1,000 Days initiative. Child pro tection and
safeguarding remain a key focus. A health visitor re presentative has been earmarked for the Safe Lives Train the Trainer course of child safeguarding and
national safeguarding strategies.
Mr. Chairman, the School Health programme
continues to be challenged with human resource i ssues, and just 15 per cent of schools health and development assessments were realised in this fiscal
year. Of the screenings conducted, 33 per cent, or 86,
of five -year-olds were identified as overweight or
obese. Whils t this data is based only on a portion of
the cohort, approximately 52 per cent, or 257, of the
target population, it is concerning. Factors contributing
to these findings include diet, screen time, lack of
physical activity, and a lack of health checks. A ddressing mental health and well -being for families of
the school -age population has and will continue to
remain a priority.
The School Asthma Education programme
and its services were disrupted by the pandemic. However, every effort is being made to recom mence
this work that pre- pandemic was conducted by a D epartment of Health nurse assigned solely to this specialist role of asthma nurse.
Travel health was negatively affected by global travel restrictions. However, since travel restrictions
have been relax ed locally and abroad, the d epartment
has seen a marked increase in people travelling.
There were approximately 743 travel consultations
conducted in 2022, compared with 106 in 2021. Consultations on travel provide education on water -, foodand vector -borne illness prevention to reduce the risk
of Bermuda’s residents returning with infectious di seases.

Physiotherapy and Occupational Therapy

Hon. Kim N. Wilson: Mr. Chairman, the 2023/24
budget estimates for Physiotherapy, business unit
32080 and Occupatio nal Therapy 32120, both on
page B -154 are $1,128,000 and $1,016,000, respectively.
Mr. Chairman, the remit of the Community
Rehabilitation Services Occupational Therapy [OT]
and Physiotherapy [PT] services is to maximise the
functional potential of indivi duals with delays in normal
motor development or with physical movement challenges. This rehabilitation service, which spans the
age spectrum, is split into three teams: early interve ntion, school -based paediatric therapy, and seniors.
The staff is compri sed of nine registered occupational therapists, eight registered physiother apists, one coordinator, and one team secretary that is
also shared with the Speech and Language Pathology
service . There are currently two vacant posts in phy siotherapy, and one vacant post in occupational ther apy which are being covered by temporary relief staff while the department undertakes recruitment. In add ition, a trainee physiotherapist will fill one of the vacant
positions with the intent to develop Bermudians early
590 1 March 2023 Official Hansard Report

Bermuda House of Assembly in the ir career and strengthen Bermuda’s healthcare
workforce.
The rehabilitation service continues to build
back from the impact of the pandemic. Staff redeployed to assist in the COVID -19 response have all
returned to their permanent posts. The COVID -19
pandem ic highlighted the benefits of using tele- health,
and we continue to leverage this tool to improve ac-cess to care, improve the flexibility of scheduling, r educe travel time and increase continuity of care. As the healthcare landscape has continued to evolv e, the
OT and PT services have adapted and strive towards
delivering quality evidence- based services to our
community.
Mr. Chairman, within the early intervention
team dedicated specialists, OTs and PTs provide ear-ly intervention for babies and young chil dren between
the ages of 0- 4 at risk of developmental delays and/or
disability. The OT and PT early intervention service
aims to complete a full assessment on referred clients
within 20 working days to ensure the appropriate i ntervention is provided and mi tigate any delays in functioning. Approximately 62 per cent of clients were assessed within the established timeframe this fiscal
year and an estimated 90 per cent of clients on the
caseload were making steady progress towards established goals.
Assessmen t clinics take place weekly to
quickly identify and provide interventions for babies and young children at high risk of sensory motor delays to facilitate optimum function and quality of life. In
addition, parent multi -disciplinary training sessions
were delivered throughout the year in the community.
It must be noted, Mr. Chairman, that these interventions continue to reduce the number of referrals sent
by the early intervention teams to school -based services. They also empower parents with knowledge
and s trategies to promote optimal development for
their children.
The school -based paediatric team aims to i ncrease early recognition of developmental delays and
provide a more equitable service for school -age chi ldren with sensory motor delays throughout the year
and not just during the school term. It must also be
noted that school -aged children with additional lear ning needs due to complex health conditions and/or
sensory motor delays require regular monitoring and
intervention to retain their functionality, ability, and to
access education. During the current fiscal year, the
team successfully conducted sensory motor screening
for each child entering Primary 1 in the government
system. Services were also provided to summer camps for children with complex medical needs, such
as, WindReach and Dame Marjorie Bean Hope Academy, to help prevent regression of skills attained
throughout the school year.
Mr. Chairman, the OT and PT school -based
service aims to complete a full assessment on r eferred clients within 20 working days. Approximately 71 per cent of referrals received were assessed within
the established timeframe and an estimated 89 per
cent of school -aged clients on caseload were making
progress towards established goals.
The OT and PT seniors’ team aims to support
clients to remain as independent as possible in their
own homes. The seniors’ team conducts home safety
and falls risk assessments for all seniors that are r eferred to minimise the risk of falls at home. In 2022/23
client and caregiver training were provided to maxi mise function and promote ageing in place. In addition,
several health promotion education activities were
conducted to further educate and promote healthy
ageing within our community. The OT and PT seniors’- based service aims to compl ete a full asses sment on referred clients within 20 working days. A pproximately 89 per cent of referrals received were assessed within the established timeframes and an estimated 83 per cent of clients on caseload were ma king progress towards established goals.

Speech and Language Services

Hon. Kim N. Wilson: Mr. Chairman, the 2023/24
budget estimate for Speech and Language Services is
listed at business unit 32100 on page B -154 is
$1,688,000.
Mr. Chairman, the Department of Health’s
Speech and Language Programme provides speech,
language and feeding/swallowing assessments and
intervention services across the community. When
fully staffed the programme consists of 14 speech and
language pathologists [SLPs] and one programme
coordinator. Of these, three s peech and language
pathologists provide early intervention services in col-laboration with the Department of Education’s Child
Development Programme for children aged from birth to four to five years of age. Eight speech and language pathologists are school based, providing services across all levels of the Bermuda Government Schools (from ages 4 to 18).
One SLP provides services to students with
special needs who attend Dame Marjorie Bean Hope Academy (which has children between the ages of 4
to 18), and one SLP provides school -based activities
to students who attend Bermuda’s private schools and
home schools. Three posts were vacant in 2022/23
and recruitment is underway with a view to increasing
staffing for this critical service in this upcoming fiscal
year 2023/24.
Mr. Chairman, speech and language
pathologists work closely with parents, school person-nel, allied health professionals in private homes and
clinic settings to raise awareness of speech and la nguage delays and disorders, to promote functional
communication skills, as well as to prevent lifethreatening complications that may occur during eat-ing and swallowing. Speech and Language Pathology
therapy services include the provision of prevention


Bermuda House of Assembly and promotion information, screenings and asses sment s, consultations, as well as intervention. Objectives are measured in terms of provision of timely and
responsive assessments. Services also include the
delivery and provision of treatment for those identified as needing intervention. Client improvement, t hat is
the effectiveness of treatment, is measured by reduction in the severity of the communication or swallo wing challenges.
Unfortunately, this year the waitlist numbers
for early intervention services have markedly i ncreased and additional speech and language
pathologist services have had to be retained to meet the demand. While current programme time guidelines
aim to provide an initial assessment for young children within three months of initial referral, the average wait
time for an assessment is no w running between six
months to nine months. Obviously, this is sub- optimal.
But the team is confident that the first 1,000 days pr oject underway can shed some light on these trends
and make recommendations so that we can not only better meet the needs of services of our infants, but
also have insight into the risk factors that need to be
controlled to reduce the demand for service.
In 2022/23 there were 67 cases referred to
the school -based programme. Fortunately, all st udents who were referred received an initial asses sment within the programmes time guidelines of 35
working days. Once identified as needing services,
clients are provided with therapy intervention. Currently, there are no school -based students on a waitlist.
Clients are reassessed on a routine basis to assess
their status and to measure progress. This also serves as an indicator to determine if services are still nee ded.
Mr. Chairman, a combined 341 cases were
followed for intervention by Speech and Language Services this year. Caseloads v ary between 40 and
68 clients per officer. Services to middle and senior schools have been adapted to be provided through a
consultative model where the therapists provide
school personnel and parents the appropriate r esources and strategies for clients wi th complimentary
direct services. Services were also provided to Dame
Marjorie Bean Hope Academy.
Mr. Chairman, the 2023/24 budget estimates
for community health [nursing] , listed at business unit
32060, and community health administration listed at busin ess unit 32010 both at page B -154, represent a
budget in the sum of $1,723,000 and $1,215,000 r espectively.
Community health nursing budget in 2023/24
will increase by $185,000. The largest contributors to
this increase are additional funds for the licenc e for
the electronic medical records for clients, medical
supplies and funding to ensure the enhanced oper ation of the adult preventative clinic with a nurse pract itioner on staff. Adult community nursing works in partnership
with other health and care pr oviders to meet client
needs, offering support, health education information,
and advice. Our community health workers are a valuable part of the skill mix. The team is committed to providing a high standard of professional care to individuals within the c ommunity setting and, importantly,
facilitate people being cared for in their homes. Care
is patient centred and evidence based.
The department’s adult preventative clinic is
designed to support and reduce stress while increas-ing capacity, educating indiv iduals and families, and
providing life skills to enable healthy living practices.
The adult health clinic has increased its capacity by
extending its hours and is seeing 60 per cent more
patients than it did in previous years , efficiently hel ping and supporting individuals who are uninsured and underinsured and cannot afford their co- payments.
Throughout 2022 there were 46 adult preve ntative health clinics held, and 206 clients were supported with their health needs. Additionally, the team
held nine COVID -19 clinics and administered 154
COVID -19 vaccines. The team did approximately 80
home visits, servicing around 116 clients to directly
administer COVID -19 and influenza vaccines to
homebound persons within the community.
While the community health nursing services
team is not fully staffed at present, and, yes, there is a worldwide shortage of nurses partly due to the pa ndemic, there is concerted work in progress to speed
up the recruitment process. This is in conjunction with
plans to strategically address succession and reten-tion of staff. Bermuda’s ageing population will demand
health workforce planning at a new level so that care
in the community is sustained and improved.
Mr. Chairman, funding for these two areas of
health care not only assists in addressing the comm unity’s social determinate of health, but also builds partnerships in collaborative working and promotes healthy living and preventative care in Bermuda’s
community. We are truly promoting healthy people in
a healthy community.
Mr. Chairm an, the community health admi nistration unit consists of administration support and
health education. These services provide administr ative support for the programmes operating in the main
Hamilton health centres as well as the satellite clinics.
Preventat ive and curative services include: child,
school, travel, immunisation, community, sexual and
reproductive health, nutrition, clinical laboratory, rehabilitation, speech and language, as well as two long-term care facilities, vaccine storage, medical, offi ce
supplies and logistics. The programme assures conditions in which the facility can operate safely, effectiv ely and efficiently for clients and staff.
Mr. Chairman, challenges associated with the
Bermuda Health Clinic’s water, which caused staff to
be relocated, brought considerable disruption and di splacement to the programme and services during
592 1 March 2023 Official Hansard Report

Bermuda House of Assembly 2022. The Warwick satellite clinic served as the main
alternative site for other clinical services from April to
September before a new venue was secured. The
transition to the third floor of Reid Hall, which is 3 Reid
Street, Hamilton, has positively impacted service users and staff. Work commenced at the Hamilton
Health Centre to rectify the issue and completion is
expected in the first half of 2023/24.
Also, a redesign and a facility modernisation
for the Mangrove Bay C linic received Planning permission and capital funding that will be available in the
upcoming budget year to proceed with the building
permit , construction drawings and tendering process.
The rel ocation and construction work were a collaborative effort across ministries and between depar tments. The services being provided at the Mangrove Bay Clinic will include oral health services, well baby
visits, including child immunisation and healthy devel-opment checks, physiotherapy, occupational therapy
and speech language pathology assessments and
services, sexual and reproductive services, adult wel lness clinics, and integrated mental health services,
which will be in partnership with MWI.
Overall, much of the effort of the unit revolved
around managing client and staff expectations, int egrating staff returned to programmes in the post -
pandemic era and managing relocations due to facility
issues.
Mr. Chairman, there were notable efforts
made within the social work team, including 94 additional new referrals, of which 67 per cent, or a number
of 63, were successfully navigated through the care
and health system for services or support for unmet needs. Such needs include, but are not limited to ,
mental healt h or addiction counselling, food and medical treatment. Of those discharged, 95 per cent described an overall satisfaction with the service. Sup-port services and advocacy were provided to connect
persons and families with resources to help meet their
needs . There were a total of 956 events which inclu ded home visits, individual and family meetings, and
collaboration and correspondence with other agencies, such as Ageing and Disability Services.
There have been continued efforts to improve
the department’s long -term care referral process for
the long- term care nursing home. Community outreach realised 85 per cent of client referrals for the
social worker within 72 hours. The main reasons for
referrals were as follows: financial (meaning the pe rson having ins ufficient funds to meet needs including
ability to purchase medication), nursing and homecare
needs, both long- term and residential care, and inhome care needs and housing needs.
Despite the challenges, staff persevered and
are to be commended. The Minis try recognised that
there is a need to invest in modernisation and we will continue to work with relevant government depar tments to plan for our future and excel in our service delivery. Perhaps less well recognised is the need to also invest in the emotional well -being of staff in r esponse to the major facility impediment —post -COVID -
19 burnout and ongoing staff shortages.
The 2023/24 budget for Sexual and Repr oductive Health, listed at business unit 32040 on page B-154 of the Budget Book is $932,000.
Mr. Chairman, the Sexual and Reproductive
Health programme consists of two subprogrammes: the Communicable Diseases programme and the Maternal Health and Family Planning Clinic programme.
The programmes aim to reduce unintended pregna ncy and sexually transmit ted infection rates, including
HIV by continually improving access to high quality
services, screening, education, and health promotion
counselling and referral services.
Mr. Chairman, in order to reach these goals
and strengthen community led responses, the pr ogramme has developed strong collaborative links with
many community based agencies, like the Bermuda
Assessment and Referral Centre [BARC], the Centre
Against Abuse Home (which is a charity for the hom eless), Turning Point, STAR (which is also refer red to
as Lighthouse), Harbour Light and focused charities for substance abuse and HIV, as well as the Salvation
Army. Partnering with other organisations can offer
innovative ways to reach our communities and
strengthen sexual health services. There is al so
strong collaboration with obstetricians to provide antenatal care and safe delivery for under - and uni nsured women.
Mr. Chairman, in 2023/24 [sic] a total of
83.6 per cent of pregnant women attending the clinic
received three or more antenatal appointm ents. Ev idence suggests more antenatal contact with profes-sionals is associated with greater maternal satisfaction and reduces perinatal mortality (and this is from
the World Health Organization). The maternity benefit, which was introduced on 1 November 2021, assists
antenatal clients with payment to their assigned O BGYN. Other components of sexual and reproductive
health services include immunisations for antenatal
clients, cancer preventing and health screenings for
males and females.
The number of people compliant with treatment for HIV infection remains high at 98 per cent, an
important factor in preventing AIDS, prolonging survival and reducing the risk of transmission of HIV to
others. The programmes managed service delivery so
as to reduce the risk of COVID -19 transmission during
the pandemic in clinics , managed staffing reduction
and testing , and maintained a focus on urgent and
symptomatic sexually transmitted infections, present ations and those at high risk of HIV for sexually transmitted infectio n acquisition.
In addition, services for family planning, cancer screening and antenatal continued uninterrupted.
As COVID -19 restrictions eased, the number of clients
screening for sexually transmitted infections increased
by 269 in comparison to the prev ious year. With high


Bermuda House of Assembly sexually transmitted infections prevalent in young
people, testing, treatment and health education and
counselling remained targeted to this population. The
team works in partnership with and refers clients to
Teen Haven, Child and Fam ily Services, to provide
extra support.
The Sexual Assault Response Team, or
SART, recently reconvened to review collaborative efforts. SART is supported by Sexual and Reproductive Health Services through coordination during the
investigative process. A t eam approach assists pr ofessionals to provide an immediate, quality victim centred response to sexual assaults in the community. As
mentioned previously, Mr. Chairman, funding for
SART will be provided by a grant from the Ministry Headquarters in 2023/24.
The Sexual and Reproductive Team will start
a new initiative in March which will see male and f emale clients between the ages of 18 and 26 being offered the HPV vaccine. Human Papilloma Virus can
cause certain cancers in both men and women and is a common sexually transmitted infection. Research
has shown that HPV vaccines can prevent more than 90 per cent of oral, anal and genital cancers caused
by HPV infection from ever developing. To address
the needs of the community in St. George’s, sexual
and reproductive health continues to offer antenatal care, family planning, sexual health screening, cerv ical cancer and breast examinations.
Mr. Chairman, the Community Mental Health
Wellbeing programme restarted in December at the
Reid Street location. The services were suspended
due to the facility closure at the Hamilton Health Ce ntre and an inability to accommodate in an alternative
site where services were offered. Despite challenges
with human resources and facilities, the team conti nued to provide a much- valued service. A community
mental health team is critical to meeting the demand for mental health care in Bermuda filling the gaps
when individuals are unable to obtain treatment from
private providers. The community mental health team
is focused on helping i ndividuals contend with the
challenges in their mental health.
Mr. Chairman, the 2023/24 budget estimate
for the Clinical Laboratory listed at line item 32090 on
page B -154 of the Budget Book represents the sum of
$787,000. This comprises the government c linical l aboratory and the Bermuda Molecular Diagnostic and
Research Laboratory [MDL]. The incorporation of
MDL to the Department of Health’s established clinical
laboratory business unit accounts for the increase of
$519,000, which is listed in the Budget Book.
Mr. Chairman, the government clinical labor atory is a COLA ( which is Commission of Office Laboratory Accreditation) accredited laboratory situated
at the Hamilton Health Centre. The government clini-cal laboratory supports the programmes within the
clinic, such as maternal health and family planning, the communicable disease clinic, the adult health pr ogramme, child health and oral health as needed.
The clinical laboratory also serves as the public health clinical laboratory for Bermuda, assisting
with outbreak investigation and public health emergencies. The clinical laboratory provides specimen
referrals for highly infectious organisms that cannot be
tested locally. Transportation of specimens to the Caribbean Public Health Agency [CARPHA] Laboratory,
or the UK Health and Safety Agency Laboratory can
be arranged for advanced testing of diseases which have major public health significance.
The government clinical laboratory continues
to focus on microbiology testing while continuing m olecular testing for sexually transmitted infections, such
as gonorrhoea or chlamydia. The laboratory will continue to participate in annual projects, such as antim icrobial resistant surveillance. Antimicrobial resistance
is a global threat that requires much attention and collaboration with several sectors in the public health
system.
The government clinical laboratory continues
to enrol in proficiency testing as a quality assurance measure providing competency and assessing the
capabilities of all who work within the l aboratory.
Mr. Chairman, the government’s Bermuda
Molecular Diagnostic and Research Laboratory is also
pursuing COLA accreditation and is enrolled in an i nternational programme of proficiency testing as a
quality assurance measure. The molecular laborator y
continues to provide routine screening of COVID -19
for high- risk clients, such as dialysis patients and care
homes across the Island. The molecular laboratory has supported the Island in testing for COVID -19 and
is now preparing to provide other screening for infec-tious diseases which will assist with the implement ation of public health measures when required.
Mr. Chairman, the government’s molecular l aboratory is expanding testing for programmes such as
maternal health and family planning, the communic able disease clinic, the adult health programme and
child health using an immunoassay analyser. The
government’s Bermuda Molecular Diagnostic and R esearch Laboratory may also expand local testing for wastewater surveillance. The scoping of work is now underw ay. Along with other data wastewater survei llance can provide early warnings of potential public
health threats which will require action.
The molecular laboratory will continue to assist with gnomic sequencing which informs major
stakeholders of the vari ants of infectious diseases
circulating amongst the population. Unit 3200—

Minister, is this a convenient place to
pause? Or do you want to take us through to another
point in your brief?

Hon. Kim N. Wilson: It may be a convenient —

594 1 March 2023 Official Hansard Report

Bermuda House of Assembly The Cha irman: I am in your hands if you want to continue on.

Hon. Kim N. Wilson: I am moving on to a different
line item —

Perfect. If that’s convenient for you.
Honourable Members and members of the
listening public, we are in Committee of Supply for
further consideration of the Estimates of Revenue and
Expenditure for 2023/24. This is the debate on the budget for the Ministry of Health and we are hearing
from the Honourable Kim Wilson.
Thank you, Minister.
Deputy Premier, will you now please take us
to lunch?

Hon. Walter H. Roban: Thank you, Mr. Chairman.
I move that we adjourn for lunch until 2:00 pm.

Good afternoon, Honourable Members and the listening public.
We are now in the Committee of Supply for
further considering of the Est imates and Revenue and
Expenditure for the year 2023/24, Head 22. We are
now going to debate it.
I call upon the Minister in charge to proceed.
Minister, you have the floor.

COMMITTEE OF SUPPLY

ESTIMATES OF REVENUE AND EXPENDITURE
FOR THE YEAR 2023/24

MINISTRY OF HEALTH

HEAD 22 —DEPARTMENT OF HEALTH

[Continuing]

Hon. Kim N. Wilson: Thank you and good afternoon,
Mr. Chairman.
Mr. Chairman, prior to the break I was just
about to commence business unit 32000, again, with
respect to Head 22, Department of Health. And this
relates specifically to Lefroy [House] Care Community and business unit 32015, Sylvia Richardson Care F acility. Mr. Chairman, the Department of Health operates two exemplary long- term care facilities, the
Sylvia Richardson Care Facili ty in St. George’s and
the Lefroy House Care Community in Somerset Par-ish, the holders of the Cup Match Cup.

[Inaudible interjections]

Hon. Kim N. Wilson: The 2023/24 budget estimate
for Lefroy House Care Community is listed as bus iness item 32000. I in vite you to turn to page B -154,
Mr. Chairman, and the budget for the Lefroy House
Care Community is $4,867,000. The 2023/24 budget
estimate for the Sylvia Richardson Care Facility listed
as business item 32015, again on page B -154, is
$5,713,000.
Mr. Chai rman, both facilities provide care and
promote independence and optimal health for persons
aged 65 years and over, who have significant nursing
and care home needs requiring 24- hour facility -based
care. The two facilities are residential care communities, providing comprehensive medical , nursing, env ironmental, and recreational services to the resident,
respite care elders. Our aim is to maintain and i mprove quality of life for elders and their loved ones. At both facilities, due to the pandemic, day care s ervices
were suspended. S hort-term respite care admissions
have resumed at the Sylvia Richardson. Both facilities
allow visitors with COVID -19 precautions in place.
Throughout the pandemic essential visitors and outside visits were permitted. Residents and staff conti nue to undergo regular COVID -19 screening and tes ting as required. Voluntary vaccinations and boosters
for those who consent has continued.
Demand for nursing beds continues to very
much exceed capacity. Sylvia Richardson and Lefroy
House work along with Ageing and Disability Services,
Community Health, and the Department of Health, as
well as the Bermuda Hospitals Board social work team to prioritise and fill the vacant beds as they become available. Internal projects are underway at
Lefroy Ho use to provide and/or improve the recreational area for elders and to optimise the current
space. Work has commenced to replace the roof and
address other much needed internal renovations to
the kitchen, dining and storage areas, including a new
staff lounge. Construction in these areas will continue
into the 2023/24 budget year.
As Lefroy House is an old facility, that community has faced many structural challenges. General
repairs and maintenance occur on a regular basis in
order to maintain a safe and c omfortable environment
for our resident elders and staff. However, an alternative will be needed. Plans to build a new Lefroy House
at a new location were mothballed during the pandem-ic, but in 2023/24 those plans are being revisited by
the Department of H ealth. Lefroy House was also i mpacted by staff retirements and resignations leading to


Bermuda House of Assembly an increased use of overtime to maintain safe staffing
levels.
This ends my presentation on the business
units of section 2201, Community Health.

Oral Health

Hon. Ki m N. Wilson: Turning now to Oral Health, Mr.
Chairman. The 2023/24 budget estimate for the D epartment of Health, Oral Health section 2202, is
$1,492,000. It comprises the business units of 32150, Oral Health Control; 32155, Oral Health Administr ation; and 32160, Oral Health Prevention. These can
be located in the Budget Book, Mr. Chairman, at page
B-155.
Mr. Chairman, the Oral Health section pr ovides comprehensive public health dental services to Bermuda’s children ages 0 to 18 years of age and
seniors age d 65 years and older. Our service is based
on high quality patient -centred care, including dental
examinations, consultations, preventative and dental
hygiene appointments, as well as a range of restor ative clinical treatments including extractions and fil lings. There is an overall strong emphasis on prevention and working with our community. We also offer
emergency service during regular working hours.
The school -based programmes are an essential part of the Oral Health Section’s service. Oral health education is offered to our school children and
a school -based fluoride supplementation programme
for children aged 6 months up to 11 years of age.
This ends my remarks with respect to section
2202, entitled Oral Health.

Central Laboratory

Hon. Kim N. W ilson: The 2023/24 budget estimates
for the Department of Health’s Central Laboratory section, which is 2204, are listed as business units
32200, Forensic Analysis; and 32220, Water and
Food Analysis. Both of these heads can be located on
page B -155.
The estimates are $741,000 and $559,000,
respectively, for a total of $1,300,000. Central Labor atory budgets in 2023/24 will increase by $28,000. The
largest drivers for this increase, Mr. Chairman, are additional funds for laboratory supplies, import duties,
preventative maintenance contracts for equipment
and increased electricity bills.
Mr. Chairman, the Central Government L aboratory [CGL] provides a wide range of analytical
services divided between two programmes; namely, the Forensic programme and the Foo d and Water
programme. The Forensic programme performs
seized drug and toxicology analysis. The drug cases
submitted to the laboratory have been increasingly complex, in addition to an increased number of items
associated with each case. This has been as a result of increased submissions due to several successful
police raids.
There is an increase in the number of cannabis-derived products in the form of cosmetics and
male enhancements. And there has also been an i ncrease in cases containing the newest for m of THC;
namely, Delta- 8 THC. While Delta -8 THC is considerably less potent than Delta- 9 THC, it must be noted
that scientifically it has been shown to have psychoactive properties on the body and should not be co nsidered a safe alternative.
Additionall y, there has been an increase in
powder submissions which contain unusual mixtures
of cocaine, heroin and fentanyl. The varying forms of
products, together with the differing types of co mpounds, has put an increased demand on the labor atory as the analysis for these items is more time consuming and complex. It should also be noted that the
powder mixture of cocaine, heroin and fentanyl is a
very worrying trend and public health threat. It is unlikely that it is in the intention of users to ingest this
type of drug mixture and they would therefore not be
prepared for the potentially lethal outcome that could
result from ingesting this type of cocktail of drugs.
Mr. Chairman, toxicology analysis is performed on coroner’s cases, cases of driving under the
influence, and urine analysis for stakeholder agencies.
The compounds that are routinely tested for are the
common drugs of abuse in Bermuda, which include
cannabis, cocaine, heroin, ecstasy and fentanyl.
There has been a steady year on year increase of
cases submitted to the laboratory and this year has
been no different. The 2022/23 year saw an increase
of 16 per cent in the number of cases submitted to the
laboratory when compared to the previous year.
Mr. Chairman, 65 per cent of toxicology cases
were com pleted within three months, which is equal to
the international standard for turnaround times for toxicology cases.
Mr. Chairman, the Water and Food Analysis
Programme performs analytical testing of potable
(which is drinking) and non- potable water sampl es,
dairy products and food. It is primarily a laboratory
support service to Environmental Health, with the r esults used to identify bacteriological or chemical risk to
human health and animal health. It is through this collaboration that the Department of Health can maintain
a low incidence in water and foodborne disease.
Potable (which again is drinking water) samples are analysed from Works and Engineering, Watlington Waterworks, Rocon Limited, L. F. Wade International Airport, hotels, private dwellings , restaurants
and care facilities, to name a few. Non- potable water
samples include seawaters, sewage effluent, and w ater from animal habitats.
Mr. Chairman, there were a total of 4,169 w ater samples tested during the budget period, repr esenting a 15 per cent increase from the previous fiscal
year as our sample intake has nearly returned to pre596 1 March 2023 Official Hansard Report

Bermuda House of Assembly pandemic levels. Consequently, our revenue rose
sharply by 48 per cent. It is noteworthy, Mr. Chairman,
that the water quality of our main bathing beaches met
the U nited States Environmental Protection Agencies
guidelines value every week through our routine seawater testing.
Dairy products are tested monthly to determine that they meet legislated limits as set out by the Public Health (Milk and Dairy Farm) Regulations
1952. Food testing is currently performed when there
is a suspected case of foodborne illness. This pr ogramme continues to meet all of its performance
measures. For the 2021/22 fiscal year turnaround
times of 5 or 10 days for disseminating water, dairy
and food testing results were achieved 99 per cent of
the time and we are on target to accomplish the same
for the 2022/23 fiscal year. Furthermore, all analysis
achieved proficiency test scores that met an international standard.
The WHO has recommended t he global elim ination of trans -fatty acids by 2023. The Water and
Food Analysis programme collaborated with the Port Health Unit to commence a baseline survey to determine the amounts of trans -fatty acids in various food
samples in Bermuda.
Mr. Chairman, it is anticipated that sampling
for this baseline survey will finish by 31 March 2023. The first batch of results positively demonstrated that
zero food samples contained two grams of fat, trans -
fatty acids per 100 grams of food, a limit that is set by
PAHO [Pan American Health Organization]. This pr oject is supported by the United Kingdom’s Health S ecurity Agency (or UKHSA). This ends my remarks for
section 2204, Central Laboratory.

Environmental Health

Hon. Kim N. Wilson: Turning now, Mr. Chairman, to
Environmental Health. The 2023/24 budget estimates
for section 2203, Environmental Health, of the D epartment of Health, listed on page B -155 as business
units 32170, Institutional Hygiene; 32171, Public
Health Nuisance; 32172, Food and Beverage Safety; 3217 3, Water and Sanitary Engineering Control;
32175, Environmental Health Administration; 32180, Housing Conditions; 32270, Occupational Safety and Health; 32285, Port Health; and 32190, Vector Control. And all of thes e combined units, Mr. Chairman,
that I ju st spoke of, represent a budget of $3,960,000.
Mr. Chairman, the Environmental Health section is an essential service providing monitoring, i nvestigative and regulatory functions in such diverse
areas as food safety, occupational safety, nuisance
control , water quality, tobacco control and vector co ntrol. Environmental Health is implementing a new data
system which will help to organise and store data in a
form that is readily accessible. The upgrading of policy
and procedures for the new system is underw ay. In 2023/24, Environmental Health staff will
focus on publicity, education and promotion to raise
the profile of Environmental Health, informing the public of the wide range of responsibilities and activities
within the section. New pesticide regulatio ns, Mr.
Chairman, are currently being developed inclusive of
stakeholder consultation, and the draft regulations are
expected in the 2023/24 fiscal year for this Throne
Speech initiative.
Mr. Chairman, the Occupational Safety and
Health office inspects places of work throughout the Island, investigates serious workplace accidents and
ensures Bermuda’s workers safety through develo pment of policies and procedures such as the requisite
training and permit system for asbestos abatement.
Having one of the two Safety and Health inspector
posts filled early in 2022 enabled a programme of
proactive workplace inspections to recommence to
ensure compliance with regulations and that safety
committees are established and operational. Industry
outreach collaboration w ith employer organisations
and worker education and awareness activities are
underway to raise the profile of safety at work, thereby
improving standards. Investigating serious accidents
can also identify uncontrolled risk or poor safety
standards.
Progr ess with ticketing for high- risk contraventions and re- establishment of the Advisory Council for
Safety and Health are key priorities, Mr. Chairman, for
2023/24. Mr. Chairman, the Port Health Unit assists in
the monitoring of persons arriving on Island at the ai rport and other ports of entry in order to provide co ntrols against any infectious diseases arriving on Island
from overseas. This includes carrying out inspections
of cruise ships and other vessels visiting the Island.
The unit also monitors food pr oducts arriving on Island
to ensure that they are safe for human consumption. The port health function facilitates Bermuda’s compl iance with international health regulations. Oceangoing vessels traffic increased substantially, Mr.
Chairman, in 2022/23. The unit undertook a number of
inspections by request for renewal of the six monthly
ship sanitation certificates. And these are required by
the International Health Regulations together with
proactive inspections for training and capacity -building
purposes.
A new inspection room and temperaturecontrolled storage facility for imported food is now be-ing constructed within the airport cargo shed. The Port
Health Unit has been actively involved in design considerations and the new development will help to e nsure compliance with the core capacities of the International Health Regulations.
Mr. Chairman, turning now to Vector Control.

Vector Control
Hon. Kim N. Wilson: Vector Control is the team that
ensures that threats of rodent -borne and mosquitoborne diseases do not manifest themselves in Berm uBermuda House of Assembly da. It is a credit to the team that they managed to continue to maintain an active programme of complaint
investigation and proactive baiting and monitoring for
vermin during 2022/23. Over the course of the year
the unit continued to operate an increased baiting programme within parks, public docks and other hot
spots.
Mr. Chairman, residents are reminded, ho wever, that the best way to limit rodent numbers is to deny rodents access to food sources such as garbage
by using metal trash containers with lids and not putting trash out on non- pickup days.
Shall I repeat that, Colonel?

Yes, please.

Hon. Kim N. Wilson: Residents are reminded ho wever that the best way to limit rodent numbers is t o
deny rodents access to food sources such as garbage by using metal trash containers with lids and not putting trash out on non- pickup days.
To reiterate this important message, the department will continue with communications outreach in the upcoming ye ar along with having Vector Control
staff participate in education programmes such as
Ministry fairs and career days.
This ends, Mr. Chairman, my presentation on
section 2203, Environmental Health.

Revenues

Hon. Kim N. Wilson: Turning now, Mr. Chairman, to
revenues for the Department of Health. They are pr ojected, Mr. Chairman, to reach $3,606,000 for
2023/24. These estimates, Mr. Chairman, can be
found on page B -156.
These revenues come from the sale of medications, vaccines and biologicals, fees for c linical se rvices, patient fees from the two long- term care facil ities, as well as fees for licences and permits which are issued by the Environmental Health Section of the
Department [of Health].
Mr. Chairman, you will have heard mentioned
several times the vacancies throughout the Depar tment of Health. This is the current situation but as
noted earlier, the senior management team of the d epartment is working with Management Consulting
Services to build back better. The impact of the pa ndemic cannot be ov erstated, nor can the competition
for nurses and other medical professionals internationally. However, we are taking a strategic approach
to assessing services and programmes in light of the Bermuda Health Strategy 2022– 2027 of which universal health cover age forms a part in placing our population’s health needs first.
Mr. Chairman, this concludes my remarks on
Head 22, Department of Health.

Minister, you may proceed to the next
Head. HEAD 24 —HOSPITALS

Hon. Kim N. Wilson: Mr. Chairman, tur ning now to
Hospitals, which is Head 24. It can be found in the
Budget Book on pages B -165 to B -166.
Mr. Chairman, the Bermuda Hospitals Board
(or BHB) delivers the only round- the-clock emergency
and acute medical, psychiatric, palliative care, and substance abuse detox inpatient hospital services. It
also delivers diagnostic, surgical and outpatient services and residential long -term care for seniors, as
well as a range of outpatient residential and acute
services for mental health and intellectual disabi lity
service users. Services are provided from King E dward VII Memorial Hospital, the Mid- Atlantic Wellness
Institute [MWI] and the Lamb Foggo Urgent Care Centre, and 26 group homes with certain administrative functions such as the medical concierge, HR, f inance
and IT all located in the Craig Appin Building in Hami lton.
BHB not only managed to keep services running at Bermuda’s only hospitals through a very diff icult period, responding to COVID -19 and the impl ementation of a major new electronic medical r ecords
system, it managed to improve service delivery throughout this fiscal year. This has been due to hard
work by BHB staff, leadership, vendors and partners and a dedicated board, all of whom have Bermuda’s thanks for their achievements.

Review of the Current Fiscal Year

Hon. Kim N. Wilson: Mr. Chairman, the current f inancial position is as follows. I would like to first start
by giving a brief overview of BHB’s current financial
situation.
BHB has worked hard and successfully over
the last few years to ensure that care services have
not been impacted by its financial challenges. This
has meant continuing to delivering each year on a
savings programme that was first initiated in 2018 and
has delivered, on average, $23.03 million per year in
savings, w hich represents approximately 7 per cent of
BHB’s budget. From June 2019, BHB has worked un-der a funding model in which Government’s funds have been set at an agreed set sum and since ince ption this cap has been flat at $322 million.
As has already been wi dely communicated by
Government, the obligations to pay what has been
agreed has fallen short over the last few years to a
total outstanding sum, which the Government projec ted to be $31,600,000 by the 31 March 2023. I would
first note that $15 million was provided in February,
bringing the projected total outstanding sum down to
$16,000,600. Although BHB has some provision beyond the $322 million for charging for a small group of
specialist services, on what is called the Schedule 4 [Part] B of hospital fee schedule, and for charging
overseas visitors if they access BHB services during
598 1 March 2023 Official Hansard Report

Bermuda House of Assembly their stay, this has never been a significant sum. During the first two years of the pandemic, in particular,
this revenue stream dropped to near zero.
Mr. Chairman, this shortfall, in combination
with the pressures and demands of unexpected and unfunded costs related to the COVID -19 pandemic
since 2020 and capital expenditure, has resulted in
BHB’s cash reserves falling to a point that it has i ncreasingly had to access an ov erdraft. And the overdraft was first put in place, Mr. Chairman, in 2021. I
am therefore very pleased to report that the BHB sub-sidy, which pays for care for seniors, youth and indigents, will increase in the upcoming fiscal year from
$108,333,000 to $112, 998,188.
This includes further funding, Mr. Chairman,
for special overseas treatment and the Tumour Regi stry. Additionally, the MWI operating grant will increase
from $38,921,163 to $42,160,645. In total, this is an
increase of $7,907,670 from these funding sources.
BHB’s total payment from Government, which is
capped at $322 million, is also made up of payments from the Mutual Reinsurance Fund (MRF) into which
insurance payments for the Standard Health Benefit
[SHB] premiums are paid. BHB is paid a percent age
of what is paid into the MRF and in 2023/24 it was
estimated to be the same as this fiscal year at around
$165 million.
In addition to the subsidy, MWI grant and
MRF payment, BHB has been allocated a $120,000 MWI Minor Works Grant to assist with repair s and
maintenance, a capital grant of $2,789,000 for essential repairs and upgrades to KEMH [King Edward VII
Memorial Hospital] campus, and a $1,766,425 MWI infrastructure upgrade to assist with essential works
on the ageing MWI facility. In total, this takes the e ntire cap for the upcoming fiscal year to [$324,834, 188]
which is an increase of $2,834,188.
Mr. Chairman, BHB’s success in delivering
savings has been instrumental in it continuing to manage obligations such as the Acute Care Wing (or
ACW) payments as well as the necessary repairs and
improvements that ensure that it is meeting quality
standards of care. However, the gains it has made through efficiencies and improved processes have
also been achieved by delaying some upgrades and
some expenditures such as basic cost of living i ncreases to staff salaries. Like Government’s public
servants, the BHB staff have had no increases in
wages and salaries for several years.
Mr. Chairman, costs have also been carefully
contained. At the end of January of this year [2023]
BHB’s total operating costs were below budget by $23.2 million, or 6.4 per cent, when operating savings
of $3.9 million are combined with concessions and
other savings of $19.3 million. Revenue is also below
budget by $3.7 million, although the increasing num-ber of tourists in Bermuda is seeing a gradual i ncrease in this revenue line for BHB. Mr. Chairman, cash continues to be the most
pressing issue for BHB. As of January 2023, BHB had $6 million operating cash on hand, of which about $4
million is restricted cash which means it does not have
reserve deposits. Clearly, this is a very much less
than ideal situation.
Mr. Chairman, the cost of maintaining quality
hospital services that are available 24/7 is costly, es-pecially in Bermuda. Costs are constantly rising as
well. Medical supplies and drugs generally increase in cost about 6 per cent per year, and the supply chain
issues due to continued global uncertainty only esc alate costs further.
BHB has worked hard to reduce the impact of
these costs by good procurement practices and effective price negotiations and savings from customs r elief. But capital projects costs also need funding and BHB is facing the need to upgrade medical equipment
that is within the window of replacement. In this fi scal
year 2022/23, BHB’s capital spend was $20 million, and this included the BHB laundry upgrade and the
electronic medical record implementation. I will go into further detail about these two projects as we look at
how BHB funds for this year were spent.
I should also note, Mr. Chairman, that the
BHB’s financial statements have been audited up to fiscal year 2019/20. These have all received clean,
unqualified audits. The annual report —

Excuse me, Minister. Would you r epeat that? I couldn’ t hear that.
Hon. Kim N. Wilson: Sure. I would note that the
BHB’s financial statements have been audited up to
fiscal 2019/20. These have all received clean, unqual ified audits.
The annual report for the fiscal year 2017/18
is ready to be laid in the House. The 2018/19 annual report has been received by the Ministry and I will be presenting it for Cabinet’s approval at the next avail able opportunity. And the annual report for fiscal year
2019/20 is with the Office of the Auditor for final r eview. BHB is working diligently with the Office of the
Auditor to complete the process for the financial
statements from fiscal year 2020/21 onwards.

For the benefit of the listening public
and Honourable Members, we are now in Committee
of Supply for f urther consideration of the Estimates of
Revenue and Expenditure for the year 2023/24, Mini stry of Health. And we are now debating Head 24.
Minister, you may proceed.

Primary Stroke Centre

Hon. Kim N. Wilson: Thank you.
Mr. Chairman, turning now to th e BHB’s
Stroke Care. In April of this fiscal year, BHB’s Primary
Stroke Centre, which is a part of a clinical affiliation


Bermuda House of Assembly with Johns Hopkins Medicine International [JHMI],
received a Stroke Distinction Award from Accredit ation Canada for its Acute Stroke S ervices and its Inpatient Rehabilitation Services standards.
Mr. Chairman, there are up to five stroke cases every week in Bermuda. And in data collected from
2020, 25 per cent of those strokes were in people under the age of 60, 73 per cent of strokes are persons
of Black descent, 24 per cent are White, and 2 per
cent are other ethnicities. Strokes can happen, whoever you are, and whilst risks increase with age, peo-ple can have strokes when they are very young. BHB
is the only health care provider of cri tical and emergency care with doctors, nurses, imaging and lab
tests, as well as surgical and inpatient services avai lable 24/7. So, if you have a stroke, you want to know
that the BHB service gives you the best chance of
recovery.
Mr. Chairman, BHB’s di stinction award is a
way to reassure the community that its services meet international standards. A letter from Accreditation Canada announcing the news reads as follows, and I
quote, “Achieving Distinction indicates that your organization has demonstrated national leadership in
the provision of high- quality stroke care. We applaud
your success and urge you to celebrate this achiev ement.”
Mr. Chairman, the results reflect the worldclass expertise of BHB staff who achieved this while navigating the unique and challenging stresses of the
COVID -19 pandemic. Stroke Distinction Certification
is the highest commendation a stroke centre can r eceive in the Accreditation Canada system. The follo wing areas of success within BHB’s stroke services
were noted by the A ccreditation Canada. And they are
as follows:
• leadership and organisation support;
• knowledgeable and committed staff;
• collaboration with Johns Hopkins Medicine I nternational;
• alignment of the Integrated Stroke programme
plan with the Strategic Plan;
• commun ity partnerships;
• communication and promotion of the stroke
programme.
Mr. Chairman, the last three years of BHB’s
primary focus has been on the COVID -19 response.
And it has been all -encompassing. And yet, although
the COVID -19 pandemic created unexpected challenges, BHB has managed to achieve, and in some cases surpass, its stroke care goals. The celebration
is not that BHB achieved the award itself, but that
stroke patient outcomes have significantly improved in
Bermuda which gives hope to anyone who experiences [a stroke.]
July of 2022, was the third- year anniversary of
BHB launching its Primary Stroke Centre. And since
that time, Mr. Chairman, a more clearly defined pr ocess in managing stroke patients has been estab-lished, together along with community promotions, to ensure everyday people know what a stroke looks like
because getting to the hospital quickly at the first
signs of a stroke can make a huge difference in outcomes.
Some of BHB’s best results have been when
14 per cent of those who experienc ed a stroke were
able to receive a clot -busting drug that increases their
chances of fully recovering. This figure was almost
double the 7 per cent average of primary stroke centres in the United States. This achievement, Mr.
Chairman, did require investment of time, effort and
money, but it is where money is best spent, improving
care and outcomes as well as the cost burden of di sabilities caused by stroke for the Bermuda population.

PEARL

Hon. Kim N. Wilson: Turning now to the implement ation of PEARL, Mr. Chairman.
One of the biggest investments since the
building of the ACW has been the implementation of
BHB’s first organisational -wide electronic medical record. Although an electronic medical record is technology, this has been an investment in improvi ng the
quality and safety of patient care over the next 10
years.
The system improves the coordination and
delivery of care. It helps staff avoid errors with inbuilt
alerts for medication conflicts (for example) and flags potential critical issues like the early signs of sepsis. It
reduces duplication and delays; it brings all the infor-mation that a clinician needs into one place and supports informed and timely decision- making by
healthcare teams with patients and their families. All of this not only impr oves the quality and safety of
care, but helps reduce costs, improve efficiency and the value of the services.
The timing was forced by the main clinical
system of BHB no longer being supported by the ven-dor as it was so old. The modern replacement of the
system was an electronic medical record. The cost of
the contract with Cerner, who is the vendor for the
selected Millennium product was publicly released in
2021. The system replaces many old systems which translate to savings for BHB. The net cost of the pr oject over 10 years is expected to be in the order of
$30 million.
Mr. Chairman, BHB staff named the system
PEARL, and were fully involved throughout the entire
process of implementation. It has been gruelling for them with over 350 staff involved in over 1,000 wor kshops to design and build PEARL in 2021, including
through the Alpha and devastating Delta COVID -19
waves. In 2022, the staff shifted to preparing for go -
live and about 1,500 staff were involved in the online
and in- classroom training. Any organisational -wide
system implementation is a major project. When the
system underpins the care delivered by the Island’s
600 1 March 2023 Official Hansard Report

Bermuda House of Assembly only hospital service, the stakes are very high in ma king sure the implementation succeeds.
Unlike hospitals overseas, here in Bermuda
there is no other hospital to divert emergency services
to if something goes wrong. To ensure the success of the project, there were two main support consultants,
Channel 3 [Consulting] and SMP Consulting, whose
contracts for this fiscal year totalled just over $3 mi llion. Work with vendors related to building interfaces
that were needed accounted for $513,000. Finally, Mr.
Chairman, an investment of $1,700,000 was made to prioritise on- the-ground support and training for BHB
staff from Cerner, SMP and Channel 3. This support
was for the go- live period when the highest risk would
be experienced as staff applied their training to their
real day -to-day work.
BHB made efforts to prepare the community
as well because as staff got used to the new proces ses and system, things would move more slowly than
usual and waits could be longer in certain depar tments. This certainly was experienced by patients and I join with BHB in being deeply grateful for the understanding of the community as BHB staff did their best
to get used to this new system.

Integrated Healthcare Clinical Pathways Programme

Hon. Kim N. Wilson: Mr. Chairman, the Integrated
Healthcare Clinical Pathways Programme at BHB is a
collection of projects unified around the goal of i mproving access and working collaboratively to improve
patient pathways and care. It incorporates valuebased healthcare and patient co- participation by examining, from a patient perspective, the care management experience across the entire Bermuda pr ovider spectrum.
The purpose of the integrated pathway is to
map out where and what services are provided to help patients. Such mapping helps remove unnecessary
activity that increases the cost of care, identifies gaps
in the provision of services at a national level and
identifie s opportunities to improve access or quality of
patient care from a patient’s perspective. The pr ogramme covers everything from mental health to cancer, palliative and long- term care to maternity.
There have been notable achievements in the
last 12 months, including the completion of patient
pathways for prostate, colorectal and breast cancers.
This will help us improve the patient experience and
quality of care for people as they move from diagnosis
through to treatment and recovery. BHB will also soon
be releasing the Breast Health Booklet which was
compiled from interviews with Bermuda- resident
breast cancer patients. This invaluable resource booklet will provide all Bermuda residents with information
on preventative breast health, the treatment pathway s
available for breast cancer locally and from our overseas partners and information on health and financial
resources for patients on the breast cancer recovery pathway. The Breast Health Booklet is a Bermudacentric tool for providers, patients and their families to
demystify their recovery journey when they are faced
with a life -changing diagnosis.
And, Mr. Chairman, if I could just pause for a
moment , I was supplied with a copy of it last evening
and it is a tremendous publication. I am very excited
for the work that BHB has done with respect to this
Breast Health Booklet and I can’t wait for it to be
made available to members of the public.

Thank you, Minister, for that hard
work.
[Inaudible interjection]
Hon. Kim N. Wilson: Men can get breast cancer too.
Mr. Chairman, a key focus is also to have a
better safety net of care options with the community to better manage health issues in the community, avoi ding costly and life disturbing acute episodes of illness.
Some of the data collect ed at BHB has highlighted,
especially, that Bermuda is no different to many countries where patients with chronic illnesses can fall
through the cracks and create more demand and
pressures on services.
Mr. Chairman, data from the Emergency D epartment identified the top 50 patients who use the service the most. Their average age is 53, although
the ages range from 1 to 88. These 50 people, b etween November 2020 and October 2021, had 778
emergency attendances between them. [There were] 101 admissions and [t hey] needed 1,002 inpatient
days. This is what we refer to sometimes as superusers.
Sixty per cent of them present with the same
issue and 90 per cent of the visits are unscheduled
with 10 per cent for scheduled IV medications or blood
transfusions. The c ost of this care was $806,241 with
$371,650 in emergency department attendances
alone. It also shows that medical and mental health
issues impact these people. Nearly one- third of the
related admissions in this group were to MWI. Of the
top five users, onl y 12 per cent have private insurance. Forty per cent used the aid subsidy, 32 per cent
had HIP, 4 per cent used the indigent subsidy and
4 per cent used the youth subsidy.
Mr. Chairman, services such as the Integrated
Healthcare Clinic at the Lamb Foggo Urgent Care
Centre and having more mental health services avai lable from community locations, will help to improve
the support many people need closer to home. The
expectation is that it reduces the need for emergency
visits and inpatient care, especially in groups who access emergency services more often.
BHB’s work with the Integrated Healthcare
programme is critical enabling work to improve quality
and reduce the cost of treatment. It will ultimately


Bermuda House of Assembly make our national goal of universal healthcare more
attainable.

Mid-Atlantic Wellness Institute (MWI) Directorate Plan
Hon. Kim N. Wilson: Mr. Chairman, in June 2022 the
BHB published a five- year strategy for Mid- Atlantic
Wellness Institute services. The MWI Directorate Plan
2021 –2026 was developed follo wing the launch of the
BHB’s Strategic Plan 2021 –2026 last year and is the
pathway for mental health, intellectual disability and substance abuse services. The plan was developed
with improved involvement of MWI staff and clients
through a very challenging period. The overarching
goal of the plan is to provide a roadmap to transform
services and experiences for clients with the stated
goal to inspire strength, hope and wellness in our
community by promoting independence, choice and
person- centred support.
Mr. Chairman, there are four aims that give
overall direction to this strategy. And they are as follows:
1. Transition outpatient and long- term care
into the community and close to MWI
sites in the long term.
2. Ensure active patient participation in our
servic es using the recovery model.
3. Use a needs -based approach to care that
ensures people get care at the right time, and the right place, at the right provider.
4. Challenge the stigma and discrimination
against mental illness.

Mr. Chairman, shifting outpatient s ervices to
community settings helps bring the care to the people
who need it. It makes assessing services easier and
takes away the stigma people feel is associated with
the MWI building itself. There is also the much longer
term goal to move acute MWI ser vices to purposebuilt space on the KEMH campus, which would be a more efficient use of lands and facilities for Bermuda
as well as to better connecting mental health to other
healthcare needs.
The goal of closing the MWI campus for outpatient and acute s ervice is a long- term aim and not
something that will happen soon; however, it is the direction of travel and we are already on that road.
Over many years intellectual disability residents have
moved to group homes, [they are] not institutionalised
on site, and the Community Intellectual Disability
Team set up last year aims to support clients in their
actual homes.
This team also oversaw two community
events this fiscal year that brought intellectual disabi lity clients, their families and the community to gether in
the summer and fall with the support of generous d onations. The sum effect of exceptionalities, hosted by
the Warwick Parish Council Field, aim to provide cl ients with opportunities to celebrate themselves in a public setting and engage in meaningful, social engagement with their peers and the wider community.
Its success was followed in the fall by the Exceptional
Fall BBQ [Celebration] on Clearwater Beach where
special aquatic therapies were also on show. It is hoped that other event organisers through these
events will understand how to make inclusion possible
for those with intellectual and/or developmental dis abilities at all community events.
And finally, Mr. Chairman, as examples of
shifting services to the community, last year mental
healt h services and support were offered from Lamb
Foggo Urgent Care Centre, the Victoria Clinic, the
Court and a Nurse led pilot programme that was run in
a GP [general practitioner] office. Also, as I had stated
previously, Mr. Chairman, we are working with M WI to
deliver services in the west from the Mangrove Bay
Clinic once planned renovations have been completed.
This year it was also announced, Mr. Chai rman, that MWI in collaboration with Habitat for H umanity and the Anglican Church of Bermuda, will pr ovide a community -based housing programme and
support for people with mental health challenges. The
tripartite partnership project will see the old St. James
Church rectory at Somerset Bridge redesigned and
renovated as a residential facility.

[Inaudible interjection]

Hon. Kim N. Wilson: This isn’t the first time you have
heard about this.

[Inaudible interjection]

Hon. Kim N. Wilson: The repurpose residence will
respect the historical nature of the property —
[Inaudible interjection]

Hon. Kim N. Wilson: —and it will also provide 24
hours —

Members, speak to the Chair.

Hon. Kim N. Wilson: The repurposed residence will
respect the historical nature of the property. It will also provide 24 hour, state- of-the-art treatment for those
requiring mental health services, as well as community support from St. James Church congregants.
Mr. Chairman, you can read the full MWI D irectorate Plan and a summary of the plan on the
BHB’s website. The increased grant to MWI this year
will help them to continu e their great work.

Minister, you may want to repeat that
for those who have not heard about that.
Hon. Kim N. Wilson: Okay.
602 1 March 2023 Official Hansard Report

Bermuda House of Assembly As I was saying, Mr. Chairman, as part of the
MWI Directorate Plan, they are moving services closer
to the . . . within the community. And this year it was
announced that MWI, in collaboration with Habitat for Humanity and the Anglican Church of Bermuda, will provide a community -based housing programme, and
this relationship will be using the old St. James
[Church] rectory which again will not be . . . it will co ntinue with the historical nature so it will not be renovated to such a state as to interfere with the historical
nature.
As I was saying, Mr. Chairman, the full MWI
Directorate Plan can be read and is located on the
BHB’s website.

Thank you, Minister.
We are going to pause for a quick second. For
the benefit of the listening public and my fellow Honourable Members, we are now in the Committee of
Supply for further consideration of the Estimates of
Revenue and Expenditure for the year 2023/24, Mini stry of Health. We are debating Head 24, Hospitals.
The Honourable Minister, Kim Wilson, is giving her
presentation. Thank you.

Hon. Kim N. Wilson: Thank you, Mr. Chairman.

For the benefit of the listening public,
this debate is going to end at 4:57. It is now 3:00 pm.
And at 4:00 pm there will be a change of [the Chai rman].

Integrated Health Clinic One-Year Anniversary
Hon. Kim N. Wilson: BHB celebrated the first year of
the Integrat ed Health [Care] Clinic (IHC) a year after it
opened at the Lamb Foggo Urgent Care Centre.
Launched in July 2021, the IHC offers people in the
East End who need mental health and chronic illness
services a place to receive care closer to home.
The IHC runs once a week on Wednesday
mornings at the Lamb Foggo Urgent Care Centre. In its first year, 145 patients were seen at the IHC and there were over 500 patient encounters. About 73 per
cent of encounters were face- to-face and 27 per cent
were telephone encounters.
There are four clinical services delivered ev ery week at the clinic: Mental Health, Asthma, Diabetes
Education and the Patient -Centred Medical Home,
which helps people with at least one chronic illness who are either not or are under insured. About 22 per
cent of Patient -Centred Medical Home patients have
four or more co- morbidities.
In its first year, the IHC was run as a pilot to
see if delivering hospital services closer to home is
beneficial to patients. BHB asked people who used the service as to how beneficial it was for them. A
senior living in the East End said it made a huge di fference being closer, and a disabled patient noted that it was easier to access as the facility is close to the
parking lot unlike other places.
One mental health ser vices patient explained
the impact of the Lamb Foggo Urgent Care Centre
location compared to MWI, and it is worth quoting as it also speaks to the MWI directorate plan wanting to
shift services into the community.
I quote, “As soon as you pull into MWI and get
out of your car the stigma starts. It’s with Bermudians period. If you actually go inside the building it’s worse
. . . . When I went over to the clinic even though the
hospital part wasn’t open, I didn’t have those types of
feelings when I walked in. Feeling like anyone was
watching or was going to say something. I felt so
much more relaxed going to my therapy because the
whole atmosphere was 100 percent different. Different
in a real positive way. When I would leave MWI, al though I may have had a ver y good session, the stress
kicks right back in just like it did when I entered. All
the people seeing me and looking, and me feeling bad
about myself and my situation. Coming out in St D avid’s I feel refreshed it’s really hard to explain the depth of it, but the good feeling from the session stayed with me and that’s the first time I had exper ienced that feeling in all the years that I’ve been in therapy. I started when I was 21 and now I’m in my 60s, so that’s a long, long, time.”
I do have to pause, Mr. C hairman, because I
do want to commend BHB and the team at Lamb
Foggo for implementing this particular programme. I
am very excited about the fact that one day, sooner
than later, it will be also repeated in the Somerset community.
The IHC at the Lamb Foggo Urgent Care
Centre is an example of delivering neighbourhood
health services directly to counteract the social determinants of health, such as poor access to chronic di sease and mental health services. This has improved access to care for patients in the East End and, as
already noted, mental health services are also provi ded in collaboration with the Ministry of Health at the
Victoria clinic and will be at the Mangrove Bay clinic
once it is renovated ensuring the delivery of mental
health and medical hea lth services in the central parishes and residents in the west.
The public may wonder if opening community
clinics increases the cost of care. These initial int egrated clinics by BHB and those in partnership with
the Ministry of Health have been achieved b y stretc hing existing resources. While this means there is mi nimal additional cost to this improvement in services, a marginal increase in resources will be required for
future projects.
Studies have shown, however, that improving
access to care, particul arly for those people at the
margins, allows earlier access to care which can be
administered with lower cost interventions, as o pposed to conditions going untreated and the patient


Bermuda House of Assembly having to access into more expensive, and lifedisrupting acute care servi ces at KEMH or MWI.

Laundry Project Upgrade
Hon. Kim N. Wilson: Following an increasing number
of equipment breakdowns and infrastructure issues, BHB started a laundry upgrade project in July this
year . . . last year, sorry . The project was publicly
communicated at its start, with the total cost expected
to be $6,600,000. The new laundry was officially given a clean bill of health this month, and the project came
in on budget. The impact of the costs on BHB, ho wever, was eased by a $1,300,000 donation by a single
donor through the Bermuda Hospitals Charitable
Foundation (BHCF).
The laundry last had new equipment and m inor upgrades in 2008 and 2004. Increasing failures
meant that there were times the washing and drying
had to be outsourced at great cost. T he new upgrade
means the laundry can work more productively and
efficiently to support clinical services.
About 6,000 pounds of laundry is cleaned,
dried and pressed every day, seven days a week, at
BHB. The laundry processes all linens, gowns and
clothes used by newborns through to those near the
end of life, the curtains used across the hospital, m icrofibre cloths used by Environmental Services, as well lab coats and scrubs for staff. It supports all the
BHB facilities, including KEMH, MWI, the UCC and
group homes. I believe in today’s daily there is a pi cture of the new facility.
New equipment was purchased, including six
new washing machines —one 450- pound machine,
five 160- pound machines and one smaller 55- pound
machine for baby linens and scrubs; six ne w dryers,
five 200- pound dryers and one 80- pound dryer; and
two new folding machines. The changes to the laundry infrastructure allow a workflow that keeps soiled
linen in a separated area away from clean linen. In
addition, there are new hot and cold water lines,
steam piping and exhaust ductwork.
An old boiler room was demolished, with new
buildings to house the new hot water system to allow the washers to operate more efficiently. The new i nfrastructure design makes repairs and maintenance
easier, with access to the back of the dryers, for example. There was also a new fire suppression system.

Senior Appointments

Hon. Kim N. Wilson: There have been important appointments this year at BHB, mostly replacing existing positions. A new Chief of Psychiatry, Dr. Anna
Neilson- Williams, and Chief Financial Officer, Arthur
Ebbin, were appointed, and a new post of Chief Hospital Information Officer was created and Keltie J amieson appointed to the post. This last position is cri tical for BHB to effectively drive an d manage its digital health strategy, especially with the implementation of
an organisation- wide electronic medical record (the
PEARL system).
I would also like to include some good news,
which is that there have been new appointments wit hin oncology. BHB had communicated last month that it
had made appointments but was waiting for the pr ocesses to be completed. This is following one full -time
and one part -time oncologist leaving at the end of last
year. One full -time oncologist, and one locum with a
one-year work permit have been appointed and work
permits approved. They will join the remaining oncol-ogist and locum already in place. The new locum has
just arrived on Island, and the full -time oncologist
should be here within the next three months. This will
increase BHB's oncologist resources, helping them
improve the overall service for inpatients, outpatients and emergency services.

Health Care Workers of the F uture

Hon. Kim N. Wilson: BHB continues to support the
future health care workers of Bermuda. There is a
global shortage of nurses and health care professionals to which BHB is not immune. Recruitment is tough,
and alongside a more proactive recruitment strategy,
encouraging and supporting Bermudians into the health care field remains critical.

Scho larships

Hon. Kim N. Wilson: BHB awarded eight scholarships this year, worth $100,000 over one or more
years. All of the scholarships are administered by
BHB.
Due to reductions in operational expenditure,
BHB has been unable to fund scholarships for the
past five years. Fortunately, through the great generosity of the Bermuda Hospitals Charitable Foundation and their donors , funding for the scholarship pr ogramme has been maintained during these lean
years.
BHB is also incredibly grateful for the conti nued long- term support of GlaxoSmithKline Insurance
Ltd, a Bermuda- based subsidiary of GlaxoSmithKline
plc, who has quietly funded multiple scholarships of
$40,000 to support pharmacy students for several
decades.

Summer Internships
Hon. Kim N. Wilson: BHB employed 38 students in
its Summer Student Programme this year. The 12-week programme provides college and university st udents an opportunity to gain experience, develop
skills, and make important business contacts in their
field of interest.
Students this year were from a wide range of
disciplines and degree programmes, both clinical and
604 1 March 2023 Official Hansard Report

Bermuda House of Assembly non-clinical from 29 different institutions based in
Bermuda, Canada, Curacao, Cyprus, the UK and the
United States. There were seven medical students at
KEMH, two psychol ogy students at MWI, and four
nursing students who worked across both campuses.
Students also worked the following BHB departments: Facilities Management, Finance, hospital
medical records, Environmental Services, Human R esources, Information Technology, Lab Services, Long
Term Care, Neurology, Pharmacy, Physiotherapy,
Project Management and Imaging Services. The pr ogramme this year was made possible by the Bermuda
Hospitals Charitable Foundation (BHCF) and their
corporate donors, who funded the programme w ith
$150,000.
Over the past five years, BHB has employed
236 Bermudian interns in its summer programme. Of
those, 39 were medical students, 191 were general
studies students, and six were culinary arts students.

Nurse Trainee Pilot

Hon. Kim N. Wilson: The Bermuda College has cr eated a problem for the Bermuda Hospitals Board, but
it is a good problem. BHB's nurse resident programme
offers newly -qualified Bermudian RNs who have
passed their National Council Licensure for Regi stered Nurses (also called the NCLEX RN) board exam the opportunity to gain the clinical experience they
need before entering their first RN position.
BHB’s nurse resident programme has been
very successful and has accommodated 10 newly l icensed Bermudian nurses per year, supporting them in gaining their clinical experience, with oversight, to
complete their clinical training to be nurses. This past
year the Bermuda College overwhelmed BHB’s res idency programme with 14 new RNs and has a potentially similar size class for next year.
BHB has responded to this excellent cha llenge by piloting a nurse trainee programme, to sup-port nurses who have graduated from the Bermuda
College while they wait for an open space in the BHB
residency programme to complete their training. Pr eviously, the nurs es waiting for a nurse resident place
did not have the option of working within a clinical e nvironment. The new trainee pilot means they have the option of working in various clinical departments with
the additional benefit of learning specific nursing ski lls
to enhance their clinical competency once a nurse
resident position becomes available.
In an incredibly cash constrained enviro nment, BHB has funded 10 new posts to accommodate
seven trainees plus additional anticipated new entrants in the pilot. At a time when there are nurse
shortages being experienced around the globe, this is
a way to encourage and support new nurses on their journey and increase the number of highly valued,
Bermudian nurses. BHB thanks and asks its sister quango, the Bermuda College, to keep up the good
work.

Jobs Fair
Hon. Kim N. Wilson: Mr. Chairman, BHB hosted a
successful job fair and speed interviewing event on Tuesday , 20 December at the Hamilton Seventh Day
Adventist Church Hall. The jobs fair ran all day from
9:00 am to 6: 00 pm, and over 300 members of the
community attended. Organised by BHB’s People D irectorate (previously called Human Resources), over the course of the day over 600 interviews were conducted with job seekers to fill vacancies in administr ative, nursing ai de, facilities, maintenance, food and
environmental services departments.
The purpose of the job fair was to put Berm udians back to work, and advance recruits for positions
that may become available in the coming months. D elays in filling posts increase operational costs and the job fair helped create a rich pool of talent to fill future
vacancies within a shorter time period.
Mr. Chairman, 122 of the attendees were currently unemployed. There were also many older and
mid-career applicants, and a substanti al number of
applicants. There was also a rich, ready -made talent
pool of certified nurse assistant applicants who had
been through the Bermuda College programme, high-lighting the benefit of such courses at the College.
It is a good reminder for people looking for
work to explore health care, dietary and facilities management training programmes on offer at the Bermuda College as they prepare people for future
job openings at BHB.

Looking Towards 2023

Hon. Kim N. Wilson: There are key stepping stones
BHB has planned that are being worked on in the u pcoming fiscal year to improve care.

Accreditation 2023
Hon. Kim N. Wilson: Every four years BHB goes
through a major hospital -wide accreditation process,
which is an audit of its patient safety standards. A
team of Accreditation Canada surveyors come on site,
looking for evidence of compliance to thousands of
patient safety and quality care standards, talking to
patients, staff and community partners, meeting with
different groups and walking through every si ngle
BHB facility.
The last survey was in 2019. The next one is
in November 2023. The full report from the surveyors, including where improvements need to be made are
published on the BHB website. It is a major process
for the hospitals, as it covers every single department,
from the lab to communications, from mental health to
intensive care services and surgery. Adherence to


Bermuda House of Assembly these standards is not always visible and people may
not know that what BHB does is very much based on
standards of care that they are tested on. Indeed,
these are standards that BHB expects staff to meet
every day, and a n award accreditation pilot that ran
this year and focuses on meeting patient safety and
quality benchmarks will be rolled out more widely in
the upcoming year.
This h ospital -wide accreditation survey is
supplemented by specialist surveys from different accrediting bodies. This means they are, in effect, ac-credited twice. Just last week MWI’s substance use
services went through an accreditation process with
the Commissi on on Accreditation of Rehabilitation
Facilities. The BHB lab and blood donor centre is accredited by the Joint Commission International, and
Imaging Services is accredited by the American College of Radiology.
Optimising PEARL and implementing a digital
health strategy . After all the efforts to ensure a successful go- live with PEARL at the end of October,
work is underway to optimise it to get the best value
possible. This work will continue well into 2023. Opt imisation is the process of using the feedback from
staff using the system to make changes that ensure the system is supporting the best possible care deli vered in the most efficient way.
For example, are the workflows correct? Are
staff using PEARL effectively? This is a critical phase
all hospitals go through when implementing a new
electronic medical [record] system. Despite multiple
testing phases through the implementation, until staff
are working with the new system it is not known if something was missed. An optimisation committee is
already meeting to oversee several activities and
tasks to ensure we make best use of PEARL.
Activities to date have included clinical adoption sessions to help physicians use PEARL as effec-tively as possible, and a major health check will be
undertaken seeking more feedback from staff and using this to adjust the system.
The feedback from physicians who went
through the clinical adoption sessions has been a lmost universally positive. About 80 per cent of phys icians who had been identified for training participated.
Mr. Chairman, 75 per cent of these physicians had
been satisfied with PEARL prior to their session, and
97 per cent were satisfied with PEARL after they be nefited from a session. Similar sessions will be offered
to the larger staff group in 2023.
BHB is a lso in the process of finalising a fiveyear digital strategy which builds upon PEARL and into future. This is in collaboration and is in alignment
with the national digital health strategy work underway. BHB’s digital health mission is to be an integrator
for health across Bermuda.

Integrated Health Care Activities
Hon. Kim N. Wilson: Mr. Chairman, work within the
integrated health care programme will continue buil ding relationships and making improvements across BHB services. Focus will continue with bu ilding on the
successful pilot of the integrated health care clinic at
the Lamb Foggo Urgent Care Centre. This will include the future state design of the clinic and implement ation. The work to move mental health care options in
the community will continue, and MWI staff are already working with the Ministry to offer mental health
services once the Mangrove Bay Clinic will open.
The work done in the cancer pathway will be
used to make concrete improvements. Similarly, pall iative care improvements are planne d including a palliative care passport and designing criteria and referral
pathways for oncology, cardiovascular disease and
nephrology.
BHB is planning a diabetes pilot for staff to
see if it can better support staff with diabetes manage
their condition with support, and technology.

Stability
Hon. Kim N. Wilson: Finally, for 2023/24, there will
be continued efforts made to stabilise the BHB’s f inancial stability and also a smooth transition of leadership. Dr. Michael Richmond who was appointed to
the CE O position in 2020 on a three- year contract
ends his tenure in December of this year. He has
been at BHB since 2017, originally employed as the
Chief of Staff. The recruitment process is already in
place for the CEO role, starting locally. This leaves plenty of time for a smooth leadership transition.
I would end by thanking the BHB Board, leadership and staff for all their efforts to keep driving i mprovements to care throughout this challenging time.
Mr. Chairman, this concludes my remarks on
Head 24, Hospitals.

[Mr. Christopher Famous, Chairman]

One minute, Minister.
For the listening public, this debate will end at
4:57, and in 30 minutes there will be a change of
chairman.
You may continue, Minister.

Hon. Kim N. Wilson: Thank you, Mr. Chairman.
606 1 March 2023 Official Hansard Report

Bermuda House of Assembly Turning now to the final Head for Health is
Head 91, Health Insurance

HEAD 91 —HEALTH INSURANCE

Hon. Kim N. Wilson: Mr. Chairman, I will now present
to you, the budget for Head 91, Health Insurance,
found on pages B -167 through B-169 and C -19 of the
Budget Book.
Mr. Chairman, the mission of the Health I nsurance Department (HID) is to provide equitable access to affordable benefits and collaborative pr ogrammes, leading to improved community health outcomes. The demand for affordable health insurance in Bermuda remains high, and the Health Insurance D epartment continues to provide viable health insurance
products that are accessible to all Bermuda residents.
Mr. Chairman, for fisc al 2023/24, $3,343,000
has been allocated for this Head. This is an increase
of $674,000 compared with the original 2022/23
budget of $2,669,000, or a 25 per cent increase.
The Head 91 budget remains the partial source of
funding behind the Health Insurance Department (HID), which is responsible for developing and admi nistering the Government’s social health insurance
products offered to the public, including the
• Health Insurance Plan (HIP)
• FutureCare Plan (FutureCare)
• Mutual Reinsurance Fund (MRF), and,
• Government Subsidy Programmes (Subsidy),
which pay towards the hospitalisation costs of
select populations.
There are 18 FTEs associated with HID.
Mr. Chairman, HIP and FutureCare polic yholders have not seen a premium increase this fiscal
year. The HIP monthly premium remains at $459.24, while the monthly premium for FutureCare remains at $530.14. Since April 2022, Mr. Chairman, 2,119 HIP
policyholders and 4,318 Future Care policyholders
have exercised the new prescription drug benefit that
was launched in November 2021, which covers
100 per cent of the cost, up to $1,000 annually per
HIP policyholder and covers 100 per cent of the cost,
up to $3,000 annually per FutureCare policyholder.
Of the 2,119 HIP policyholders who have ut ilised the prescription drug benefit, HID has paid
$1,068,282 in claims, averaging $504.14 per active
HIP policyholder. Of the 4,318 FutureCare policyhol ders who have utilised the prescription drug benefit,
HID has paid $6,040,225 in claims, an average of
$1,398.84 per FutureCare policyholder.
The Health Insurance Department continues
to administer the Maternity Benefit Programme. The
goal of ensuring equity and access to essential care,
in this case maternity related care, remains important.
The programme pays maternity -related cl aims for up
to 100 pregnant women who qualify, based on their
uninsured status. To date, HID has paid $90,000 for
individuals who have qualified for and benefitted from this programme. HID looks forward to working with our
partners with a view toward possi ble expansion of the
programme, to ensure that the needs of this popul ation are met.
Mr. Chairman, the Health Insurance Depar tment continues to provide the Personal Home Care
(PHC) benefit to eligible policyholders. This benefit
has proven to fill home care gaps in the community
and supports the ageing in place concept. This benefit
contributes a pro- rata monthly maximum amount to
supplement the cost of in- home caregivers, which
provides income for those persons, such as family members and the like, who care for the policyholders.
There are currently an estimated 457 polic yholders who regularly use the PHC benefit, with HID receiving on average, eight new requests on a weekly
basis. HID continues to administer their in- home assessments virtually and by tel ephone, and the average wait time for an assessment is seven business
days. The nurse case management team can co mplete as many as eight to nine assessments per day,
which includes reassessments, administered at the request of the family/responsible party or health care
provider when clinically indicated, or on an annual
basis, to ensure appropriateness.
During the fiscal year 2021/22, HID paid out
$7,000,000 in PHC claims. To date, HID has paid out
just under $5,300,000 in PHC claims this fiscal year, averaging $11,535 per policyholder receiving PHC
benefits. It is anticipated that for the fiscal year
2022/23, HID will pay out a total of $6,800,000 in PHC
claims, which is a decrease of 3 per cent from the
previous fiscal year. This decrease can be attrib uted
to the PHC efficiencies made by the department, which includes a rigorous and detailed health assessment, as well as the development of a calculation
tool to assist in the total hours awarded, based on the policyholder need. It is expected that as the popul ation continues to age, this benefit will continue to grow
exponentially. HID continues to look at ways in which
to ensure maximum benefit to our policyholders who
utilise the personal home care benefit.
Mr. Chairman, the Enhanced Care [Pilot] Programme (ECP) is a programme HID has administered
since 2017 for the treatment of chronic noncommunicable diseases for the underinsured and uninsured. The programme provides access to primary
care which enables participants to receive treatment
they may not have had access to prior to becoming
part of the programme. Currently the programme has
89 active participants. These participants continue to receive access to their primary care physician four
times a year, without a co- pay and access to vital
medications to assist in the management of their
chronic diseases. Consensus from the programme
participants has been positive, and we continue to see
clinical measures trend down for this small cohort.
Mr. Chairman, the department will soon begin
work with the Off ice of the Auditor General on the


Bermuda House of Assembly 2018 financial statements and will continue to work
through the remaining fiscal years.
Mr. Chairman, I will now summarise the operating results of the various funds under HID’s admi nistration, followed by a discussion of the Performance
Indicators for the department over th is period.

Part 1: Operating Results

Hon. Kim N. Wilson: The Health Insurance Fund
[HIF] includes two products and policyholder groups,
those being HIP and FutureCare. Fiscal 2022/23 sees
an average policy headcount of 8,646, a 1 per cent
increase over the 2021/22 estimated headcount. Pr ojected, gross policyholder HIF premiums earned for
fiscal year 2022/23, should this constant remain,
would be $51,700,000, an increase of $2,300,000 or
4.7 per cent o ver 2021/22. Claims incurred in 2021/22
equalled $38,400,000 with 2022/23 claims incurred to
date, totalling $36,100,000, and estimated to be at
$41,600,000 by this fiscal year end. This represents an increase of 8 per cent.

FutureCare Operating Results

Hon. Kim N. Wilson: The projected headcount for
FutureCare in 2022/23 is 4,878 persons. An increase
of 102 persons, or 2 per cent, compared to the total
headcount in 2021/22.
Projected FutureCare premiums earned for
fiscal 2022/23 are $31,000,000, an increase of
$4,000,000, or 15 per cent from 2021/22. Claims i ncurred for 2022/23 as of date are $28,700,000. Est imated total in 2022/23 would be $33,500,000, as compared to $31,100,000 in 2021/ 22.

HIP Operating Results

Hon. Kim N. Wilson: The 2022/23 proj ected headcount for HIP is approximately 3,768 persons; an i ncrease of 13 persons or 0.3 per cent compared to the
31
st of March 2022.
Projected HIP premiums earned for fiscal
2022/23 are $20,900,000, an increase of $2,500,000,
or 14.0 per cent from 2021/22. Claims incurred for
2022/23 are estimated to total $8,130,000 as compared with $6,800,000 in 2021/22.

MRF Operating Results

Hon. Kim N. Wilson: The Mutual Reinsurance Fund
[MRF] premium for 2022/23 fiscal year remained at
$376.97 per person per month. As of the current date,
MRF totals are $158,000,000 with $17,610,000 per
month average. Should this remain constant, the 2022/23 MRF total will be $211,300,000, an increase
of $19,300,000, or 10 per cent over the prior year. The
administrative costs for 2 022/23 are estimated as
$300,000, an increase from $288,000 the year prior. Subsidy Operating Results

Hon. Kim N. Wilson: Mr. Chairman, the total for ecasted claims paid for hospitalisation under the Youth,
Aged and Indigent Subsidy Programmes are
$106,600,000 for the year ended the 31
st of March
2023. These claims, which are processed and adjud icated by the Health Insurance Department, are paid from the Consolidated Fund in the hospital budget and
represent a decrease of 8.5 per cent when compared
with fis cal year 2021/22.

Part 2: Performance Measures
(Qualitative Service Performance)

Hon. Kim N. Wilson: Mr. Chairman, we will now co nsider the department’s Qualitative Service Performance found on page B -169 of the Budget Book.
HID reviewed and revise d its performance
indicators, with a continued focus on the following objectives:
• improving HID stakeholder level of engagement and ease of doing business ;
• reducing paper use;
• operationalising Personal Home Care means testing ; and,
• improving reliability and efficiencies in the use of digital applications.
Mr Chairman, in light of the Throne Speech i nitiative to merge the Government Employee Health
Insurance with HID, in the 2023/24 year, HID will work to regularise its staffing situation, and the budgeted
increase anticipates these changes. HID is already
working with Management Consulting Services in this
regard.
Mr. Chairman, I would like to take this opportunity to thank the dedicated team at the Health Insur-ance Department and the Health Insurance Commi ttee for their continued hard work this past year. I
would also like to thank HID’s business partners:
Sutherland Healthcare Solutions, Argus Insurance, LifeWorks, Global Medical Management Inc, and Pr oServe, who continue to provide support to the Health Insurance Department.
Mr. Chairman, this ends my presentation on
Head 91, Health Insurance Department.
Mr. Chairman, in closing, as you can see, the
mandate of the Ministry of Health is wide- ranging. We
are lucky to benefit from the dedication, hard work ,
expertise and experience of a broad range of health
and business professionals. Their commitment to public health is unwavering, despite deep challenges with
resources, the growing health needs of our ageing population and, of course, despite the past tw o and a
half years of the pandemic and impact of such an i ncredible national health emergency on our ability to
deliver public health services.
I am indebted to our staff and to our health
partners who work long hours every day to plug gaps
608 1 March 2023 Official Hansard Report

Bermuda House of Assembly and catch peopl e who have fallen through the net, to
care for their health and social needs. I applaud their
extraordinary efforts and encourage the whole community to do so as well because, without them, Bermuda would look very, very different.
We look forward to collaborating with the wi der health system participants as we progress changes
which will strengthen our health system and achieve the Ministry’s vision for healthy people in healthy
communities .
Mr. Chairman, t his concludes my budget brief
for the Ministry of H ealth. Thank you, Mr. Chairman

Thank you, Minister.
For the benefit of the listening public we are
now in Committee of Supply for further consideration
of the Estimates of Revenue and Expenditure for
2023/24. The Honourable Kim Wilson, the M inister of
Health has completed her presentation. And now I
suspect the Opposition wishes to have something to
say.

Hon. Michael H. Dunkley: Yes, good afternoon, Mr.
Chairman.

Yes, Honourable Michael Dunkley.
You have the floor.
Hon. Mich ael H. Dunkley: Thank you, Mr. Chairman.
I will start out by thanking the Honourable
Minister for her presentation. I won’t say brief, because it was not brief. But I thank the Minister for her
very thorough presentation today on the Ministry of Health and its four different departments in the Mini stry.
Let me start out by saying that this is the second largest Ministry within the Government of Berm uda, right behind Finance. And that is solely because
Finance has an allocation in there of $130.4 million of
debt servicing. So without that, the Ministry of Health
would, quite rightly, be the largest Ministry within the
Government. And I say quite rightly so because, to
me, I look at it as the engine room; the engine room in two separate cases. One is the hos pital is there and
that is where we all go for our care when it is required. And, secondly, within this Ministry you have the D epartment of Health that is responsible for a lot of i mportant services, monitoring and things like that within
our community. So this is, to me, the most critical Mi nistry within the Government of Bermuda and I appr eciate the Minister taking some time to go through the
various heads in some detail.
Mr. Chairman, one thing that I always do
when we get into the budget debate, and I look forward to budget debates because it gives us an opportunity to focus in on the numbers in the book, but it also gives us an opportunity to see, as time goes by,
how the original estimates get revised, and then
changed to final budget numbers. And I t hink that is important for us to understand. But I think it is also
important when we look at the budgeting process for
us to take a look at that because, traditionally, if a
budget in a certain Ministry is spot on, this tells you
something very important. Or, if it is one way or the
other, this tells you something as well.
So, Mr. Chairman, as I start my comments
today, let me be very clear. My comments will critique;
but they will also support. I have the utmost respect
for the hundreds of individuals wh o work in the Mini stry of Health, whether in the departments of the Mini stry or within the hospital itself. Quite often they are on the frontline, but they are not seen on the frontline
because of the work that they do. And there is critica lly important work done quite often, as in the case of
the hospita l, seven days a week. And we should a ppreciate and understand that with the absolute critical
nature of the budget that we discus s today, it is i mportant that we take a look at it to make sure that if
there are challenges that we are facing within any part
of the Ministry, or department within the Ministry, that
we focus in on those challenges and we deal with them. And the Budget Book gives you an ample opportunity to look at that.
What the Budget Book does, Mr. Chairman, is
lets you understand government policy and how it is
portrayed into a government budget and then how it
comes out in the programmes and the money that is associated with the programmes. So, once a year we
have the opportunity to go through this budget exercise which is very important. And the Government obviously has their professional staff to support them, and I would like to acknowledge the work of their staff.
And the Opposition has the opportunity to look at prior
records that have been stated in the past, such as the
Budget Book, and also briefs from previous times.
I go through all of those, Mr. Chairman, because it is important in this Ministry, it’s critically i mportant, when we are focusing on health care that there are a number of key drivers to it. It is the deli very of care, which the Minister talked about; it is the
quality of care which we all expect to be of the highest
quality; it is the affordability of care which we have
been wrestling with more and more in recent years .
And, Mr. Chairman, I am pleased to see the Minister
focus on the prevention aspects that are required and
the focus in on a healthy lifestyle and diet.
Mr. Chairman, with some of those introductory
comments, let me start by looking back at the budget overall, because it tells us [of] a challenge that we
face, and a challenge that we have to correct.
Mr. Chairman, I remember three years ago in
this Chamber. When we started to debate the budget,
COVID -19 was just starting to catch all around the
world. It was March of 2020. I remember a comment
from the Honourable Pat Gordon- Pamplin, who is now
retired, where she made the suggestion at the time
that perhaps we should review the budget because of
the impact COVID -19 would have in our community. I


Bermuda House of Assembly thought that was an interesting comment at the time.
And as I reflect back now and have managed to get
some final numbers for, certainly, the Ministry of
Health, it was a very wise statement that was not really paid much attention at the time.
If you take a look at the budget for 2021, the
original budget was $193 million for this department.
Now we see the final budget come out at $205 million.
So that was $9 million more. If you take a look at
2021/22, which you will see on page B -148, the inside
column shows you t he final number for the total Mini stry of Health Department was $214 million. But, Mr. Chairman, the original budgeted number was $187.2
million. So there was a $27 million increase.
Now, a large part of that was because of
COVID -19 and money that had to be spent. Like the
rest of the world, we were caught doing our best. And
countries all over the world had to find money to
spend. But also there were additional spends for the
hospital. Then if you go on one more year, Mr. Chai rman, also on page B -148, you will see that the original
. . . you will not see the original estimate . . . sorry, the
original estimate was $194.5 million and the revised
estimate is now $213 million. So that means it has
gone up $18.5 million. The final estimate will be
known during the budget we debate for the next financial year.
So that goes up $18.5 million. In my general
review of the numbers, again, it is because of COVID -
19 and because of the hospital. So, Mr. Chairman,
this year the Government is seen appropriate to all ocate to this Ministry (and you will see the number)
$199.2 million, which is an increase of $4.7 million. I
focused in on those because it is certainly not a good
picture to see the increase in budget and the need for
Government to support more without understanding
how we are going to get that financial position under
control.
Mr. Chairman, if you take a look at this budget
for this department, in itself alone, hospital funding
just for the budget, not including the grant that comes
from the M utual Reinsurance Fund, but just the hosp ital money in the budget for this financial year of $155
million, is 15 per cent of the total government budget.
So that is quite a significant amount of money, Mr. Chairman. And it is important that we do all we can to make sure we get it right.
During the Minister’s presentation she mentioned some of . . . I should put it this way. During her
overview of the Ministry, the Honourable Minister
talked about the direction we were going and we are
pleased to see that the Minister made one comment, and I wrote it down, that COVID -19 was largely behind
us. So, the first question I have for the Honourable
Minister is what impacts of COVID -19 does she think
we should be cognisant of, or aware of as we go forward?
I think I am correct, Honour able Minister
(speaking through you, Mr. Chairman), that last week was a week where there were no active COVID -19
cases being reported in Bermuda. And that is certainly positive. I find it interesting —

Was that a pun intended?

Hon. Michael H. Dunkley: Well, sometimes the mind
works in interesting ways. I am trying to keep up with
the Minister’s humour in what often gets to be a m onotonous debate or can get to be contentious. But, it is certainly very interesting to me because I recall in this place, and other places, and certainly throughout
the world, like all politicians we watch the news quite
acutely. Two or three months ago, most people who had some authority in health would have said that
they would not believe that the world would be i n this
position with COVID -19 today, in a much better place.
Hong Kong is just opening up now; China’s economy
is starting to rebound. So, all of the alarming media
stories about COVID -19 seem to have disappeared
quite quickly. So this is certainly excelle nt news, because COVID -19 had a drastic impact, we all know,
on ourselves and how we lived, and on our health.
And couple that with some of the other challenges that we faced. Now we can get back and focus on things
that we expect to be in front of us. Not things that
have come in front of us, such as COVID -19 back in
2020.
Now, before I get off COVID -19, Mr. Chai rman, because the Government has spent a significant
amount of money in that direction, and I would not
want to try to estimate what total amount has been
spent in this time, but I think it would be appropriate if
the Government considered doing a review of COVID -
19, the money spent and how it was spent. I say this because a significant amount of money has been
spent. And it had to be spent quickly . I am aware of
that because we had challenges that we had to face,
and by and large, we got out of the starting blocks in a pretty reasonable position and we dealt with COVID -
19. We protected the community.
But, I think as the world starts to move on
from COVID -19, still with it in the rear -view mirror, that
there were challenges associated with it and still our economies are buckling under the strain of closing down, for example, quickly and unexpectedly, I think it
is important to take a look at how money was used,
how much money was used and if, in the future these
types of events take place, would we make the same
decisions because history repeats itself. Whether it is
five years down the road, fifty years down the road or a hundred years down the road, as was the last pandemic, history repeats itself. So it would be a good
learning experience.
I am not calling in any way for us to spend
exorbitant amounts of money on a review. I think there
are certainly bodies that can do a fair review of som ething l ike this in a cost -conscious way. The Auditor
General did an early COVID -19 review report, I don’t
610 1 March 2023 Official Hansard Report

Bermuda House of Assembly know if the Auditor General has one planned. The
Public Accounts Committee can look at it, or even the
Government can form a committee of parliament to
espec ially look at it, because I think the information
that we learn from that will put us in a much better
position as we move forward, Mr. Chairman.
Now, Mr. Chairman, the Honourable Minister,
for the last couple of years as I have been the Shad-ow Minister o f Health, has taken a fair amount of time
during the budget presentation to, my words, focus in on personal responsibility for our health. And we in the One Bermuda Alliance fully support that approach
because . . . and I say this casting a broad stroke. I f
you look around us now in recent years, too many of
us are more unfit and more unhealthy than is neces-sary. The Minister used the words diet, screen time,
which I think was important, and a lack of activity.
Very interesting enough that in making some notes for
this presentation, I used the word “diet,” I used “lack of
physical activities,” sitting in front of a TV or screen.
But I also , for a larger percentage of our older popul ation, focused in on excessive consumption of alcohol
and cigarettes or marij uana, which all has an impact
on our health.
It is interesting, because just this morning
when I was at the gas station I bumped into a guy and we were talking about health insurance. He made me start to think a little bit about it because we all expect
. . . well, many people expect health insurance to help
us when we get ill. It will. It will help us cover some of
the claim. But what it will not do, Mr. Chairman, is put
your body in a better position of good health. We have
a responsibility to get there. So we have a personal
responsibility to make it a good daily routine to do
some exercise, as Members in this Chamber I am
sure do on a regular occasion. So it hurts me, Mr.
Chairman, when I see so many people in our society
lacking in good health when the y could themselves do
something important about it.
One of the things that jumped out at me when
I was looking through the Budget Book through the
course of preparing for this debate (and I will find the
page), the Honourable Minister mentioned it when she gave her presentation. It’s on page B -158, Mr. Chai rman. If you look down at the third line from the bottom on the performance measures for the Department of Health, the third block line from the bottom, you will
see percentage of five- year-old students who are
overweight or obese to promote healthy habits. You
see that 33 per cent, which the Honourable Minister
mentioned in her presentation today. Well, Mr. Chai rman, I cannot ask you the question, but I will ask the Minister and colleagues a question thr ough you. The
original outcome for that percentage in 2021/22 was
16 per cent.
So, in two years we have seen the percentage
of five -year-olds grow from 16 per cent to 33 per cent
who are overweight or obese to promote healthy habits. That is telling you, Mr. Chairman, that the problem is bigger than we maybe have focused in on. And ev erything starts young. If you learn something when you are young, it will be a habit for a lifetime. If you
learned good habits when you were young, you can
be set for lifetim e.
So, Mr. Chairman, when politicians talk about
the importance of putting more time into our health
and into our personal responsibility of taking care of
ourselves, and helping our young people understand
the habits of healthy eating in getting our fami lies to
eat more prepared meals rather than take- out meals,
and getting our people to put our phones down to move , to get out and about, to be involved in society,
the results will be there very quickly. And I applaud
the Minister. And I will get to it thr ough parts of my
conversation today with the Chair. I applaud the Mini ster and the department for focusing in on healthy lif estyles and the promotion to do it as well because, Mr.
Chairman, you yourself know that too often too many
people will look at a ce ll phone and they miss the i nformation that they need to see. And some of the i nformation that we need to see is about healthy lif estyles because it is not on social media. That doesn’t
sell social media. But it is important that we have that,
Mr. Chairman.
I want to support the Minister and all colleagues in making sure that we all take some personal
responsibility in healthy selections and doing what we can because while the Government and the professionals in the industry of health care will do what the y
can, we need to make sure that we stay away from
their doors.

Inasmuch as your presentation is extremely enlightening, unfortunately, I have to give up
the Chair for the Honourable Scott Simmons.
So, for the benefit of my H onourable co lleagues and the listening public, we are now in Committee of Supply for further consideration of the Est imates of Revenue and Expenditure for the year
2023/24. We are debating the Ministry of Health. The
Minister, the Honourable Kim Wilson, JP , MP, of
Somerset has given her presentation and now the
Honourable Shadow Minister, Mr. Michael H. Dunkley
is giving his presentation which comes with questions.
So, now, I call upon the Honourable Scott
Simmons to come and take the Chair.
[Pause]



Bermuda House of Assembly [Mr. Scott Simmons, Chairman]

Thank you, Chairman Famous.
Honourable Members, we are now in Commi ttee of Supply for further consideration of the Est imates of Revenue and Expenditure for the year
2023/24. That would be Heads 21, 22, 24 and 91. As
the former Chair mentioned, the Honourable and
Learned Member, the Minister has already made her
presentation and the next to speak will be the Honourable Mr. Dunkley.
Mr. Dunkley, you have the floor.

Hon. Michael H. Dunkley: Thank you, Mr. Chairman.
So, Mr. Chairman, moving on from there, the
Honourable Minister has stated, and the Government
has stated through this budget process, that they will
be focusing in on nutrition and promotion of healthy
lifestyles. And we certainly support that. And I w ill ask
some questions in more particular when we get to
those various heads. But also, the Government has said that they are going to make some changes in
regard to the sugar tax and, in my words, that there is
going to be a review.
I certainly think that is wise to do because, Mr.
Chairman, I think tax is, certainly, for health purposes, something that most politicians would love to debate and support. However, I think when it comes to our
particular situation in Bermuda with food costs being
high and no w unfortunately inflation being high as
well, a 75 per cent tax on sugar is something that we
need to make sure that we keep in advisement to make sure that (1) it is not an onerous burden on a
very difficult time for people in food costs, but (2) to
make sure that this tax is being effective and the re venue is being put forward to programmes that can
benefit our community.
I understand this review is going to be based
around–– and I declare my interest because I am in
the food industry ––items that perhaps fell into the
basket of the tax that were not necessarily intended to be that. So, having said that, I look forward to the time
of that debate but I think it is good that Government is listening and I know that there have been a number of
Ministers who hav e worked on this and certainly the
Ministers who have worked through the pandemic on
making sure we had our food supplies, they should be
commended for at least taking them on board. And so,
I look forward to the opportunity to debate on that.
Now, Mr. Ch airman, I went through the overall
budget of the Ministry, and I looked at the expenses
and I related those to the House on how they have changed and now I am going to focus more specifically on Ministry Headquarters in itself. And at the top of
page B -149, there are five department objectives,
which I think are noble in themselves. And I think
members of the public would like to take a look at
those and understand the progress we have made on
them. The first one is Access: All residents have affordable health
insurance that enables them access to essential health services.
Well, I think that is a work in progress. It is
something that the Minister has alluded to.
Quality: Health services are safe and effective.
And I believe that we can check that we are
currently in a reasonable position, although we can do
better. I have always known that the quality of care is there whether it is for myself or people that I love or just in my job as a politician and Shadow Minister of
Health. So, I think we are in a good position here, certainly when you compare us with places around the
world.
Efficiency: The health system operates eff iciently to improve its financial sustainability and popu-lation health.
Now, that is one of the objectives that I think
we have to put a qu estion mark beside because there
is still a lot of work that has to be done because the financial sustainability is something that has to be questioned and I will get to that in more detail. The
next point is:
Accountability: The Ministry of Health operates in a way that is accountable, effective and transparent.
I think the Ministry does, but when it comes to
financing of our major hospital , we need to work on it.
And I will get to that.
Leadership: To provide strategic leadership of
the Health System.
Now, I know it is well- intended and the Go vernment is trying to do it, but with the (my words) stop,
start and the stuttering of the National Health Plan and
universal health care, I think that is a questionable
objective at this time because if we take a look back,
the National Health Plan was first mooted in 2010 by
the PLP Government at that time, and now here we are 13 years later still trying to make some progress
on it. So, those objectives I think are laudable and we
need to make sure that we keep worki ng at them because the report card is still in progress, Mr. Chai rman.
So, let me break down some of this budget
specifically here, Mr. Chairman. If you take a look at,
staying on page B -149, you will see that the . . . under
the General Administration lin e item of 31000, you will
see that the original budget for the current financial year was $2.7 million. It jumped up to $3.4 million and
now the estimate for the next year is $4.3 million.
So, Mr. Chairman, through you, a question to
the Honourable Minist er when the Minister has an opportunity to respond is, Those increases of $700,000 over the budget for the current financial year and
$900,000 new money for the next financial year, are
they actual spending in relation to the Programme Management office that the Minister talked about that
is being developed within the Ministry of Health? And
612 1 March 2023 Official Hansard Report

Bermuda House of Assembly if that is the case, the numbers that the Minister gave
out, those would account for the increases in those
areas.
So, you are shaking your head. The Minister
is shaki ng her head so I think we can do business like
this, that yes, that is correct. I appreciate that and I
thank her for the overview on that.
What I will say about that, and I am not saying
this, Mr. Chairman, as a criticism because I think the older I get, maybe the wiser I get, but the more I want
solutions rather than friction.

Mm-mm.

Hon. Michael H. Dunkley: If you take a look at this
new office of the Programme Management, and if you
take a look at the functions of the Bermuda Health
Council, some of their roles overlap or seem to be
interlocking or some of them seem to be of the same
responsibility. And so this new office of Programme
Management is working on a universal healthcare plan, but so is the BHC [Bermuda Health Council ]. So,
I am sure the Government has taken a look at it and is
cognisant of that fact, and they must feel comfortable
that we can be efficient doing it that way and so I just
want to raise the point and make sure that I understand how Government believes that we can have two
separate entities working on one plan, which is crit ically important to us.
Wouldn’t it be more efficient to have that office
of Programme Management within the Bermuda
Health Council to oversee it or have all the respons ibility for universal healthcare in the Ministry of Health?
Because now we have created two separate entities in two separate departments. Now, I know they talk to
each other but . . .
In relation to this subject, the Bermuda Health
Council was created a few years ago and every time
there is legislation in this House I have spoken to the
need to make sure that as we give the Bermuda
Health Council more responsibility, we also arm them
with the capability to take care of that responsibility.
And to me that is a critical point because I have seen some of the legislation come through this House and I
have looked at what they have to do and I am thinking, Wow. There is a lot of work that is involved in
that. And we have heard through time of the inability
for the Health Council to get the staff they need to get
the work they need done, all of that type of stuff. As it
relates to universal healthcare, time is not really on
our side in pushing this forward because a lot of time
has passed. And so we need to make sure that what-ever we set up in this new office of Programme Management we look for results on it because it has to
happen soon. So that is one point in relation to the
increased costs that I saw there.
Mr. Chairman, looking still on page [B] -149 of
the Budget Book —

That’s fine.

Hon. Michael H. Dunkley: I am going to Grants and
Administration, 31015 . . . the Minister outlined the
increase to $4.1 million and th e extra $500,000 to
LCCA. And the LCCA has always done great work.
And the Minister said that some of it was due to . . .
and I can’t find the notes where I wrote it down, but
some of it was due to, I think, excessive procedures or
something like that that had to be covered and the
costs were higher. A question to the Honourable Mi nister, I know the LCCA is always under a lot of pres-sure and I know that with the hospital struggling
through COVID -19 and [therefore] some of their services are limited, is any of this additional $500,000 to
the LCCA allowing them to cover some of the elective
procedures that are not . . . or unable to be done at
the hospital at the present time?
And the Minister is saying No, they are all
overseas. But as long as long as those procedures
can’t be done in Bermuda then I got the answer.

It is. Carry on.

[Inaudible interjection]

Hon. Michael H. Dunkley: Exceptional, exceptional
circumstances. Yes, the Minister’s words.
Minister, also, you said the SARC, the Sexual
Assault Resource [Centre] was $6,000 but then the
Minister said something about $61,000. So, if the Mi nister can clarify that at some time. I was lost in that.
I am pl eased to see that now we are getting
back to providing public health scholarships. Because
with the global shortage of professionals around the
world, I think that we are very ambitious in what we want to do within healthcare, but with the global shor tage of professionals around the world and talent of
any nature ––I guess you could put in that ––I think we
are going to find it harder to capture that talent. And
what I will do, I want to address this here now because time is not too much longer for this debat e.
What the Government appears to be wanting
to do is provide the affordability of healthcare, the
availability of healthcare to everyone, through universal healthcare as well. So, what Government has announced this year is opening up the clinic at Mangrove Bay. And I think, Mr. Chairman, on the face of it, I love that, because you want to bring it to people, especially seniors. Seniors don’t want to go too far out of


Bermuda House of Assembly the way to get any type of medical care now. They get
out of their comfort zone, and I understand that. But I
want to make sure that if we are going to open up that
clinic, which I support 100 per cent, because we got to
make sure we take care of the West End of the Island
so we keep winning the Cup for future generations.
Mr. Chairman, that w as a joke today for the East
Enders.

It is a reality for us in the West End.
[Laughter]

Hon. Michael H. Dunkley: Thank you very much.
But back to all seriousness, Mr. Chairman, we
want to make sure that if we open something for the
good and the benefit of our community we continue to
make sure that it is sustainable, not only with the pr ofessional services we need. And we know the hospital
is struggling for nursing. It is just everywhere. We
want to make sure that they have the staff to do what
they have to do and also financially we can sustain
that. So, I mention that not as a criticism but just as
marker so I can get surety from Government that,
Yes, we feel comfortable with the financial model will
allow it to work. And we won’t have to change the
hours that are being operated into place. We won’t have to change what is being offered in the clinic. All
this type of stuff. Because once you give something to people, it is very hard to take it back.

Mm-mm.

Hon. Michael H . Dunkley: Very hard to take back.
Now, staying on that grant on page C -18, you
will see that that grant , Mr. Chairman, for the Health
Council is $1 million. But now if you reflect back to the Honourable Minister’s comments during her present ation, my ded uction is that the Health Council will have
a budget this year of $4.3 million.

Right.

Hon. Michael H. Dunkley: The Minister is shaking
her head. So, there is budget of $4.3 million and last
year the budget was $3.1 million. The Health Council
is getting a $1.2 million increase, roughly, to do their
regulation, to do their quality and standards, and all
the different areas the Minister talked about. Last year
and this year the Minister talked about the high cost
for kidney transplants and all that type of stuff. So, I
raise that for the recognition, Mr. Chairman. I want the
best of healthcare for my loved ones and everyone in
Bermuda. We all deserve to have q uality of health
care, and dignity associated with that, whet her we are
younger or are in our older years. But one of the things that I see here now is
that budgets keep going up. While health insurance
costs keep going up, health care costs keep going u p.
So where is the affordability coming from, Mr. Chai rman? Now, that is not a criticism; that is a reality. Right? That we all face. Sometimes politicians have to
deal tough messages. Okay. If we all want something,
and we are giving it, we can never take it back. And it
is just like . . . I was talking with somebody the other
day about . . . there was a poll put out about what
people would like to see, “X, Y, Z” and people asked
for everything under the sun. And then the group
came to him and said, Okay, well, that is what we are
going to give you. But then they didn’t figure out how
they were going to pay for it. And so, the Government
has a very difficult challenge because everyone wants the best that they can get, but somehow we have to
pay for it. And that is why it is critical that we get our
economy in a better position.
If you take a look, Mr. Chairman, at the number of people paying into health care in Bermuda—and that is a question for the Honourable Minister.
Can the Honourable Minister give us some stats on
the number of people paying for health insurance in
Bermuda and has that number declined over the
years? Because we know that there has been emigr ation from Bermuda. We know that . . . we all talk about
it as politicians that there are more seniors in Berm uda. And so, if there are fewer people paying into the
health insurance then that means that that insurance
is going to become more expensive, or it has to be
shared around more with people who are already pa ying into it.
So, I raise those concerns that, yes, we can
. . . we should fund health as best we can but when
we do it, we also have to have that tough conversation
about how we are going to pay for it. Because now the
Bermuda Health Council is up to $4.3 million in their
revenue for the y ear.
To the Honourable Minister, to be fair, I see a
noticed improvement in the reporting that is done.
Their website is pretty up to date. It provides information. And the Honourable Opposition Leader and
myself and my colleague, the Honourable Susan
Jackson, had a meeting with the Health Council the
other day and I was quite comforted by the convers ation we had and also it seemed like their genuine de614 1 March 2023 Official Hansard Report

Bermuda House of Assembly sire to make a difference. But we need to make sure
that we are reining in increases because they have to
be paid [for in] some way. And when the economy is
struggling, it is going to be a difficult thing for us to do.
A quick question for the Minister, staying on
the same page [B -]149, 31030 Health Care Registr ation and Regulations . . . you will see that the original
budget for 2022/23 was $621,000. It rose to $808,000.
An increase of about $187,000. But then the budget
for this next financial year dropped down to $645,000.
What is the reason for that decrease?

I will let the Shadow Minister just
pause for a second. He will probably get a glass or just have a . . . give him a minute to just pause.
Members, we are now in the Committee of
Supply for further consideration of the Estimates of Revenue and Expenditure for the year 2023/24.
The Honourable Shadow Minister . . . I just
want everyone in the House know that it concludes at 4:57, which is about 37 minutes, by my math, from now.

Hon. Michael H. Dunkley: Okay. And I think we will
be all right without any more station breaks.

Yes, sir.
Hon. Michael H. Dunkley: Mr. Chairman, as I move
off the National Health Plan, because time is running tight and I can’t cover everything that I would like to
cover, to me the two main issues were to make sure
that we have universal health care so those people
who aren’t covered can have insurance. And the cost
of health care. But we have tremendous headwinds
that we have to deal with. Fewer people in Bermuda,
fewer people paying insurance, rising costs, more
seniors, more retired people, and no w it is important
that we make sure that we deal with those headwinds for the benefit of the people of Bermuda. So, I hope
this Programme Management office can get some
action, and they work very closely with the Gover nment (obviously they have to) but als o with the Bermuda Health Council.
Now, Mr. Chairman, flipping through some
pages here because obviously there is not a lot of
time left. I will go on quickly to the Department of
Health. Mr. Chairman, the Minister gave an overview
of the department that was very comprehensive. I am
not going to get into all the information, although I will read my notes and go through the Hansard and look
at some more information. But as I said before, I cer-tainly support the health promotion aspect of it. And
the increas e in dollars, if that is actually real, Health
Promotion [business unit] 32240, was $570[,000] for
last year. We are on page B -155. But we actually
spent $419[,000] and now it is $534 for the next fina ncial year. Perhaps that is because nutrition has been moved to another head by itself. And the Minister is
shaking her head, so—

[Inaudible interjection]

Hon. Michael H. Dunkley: Right. So now, I am co mfortable because I think now we are going in the right direction because people need to know. And coordinating those resources is important.

[Inaudible interjection]

Hon. Michael H. Dunkley: Yes, I got that. Yes, it
moved to Community Health.
Mr. Chairman, go halfway up that page to E nvironment Health and a question to the Honourable
Minster, the budget f or Environmental Health you will
see at the start of 2022/23 was $3.971 million. It is
estimated that only $3.454 [million] will be spent. So, a
reduction of about $520,000. Can the Honourable
Minister give some overview of why this is the case at
that tim e?
You see Vector Control was down significantly. Occupational Safety and Health was down signif icantly. And Port Health I can understand being down
a bit because we are coming out of COVID -19. But
when the estimate was made for $414,000, we should
have been able to figure out, Okay. We are still going
to have some lingering impacts of COVID -19. Why do
only spend $131,000? Now I am seeing it going back
up to the $3.96 [million] which is fine. But I am just
trying to understand the reduction in that.
There was a comment by the Honourable
Minister, I think somewhat in jest, about Vector Control. Those guys do a fantastic job as far as I am concerned. And you know, we can’t just say, People
shouldn’t put their trash out unless it is a trash day.
Because that i s easy for us to say. We need to take
some responsibility to make sure that when we say it
is going to be collected, it is collected, because a lot of
time it stayed there and you know. I have told my co lleagues whenever I have been out canvassing at unusual times, just dropping stuff off, that the rats are
there having a play day. They don’t care about people
anymore.
We need to do better than that because I think
it was Mayor Rudy Giuliani in New York, you know, he
said, It’s a broken window policy. If y ou see little
things that bother you, fix them. And this is a little
thing, Mr. Chairman, that we should fix. And it goes a
long way. Now, it’s not the workers’ fault because I know those guys are good. If I call them and have a
challenge in my constituenc y or somewhere, those
guys get right to it. I can’t stand vermin. And so, let’s
get rid of the vermin.
Mr. Chairman, switching back to page B -154,
you will take a look at Lefroy [House] Care Community and the Sylvia Richardson Care [Facility] and the
budg et for the current financial year for Sylvia Ric hBermuda House of Assembly ardson was about $170,000 more and for Sylvia Ric hardson [sic] it was about $300,000 more. Now, the
actual budget for 2021/22 for both of those facilities,
also saw the same thing. The budget for Lefroy Hous e
was $5.055 million. But the original estimate was
$4.65 million. So, you know, another $400- andsomething thousand was spent.
Sylvia Richardson was the same thing. About
another $300,000 was spent. So, based on the fact
that in the past two financial ye ars, more money has
been spent than was originally budgeted for, how do
we think that the funding for Lefroy House and Sylvia
Richardson would drop to levels below the last financial year? I think it would be a difficult thing to accomplish but I would be interested in understanding from the Honourable Minister how that would take place.
Now, let me say, myself and my colleagues
support the work of those two rest homes because by
all measures the standards and the comfort that our
seniors gets is laudable. One is relatively new and the
other one needs some work. The Honourable Minister did mention back when . . . on page B -5, I think it was,
Mr. Chairman, remembering off the top of my head the Honourable Minister did go back and talk . . . yes,
page B -5, abo ut capital development. And Lefroy
House is going to have $473,000 for refurbishment, and $250,000 [will be for] Lefroy House Care Com-munity. Now, with building costs in Bermuda drastically escalating over the past couple of months, I do not
know how far t hat is going to take us in the work that
is done.
But I am interested to see that $700,000 now
is being put to parish clinics. Mr. Chairman, there was no mention of that. I am not being critical of parish
clinics in any way, but I would like to see the money
being put into Lefroy House because it is an old buil ding. The PLP talked about renovating it when they
were the Government back in the 2010/11. We need
to make sure that our seniors are taken care of as
best as we can, but I can’t see how $700,000 is going
to do much to an old building. So, I would like to have
more understanding of what actually will take place
with that, Mr. Chairman.
So cognisant of time, let me just continue to
move on. One thing I will say, Mr. Chairman, [with the] Department of Health, the Honourable Minister in her overview [said], there was some conversation about
staffing levels. If you look at page B -157, you will see
that the original number of staff in the department was
285. This financial year it looks like the number of st aff
will be 240 and next year it will go to 290. So, can the Minister actually confirm that this 240 number is a r ealistic number of where we stand today? And can the
Minister confirm . . . is the Honourable Minister opt imistic that we can get the 290 staf f that we need in a
difficult environment to get people when everyone is
chasing human talent as well. And the reason why I
say that is because if you look at Lefroy House, they
were nine staff down. In the top of this budget line. Sylvia Richardson was al so down, six staff at that
time. So, these are important things that we need to look at.
Two questions to the Minister. How many v acant and funded posts are there in the department? How many vacant and unfunded posts are there in the
department?
So, Mr. C hairman, I am running out of time
and I need to devote some time to the hospital. As I said, the quality of care and the attentiveness that I
have seen there I am very comfortable with. But we need to call it like it is. And we need to stop making
excuses for it. We have a funding challenge that is still
not getting addressed, Mr. Chairman.

Go right ahead, sir.

Hon. Michael H. Dunkley: —page B -165.
The Chair man: No, go right ahead.
Hon. Michael H. Dunkley: Thank you.
We have a financial situation that is very concerning. If you look at the hospital over the past two
years, it has been $15 million over budget and $11
million over budget.
The Minister said today that cash reserves are
basically gone because there is $4 million that is u ntouchable. And I think the Honourable Minister said there was $6 million in reserves left. So, that is $2 mi llion, that is probably not even a couple of days of op-erating for them. And if you look at those two problems that I talked about, and the third one, the budget is not cutting it. It means the last couple of years we
have come forward with significant additional funding. The cash reserves are spent. And the financial repor ting is late.
Now, the Honourable Minister did give an
overview of the financial reporting, and I will deal with
that later, and I am pleased to see there has been
some progress made. But to me, it is still minimal. So, when you take a look at the financing of the hospital,
unless we arrest this very quickly, there is potential
that services and care could be impacted in some
way. And that is the last thing any of us want. No one
wants to go there. Because when I rush to the hospital
for care for a loved one or myself or a friend . . . now I
feel comfortable that they are going to be greeted with
the type of care that they need.
We do not want that to change. But the f inanc ing has gone downhill, Mr. Chairman, and I think
one of the reasons it has gone downhill is because in
2018/19 the PLP decided to go to the block grant, where it was capped at $322 million. And that might
have seemed like a good model, to tell somebody,
616 1 March 2023 Official Hansard Report

Bermuda House of Assembly Here, you have got $322 million you can work with.
Don’t come back and ask for any more money because we aren’t going to give it to you. But what that
does is it takes away the incentive to people to actua lly say, How can we get more people to pay money into it? Now, I could be totally wrong, but I was down
at the hospital not too long ago with somebody, wai ting for an emergency procedure, and I was talking to professionals down there. And I am not going to name
names because I don’t think that is important in this
conversation, but the operating theatres are not all open.
Now, I can see through COVID -19 that you
would have to make some precautions, but operating theatres, in my mind, are critical to a hospital, not only for emergency services, but elective services. And if
you can’t make that revenue, and this is only one way,
in electiv e services, you are chasing it somewhere
else—outside of the hospital or overseas. That is easy
pickings when you have professionals on this Island who are good at hip replacements, for example. Or knee replacement, or eye surgery, or whatever it may
be. A nd there is one reason why there is a gentleman,
very professional (I am not going to mention names,
again), who has opened up his own facility with an
operating facility in it.
So what we are doing with that block grant,
my assessment as a business person. I have studied numbers for a long time even though I don’t look grey
in here, it is there. I see we are chasing away the re venue. We are chasing away the incentive. And I ask
Government to take a look at that. It is important that
we get it right because we need that hospital. It is the
only hospital. I remember when it was just that little
one shelter you drove into on Point Finger Road. And
now, we have seen it has grown. And it has gone from
strength to strength. I was born there. My grandchi ldren have been born there. We go there for care. It is
doing the job for Bermuda, but we need to take full
hold of the challenges we face with the financials in
here.
And the Honourable Minister did say that the
2018 financials have now, I think, been deliv ered to
the Minister. (My words; maybe not the Minister’s
words.) But last year the Minister’s actual words were
that the 2018/19 financials are being designed. So in
one year it has just been designed and given to the
Minister. Now, I am not saying that . . . because it was
. . . the audit was good. It was a clean audit, from
what the Minister said. So I am not trying to allude that
there is anything nefarious going on there.
What I am trying to say is, when you are running an organisation this big, it is a major warning si gnal if your financials are not up to date, because it is
difficult to make important decisions that you will have
to make.
Now, I know the hospital probably has management accounts. Any facility, any good business will have management acc ounts which they can work from, which is some consolation. But as politicians,
when we come into this Honourable Chamber and we
have to make decisions and we have to approve a
budget for the hospital with a $322 million block grant,
it is very difficult for me to say, Okay, I’m cool with
that. I know I need to say that I’m cool with that, because they need the money. But I don’t want future
generations to say, I don’t want my grandson to say,
Hey, Pop, you were there when that hospital was u nderfunded year in and year out. What did you do
about it?
It is the future of Bermuda that is important,
so, this is a criticism but it is for the well -being and
safety of all of us. And it is taxpayers’ money going in. So, I was blown away when the Honourable Minister
had a press conference in referencing the Budget D ebate a couple of weeks ago and we heard that all of
the block grant wasn’t paid over the last four years.
And I am thinking to myself, Mr. Chairman, how could
the block grant fail to get paid when, one, somebody
from government has to pay it, and somebody in the
hospital has to receive it? So how could we miss it one year? We missed it four years for the tune of just
under $32 million. And now Government has given up,
had to pay $15 million which we . . . it does n’t look
good on the books right now. And there is still $16plus million left.
So a question to the Honourable Minister is,
How did this [situation] slip through the cracks. It is just simply inexcusable that something would slip
through the cracks like that.
A question to the Honourable Minister, when,
or will, the $16 million that has not been paid in the
grant, be paid?
Another question to the Minister is, What is
being done to make sure that future payments of the
grant are actually going to be paid on time?
Mr. Chairman, I think I have been direct
enough on my comments about the hospital and the
finances. I have little faith that with the budget this
year and the extra $50 million we paid last year, that
we are not going to be in a similar position when Parliament has to look at a budget in the next year, because while the Minister did mention that there have
been cost savings, she said the same thing last year. And I applaud the hospital for those cost savings.
They are in a very difficult position. As the Minister
said, they have been working seven days [a week]
straight through COVID -19 and they have been on the
frontline. They have burnout. But one of the most i mportant aspects of any business is to make sure that at the end of the day you know how your money is
being spent. You know when you money is coming in
and you make sure that you put yourself in a good
financial position. And we as Members of Parliament
have the fiduciary responsibility to make sure that we
ask these types of questions.
So, I have real concerns, Mr. Chairman, [if]
we will see improvements next year. Because last

B ermuda House of Assembly year and the year before I raised these concerns and
in all honestly I cannot put my hand on my chest and
say I feel better about where we stand today, because we had to pay $15 million because we are $32 million
short. And then when you look at some of the add itional challenges that the hospital faces, Mr. Chairman . . . if you give me an opportunity for a minute just to
talk about it, because I don’t think most people understand.

There are about 22 minutes left in the
debate.
Hon. Michael H. Dunkley: Thank you.
I don’t think most people appreciate and realise that every year the hospital has to make $42 mi llion of debt payments, give or take a bit, in three di fferent ways. So, for 2023 to 2044, we still have $251
million to pay on Paget Health Services, the contract
to build a new acute care wing. That is about $12 mi llion a year. We still have contract obligations to Paget
Health Services in respect to this acute care wing from 2022 to 2044 of $527.153 million. It is about $24 million a year, and various other long- term contracts
within the hospital, an average commitment of about $6 million. So that is about $42 million in debt that has to be paid every year.
So, I really get a little bit frustrated and exasperated when I hear Honourable Members of the Government talk about the airport. Because here we
are, a hospital that . . . they tried to build on the Botanical Gardens. Then they went over and built just an
acute care wing. We paid $42 million a year now going forward for a number of years and we are strug-gling financially to make this hospital do the work that is supposed to be done. And it is unfair on the staff
who are busting their backsides every day. And it
must be difficult on the financial officers who have to
juggle the books every day. So we need to free them up.
We need to free them up in a better way and
we need to bring the incentive back to business. B ecause when you take the incentive away from people, they just walk around. Not like zombies. But they lose their enthusiasm for doing things. We have to give them the incentive to get back into it. Because with the significant debt payment that we have, with the
significant funding we have, it is going to be a real
challenge.
So, Mr. Chairman, in light of my time, a question for the Honourable Minister is, What has been the
final position of the hospital as far as a profit or a loss in the last two financial years?
A question to the Honourable Minister, Since
cash reserves are at $6 million, will the current over-draft be sufficient to allow the hospital to run unen-cumbered through this next financial year?
Mr. Chairman, I am pleased to see oncol ogists here now. Let’s get on with the ENT and let’s bring some business back into the hospital so we can
make sure that our business, our health business
down at the hospital is very important.
So, in giving some time to my honourable co lleague, the Opposition Leader who would like to speak, let me wrap up by saying that I hope the Honourable Minister and the Government take my comments in the way that they are intended to try to steer
a better way for all of us in Bermuda. We have signif icant headwinds in health care that we have to deal with. A s somebody told me on the street the other
day, The cost of things are going up. The cost of
health insurance has gone up. The cost of health care
has gone up. I am not seeing any light in the affordability equation of that yet. And that is one thing that we
have worked hard to try to get to. Government hasn’t got there yet.
So I will end with one question, Honourable
Minister, do we expect increases in the Mutual Rei nsurance Fund premiums for the next financial year?
Thank you, Mr. Chairman, for your indu lgence
and I look forward to further debates.

Thank you, very much, Honourable
Shadow Minister.
Would any other Member like to speak to
these heads?
I recognise the Opposition Leader. Opposition
Leader, you have the floor.
Ho
n. N. H. Col e Simons: Thank you, Mr. Chairman.
I would first like to begin by thanking the Mi nister of Finance [sic] for her thorough brief. It was very
enlightening and informative. I would like to in es-sence pick up where my colleague, the Shadow Mini ster of Financ e [sic] finished. Mr. Chairman—

You were upsetting me.
618 1 March 2023 Official Hansard Report
B ermuda House of Assembly [Laughter]
Hon. N. H. Cole Simons: Let me just say this. Based
on what I have just heard the [$322 million] annual
obligation and the current guarantee obligation of $758 million, we are talking about an obligation to the tune of [$1,080,000, 000]. And is that sustainable? I
understand the need for a guarantee. And my question to the Minister is, or to the financiers in her de-partment, we issued that guarantee when we were planning for the development of the hospital. Fast fo rward 10 years, 15 years, our loan commitments have reduced. Is there a way that we can meet with the
principals, the people whom these guarantees are
benefiting, and sit around to reduce our commitment in that space, based on the level of debt that we have at this time?
I think it would be prudent for the powers that
be to investigate the possibility of renegotiating a new
guarantee based on the current level of debt. So I am
just putting that out there because I think it is chal-lenging for us to maintain a guarantee of [$758.12]
million for the duration of this development. And it is a burden hanging over us that will impact the financial
viability of the hospital. So that is something that I
would ask the Minister to consider.
The other issue that I would like to speak to is
a comment that I read about [the] service level.

Mm-hmm.
Hon. N. H. Cole Simons : I will go there if you will just
allow me.
Last year . . . it says, in December it took 442
minutes to get a bed assignment from emergency and
an average of 596 minutes to be admitted to the ward.
So we are talking about . . . you have to be in emergenc y for seven hours for a bed assignment. And then
an additional two hours to be admitted after the bed is assigned. So this is nine hours waiting, nine- plus
hours waiting. And I would ask the Minister, Where do
we stand today in the waiting periods?
We touched upon elective surgeries. I know
for a fact that for some of the preventative elective
surgeries, the waiting time is five months. And again, is there anything that we can do to make the schedul-ing more expedient so that we can reduce the time
one has to wait to have these important procedures
done, and to also address the waiting time in the emergency to get a bed? So, those are my service level issues. (I am just checking my notes, if you will allow me.) On the matter of the overdraft, last year it is
my understanding that they drew down $5 million. My question to the Minister is, What is the current level of the overdraft? How much is the current overdraft val-ued at at this time? Is there a possibility of renegotiat-ing that overdraft facility to make it more favourable?
I am certain that you should be able to get
with the institutions and possibly find a more favour able rate or terms and conditions. So if the Minister can show us the value of the overdraft facility, and what we are doing to manage this as well to make it more
efficient and more palatable to the institution from a financial point of view.
Just a second . . . bear with me. I think that is
all I have on the hospital. Oh, one other thing. This is hospital and the Ministry of Health Headquarters. This pertains to cancer pathways. I recently went to the
funeral of a young lady. She died of ovarian cancer. I was talking to her husband. He indicated to me that
during his wife’s last days he needed support because
he was helping her and trying to keep her comfortable during the last days. So my question to the Minister is, What support can we give spouses of cancer victims who are feeling the pain, they get depressed, number
one, because of the fact that they are losing their
spouse. They are act ually not equipped to deal with it
as a professional would, because it is so emotional.
Can the Minister give an undertaking to see
what we can do to help family members who are providing support to cancer victims in their household,
whether it is some type of respite where they can take
a day off and have somebody come in and help them, just to make it a bit more easier (if I can say that). B ecause when he said that I said I’ll raise it when I can.
You are not the only one who has been through that.
And maybe we could have some type of care for fam ily members who are going through these challenges.
Now, the Health Council (and then I will be finished). As the Shadow Minister said, I think we have a
very, very good team at the Health Council. They are comm itted to Bermuda, to the job at hand and they
are open to suggestions and their mandate is very, very broad. And as the Honourable Member Dunkley indicated, we have to position them to succeed. And I know that we have a commitment of $4 million. But the question is, from what I gather they may need more human capital to be able to deliver on their
mandate. They said, you know, the Minister indicated
that they had to basically look at enhancing the sy stem, consolidating the system, and one other mandate that they have.
My question is, Do we have a dedicated team
who is responsible for each of the mandates provided
to them under the Act? Are they able to provide a plan
for each of the mandates provided under the Act to ensure and measure the progression to ma ke sure
that their mandates are being met? We can’t have a Health Council that is putting out fires all the time. I know, I have been in business. In some of these i nBermuda House of Assembly dustries you live as a regulator putting out fires, a nswering questions. But the overarchi ng, long, sustai nable development of the organisation and the industry
is compromised because they can’t get to the core
mandate which is the sustained ability of health care and the long- term management of health care in this
country in a positive fashion.
Can the Minister give us an update on the N ational Digital Health Care Strategy, its features, and
how it works to consolidate the plans?
The last thing I have . . . because I want the
Minister to address some of the questions as well. Last year we had a total commitment of approximately
$7.76 million in COVID -19 expenses. Now that
COVID -19 has subsided, when we compare to
2020/21, what type of budget is the Ministry of Health allocating for the management of COVID -19 or its e ver-evolving . . . (what is the word that I want?) Om icron and other related respiratory diseases that fall
under the COVID -19 umbrella? So if the Minister can
provide what is budgeted for COVID -19 and its . . . (I
know the word; it just can’t come to me.) and its ever -
evolving respi ratory diseases.
And on that note I think those are my only
questions. Again, I say, Minister of Health and the
team at the Ministry of Health and the team at the
hospital, we are here for you. We want what’s best for you and we will work together to make sure that Bermuda’s healthcare is the best in class going forward. But it is going to take hard work and we have to deal
with the challenges. And as we stated, where there
are challenges there are opportunities. So, let’s work
together to get this done. T hank you.

Thank you. Good afternoon, Mr. Chairman.
First of all, I would like to disclose that I was a
former board chair member of the hospital and I am
also a member of the hospital board.
As was stated, I have a few questio ns but a
couple of comments. We are all at some point going to walk through the doors of this hospital. Whether it is
you, your children, your mother, your father —we will
walk through. And the expectation is that you will r eceive first -class quality care. The Bermuda Hospitals
Board and everyone who works there is committed to doing their job. And to my colleagues and to everyone
who works in that hospital, I commend you, especially during the pandemic.
I guess my first question to the Minister : Notwithst anding the delayed payment , is there any inte n-tion to reconsider the model that was in place for
2019?
My second question is, In terms of the preventative programmes with the clinic, is that the direction
that we are going to move into to offer more pr ogrammes in the community? For example, the clinic.
As you are aware, prevention and healthy lifestyle will
eventually reduce the cost of health care in this country.
I will also say that this Government is commi tted to ensuring that this hospital will not fail. They will
have the funds that are needed for it to function, to get
the appropriate equipment and to hire the appropriate
staff. In regard to nursing, another comment I want to
make is that as we know there are major challenges in
this country and al l around the world in terms of r ecruiting nurses.

None of us will desert
it. But the reality is if you want improved quality care, if
you are going to constantly be contacting Dr. Goggle
in terms of what you need, it is going to cost more
money for this hospital because we have to buy more
equipment and provide more services to provide the
care that this country demands. Thank you.

Four minutes.
Hon. Kim N. Wilson: Thank you.
—go through this as quickly as possible.
One of the questions that was asked by the
Opposition Leader, which I want to start with, which is
with respect to the person that . . . the husband . . .
that particular question. It is critically important and I just want to make sure that you have an answer. There are end . . . there are a number of existing su pports in the community for persons who are finding
themselves in similar circumstance. There is the endof-life palliative care benefit through the Standard
Health Benefit. There i s the caregiving programme.
PALS also offers and provides support as well as the Friends of Hospice.
Thank you, Mr. Chairman, going through the
other questions as quickly as possible. And these are not necessarily in the order that they were asked. The Honourable Member Dunkley asked about the headcount number. It is anticipated that 2021/22 was 46,558 and this year 2022/23 is 47,340, which repr esents a difference of 782 or 1.68 per cent. You asked
about headcount.

[Inaudible interjection]
Hon. Kim N. Wilson: [Those who] are paying into the
insurance.
[Inaudible interjection]
Hon. Kim N. Wilson: Okay. With respect to . . . going
back to the question about obesity. There was a ques-tion that was raised concerning the 33 per cent of
children who are obese. Child Health works in collab oration with Healthy Schools and public health nutritionists to promote the schools nutritional policy, which
includes school screening (which is ongoing).
And the question about Mangrove Bay. Yes,
we will rotate programm es and services. So some
services may be offered, for example, maternity health on a Wednesday in town and on a Thursday at Mangrove Bay. So we will be able to utilise services in that regard.
Grants and Administration. Is there an additional funding for LCCA, allowing them to cover . . . I
answered that with the headcount.
The total SARC programme, as I indicated, it
was an error in the Budget Book. So it will represent a total of $61,000—

[Gavel]

By all means.
Members, this is under Head 86 and 23. It is
set for three hours, and the time will be set from now
and it will conclude at 7:59 or 8:00, at 8:00 pm.
I recognise the Honourable Minister.
Minister.

Hon. Tinee Furbert: Thank you, Mr. Chairman.
I move that the following Heads: Head 86—
Ministry of Social Development and Seniors Headquarters, and Head 23— Child and Family Services b e
now taken under consideration.

It has been moved that Heads 86 and
23 be now taking into consideration.
Go ahead, Minister.


Bermuda House of Assembly MINISTRY OF SOCIAL DEVELOPMENT
AND SENIORS

Hon. Tinee Furbert: Thank you, Mr. Chairman.
Mr. Chairman, I am pleased to present the
fiscal year 2023 /24 budget estimates for the Ministry
of Social Development and Seniors which comprises
the Minist ry of Social Development and Seniors
Headquarters, inclusive of Ageing and Disability Services and the K. Margaret Carter C entre) and the Department of Child and Family Services .
Mr. Chairman, three hours have been allocated for this Ministry and I will attempt to finish in two
hours to give time for the Opposition to ask questions
or to seek clarification on fiscal year 2023/ 24 Est imates of Revenue and Expenditure for the Ministry.
Mr. Chairman, the 2023/24 budget allocations
for the Ministry of Social Development and Seniors will demonstrate that there is a continued commitment
with funding to support Bermuda’s most vulnerabl e
and cherished population group, that is our children,
persons with disabilities and our seniors. To this end,
Mr. Chairman, we have ensured that the services and
programmes offered by the Ministry will directly impact
and improve their overall well -being and quality of life.
Mr. Chairman, the Ministry focused on a number of national priorities during the last budget year
which are ongoing and will continue in the upcoming
2023/24 budget year. I will briefly highlight these.
Mr. Chairman, ensuring the best interest pr otections and safeguarding of our children is critical. As such, during the past year the Ministry of Social D evelopment and Seniors has been very diligent in d esigning and developing a Litigation Guardian Fram ework. The work has been intentional , particularly in
strengthening the partnership with the c ourts so that
focus on the welfare of our children is paramount. With the support of a Consultant from the UK Foreign
Commonwealth Development Office who was a for-mer chief executive of England’s Children and Family
Court, a new team of Litigation Guardians were
trained. Other training was held for s ocial workers and
managers in the Department of Child and Family Services , members of the Family Court Panel , judges ,
and acting magistrates. The aim i s to collaboratively
make the best decisions for our children and to ensure
that their voices are heard.
Mr. Chairman, during fiscal year 2022/23, the
Ministry of Social Development and Seniors held a
consultation process for the development of a National Plan for Adults with Intellectual Disabilities and their
families. This was to create awareness and ensure
that the p lan takes a coordinated approach for service
provision to address critical gaps impacting the lives
of persons with intellectual disabiliti es and their fam ilies. To facilitate and underscore meaningful inclusion
for persons with disabilities, an accessible easy -toread version of the National Plan has also been d eveloped. This is exciting work as we progress forward to empower all persons wit h disabilities with the requisite services, programmes and resources they require to live their best lives with dignity.
Mr. Chairman, Bermuda’s first -ever Gender
Affairs Council was established by this Ministry last year. It comprises 10 members who collectively bring
a depth of knowledge, skills and experience relevant
to gender issues in Bermuda and who represent nonprofit, civil society organi sations and entrepreneurs.
The Council is assiduously working on a terms of reference framework to steer the lo nger-term work, as
the Council will have the ultimate responsibility of
identifying and advising on the social, educational,
economic, and legislative factors to advance the best
practice principles of gender equality and equity in
Bermuda.
Mr. Chairman, t o raise awareness and educate the public about gender -based violence the Mi nistry of Social Development and Seniors organi sed its
first awareness campaign for gender -based violence
and participated in the observance of the United N ations International Day for the Elimination of Violence
Against Women with the theme UNiTE. This was in
solidarity with women advocates for the prevention of
violence against women and girls. Orange ribbons
were distributed that represented a bright future, free
from violence aga inst women and girls. The Ministry
strives to educate the public about matters concerning
gender affairs to empower our women, girls, men and
boys with the ultimate aim of eliminating gender -
based violence within our community, which many
times gets overlooked.
Mr. Chairman, last year the Ministry was directly involved in the U nited Nationals women’s initiative “Multi- Country Sustainable Development Cooperation Framework [2022- 2026]” as Bermuda l aunched
the Joint Sustainable Development Goals Fund Pr ogramme entitled “Building Back Equal through Innov ative Financing for Gender Equality and Women’s E mpowerment. ” This was attended by Her Excellency the
Governor, a UN delegation, Members of the House,
Senators and representatives for the UN Women Multi-Country O ffice—Caribbean, amongst others.
Mr. Chairman, the joint programme supports
Bermuda’s Economic Recovery Plan, p ost COVID -19,
by diversifying Bermuda’s economy to support the growth of new opportunities. It focuses on empowering women, youth and persons wit h disabilities to engage in key economic industry sectors. The pr ogramme will help Bermuda to achieve the UN Sustainable Development Goals , in particular, Goal 5 —
Gender Equality ; Goal 8— Decent Work and Economic
Growth ; and Goal 9— Industry, Innovation and I nfrastructure. Mr. Chairman, the Ministry continues to be
involved with the work of UN Women—Caribbean.
Mr. Chairman, during fiscal year 2022/23 the
Ministry engaged the community through various platforms, such as YouTube, Instagram, CITV, radio educatio n sessions, live -stream panel discussions and
622 1 March 2023 Official Hansard Report

Bermuda House of Assembly expos to ensure members of the public are aware of
Ministry initiatives, services and programmes that are
beneficial to them. Some of these included
• Joint Fund Programme: Building Back Equal
through Innovative Financing for Gender
Equality and Women’s Empowerment ;
• Parenting Expo;
• Nurturing our Nation: Imperfect Parenting S eries;
• Let’s Get Social ; and
• The Golden Hour .
Mr. Chairman, I am pleased to share some of
the events that were hosted by the Ministry of Socia l
Development and Seniors, which provided meaningful
interaction with a cross -section of people within our
community. The Ministry hosted its first Seniors Talk
and Tea in August 2022, attended by approximately
100 seniors. The Ministry understands that seniors are facing additional challenges in light of the rising
cost of living. This forum ensured our seniors were
able to learn more about the Ministry of Social Development and Seniors through an interactive present ation that was focused on the Ministry’s aims to i mprove the lives of seniors in Bermuda.
Attendees also had the opportunity to partic ipate in engaging discussions about their concerns
and how workable solutions could be attained. A question- and-answer period allowed seniors to pr esent questions to the guest panellists. The Ministry will
continue to provide the support and services that will
enrich and benefit the daily lives of our seniors so no
one gets left behind.
Mr. Chairman, during the past budget year,
the Ministry was directly associated with social protection efforts through proclamations, ministerial statements, guest speaking events, and p ress releases.
Some of these include
• International Day of Persons with Disabilities;
• World Elder Abuse Day;
• International Day for the Elimination of Vi olence Against Women;
• Human Rights Day 2022;
• World Braille Day 2022;
• International Women’s Day 2022.
Mr. Chairman, it is important that the public
knows that the monies budgeted for this Ministry for
the past fiscal year were directly invested in suppor ting our children, our seniors and our adults with dis abilities.
Mr. Chairman, let me move on to the summary of the fiscal year 2023/24 current account budget estimate for the Ministry of Social Development and
Seniors which is found on page B -281 of the A pproved Estimates of Revenue and Expenditure for the
year 2023/24 ( or Estimates Book).
The Ministry’s total budget estimate for the
fiscal year 2023/24 is $26,439,000. Mr. Chairman, this
represents an increase of $1,848,000 or 8 per cent compared to the ori ginal estimate of $24,591,000 for
fiscal year 2022/23.
Mr. Chairman, the breakdown of the Ministry’s
current account budget estimate for 2023/24 by head
as shown on page B -281 is as follows:
• Head 86, Ministry Headquarters —$7.62 mi llion, an increase of 10 per cent;
• Head 23, Child and Family Services —$18.814
million, an increase of 6 per cent;
• Overall Ministry total —$26.439 million, an i ncrease of 8 per cent.
Mr. Chairman, this summary shows that the
2023/24 current expenditure allocations for both Head
86 and Head 23 have increased. I will explain the i mpetus for these changes in the budget further in this
presentation.

HEAD 86 —MINISTRY OF SOCIAL DEVELOPMENT
AND SENIORS HEADQUARTERS

Hon. Tinee Furbert: Mr. Chairman, the current account expenditure for Head 86 —Ministry Headqua rters will now be presented and can be found on pages
B-281 to B -286 of the Estimates Book.
The Ministry Headquarters is responsible for
the budget of five business units: 96000—
Administration; 96040—Ageing and Disability Services; 9605 0—K. Margaret Carter Centre; 96060—
Policy Development; and 96070 —Grants to the Third
Sector.
Mr. Chairman, the mission of the Ministry of
Social Development and Seniors Headquarters found
on page B -282 is the protection of all individuals during their life time and facilitation of well -being. The o bjectives of the Ministry Headquarters are to
• collaborate with Ministry departments in order
to ensure overall policy objectives are met;
• create partnerships that will allow for better
coordinated services that are more synergistic
with Government’s social initiatives;
• help facilitate or improve social supports for
Bermuda’s at -risk populations; and
• advance Government’s social policy initiatives
with an emphasis on social cohesion.
Mr. Chairman, page B -283 shows that the total budget allocation for the Ministry Headquarters for
fiscal year 2023/24 is $7,625,000, distributed amongst
the following business units:
• 96000— Administration, $1,815,000;
• 96040— Ageing and Disability Services,
$980,000;
• 96050— K. Margaret Carter Centre,
$1,736,000;
• 96060— Policy Development, $154 ,000;
• 96070—Grants to the Third Sector,
$2,940,000.
Mr. Chairman, the total budget allocation re presents a net increase of 10 per cent, or $700,000.


Bermuda House of Assembly Business Unit 96000 —Administration

Hon. Tinee Furbert: I will now share details of each
of these b usiness units commencing with b usiness
unit 96000 —Administration , page B -283.
Mr. Chairman, the 2023/24 budget for the
Administration business unit 96000 of $1,815,000
compares to the $1,535,000 originally budget ed in
fiscal year 2022/23. This reflects an increase of
$280,000 or an 18 per cent increase as shown on
page B -283.
Mr. Chairman, the increase in budget alloc ation for this b usiness unit 96000 includes
• $160,000 to cover the cost for the treatment of
vulner able adults where all treatment options
available in Bermuda have been exhausted;
and,
• $120,000 for the National Seniors Regime,
which is inclusive of the National Seniors
Strategy.

Business Unit —96040 Ageing and Disability Services

Hon. Tinee Furbert: Mr. Chairman, I will now present
the budget for business unit 96040, Aging and Disabi lity Services (or ADS) which can be found on page B -
283 of the Estimates Book.
Mr. Chairman, the mission of Ageing Disability
Services is To support and protect seniors and persons with disabilities who are at risk of abuse, neglect
or self -neglect through providing compliance, pr ogramme delivery, education and stakeholder collaboration.
ADS, has a budget allocation of $980,000, for
fiscal year 2023/24. This allocation is 21 per cent
more than the budget allocation in fiscal year 2022/23.
Mr. Chairman, the primary focus of the Office
of Ageing and Disability Services is adult protection through their case management program me, but ADS
also provides accessibility consultations and educ ation. During 2022/23, Management Consulting Services completed its organi sational review of the structure and services offered by ADS. In alignment with
global trends, Bermuda continues to experience an
ageing population and it is critical that A DS is pos itioned to meet the increasing demands of our senior
population. The organi sational review recommended
that in addition to its current three c ase managers
(with social work backgrounds), ADS should be r esourced with two s ocial workers and a p olicy analyst
as staff capacity will continue to be an important var iable in the sustainability of the support services for seniors who often need assistance with daily living.

Accessibility

Hon. Tinee Furbert: Mr. Chairman, one function of
ADS is to provide guidance to community individuals
and government partners to ensure accessible buil d-ing and environmental design. The ADS Accessibility
Officer completed 52 assessments/consultations prior
to the end of 2022 compared with 28 assessments
completed in 2021. The Accessibility Officer is on
track for the targeted performance measure of 60.
While COVID -19 significantly impacted this
measure previously, consultative engagement and
assessments have increased by 53 per cent in co mparison to last year. Under this remit, ADS is also r esponsible for processing duty relief exemption r equests for materials to facilitate persons age ing at
home. To that end, ADS received and approved five
duty relief exemptions this past year compared to
three in 2022/23.

Education and Aw areness

Hon. Tinee Furbert: Mr. Chairman, education and
awareness has been limited in recent years due to ongoing resource challenges. High complex cas eloads resulted in education resources being redirected
to case management. However, ADS provided or par-ticipated in six education and awareness events during the last year. These included the following:
1. Celebration of UN Day for Disabilities incl usive of a p roclamation by the Minister .
2. As an ex -officio member of the Disability A dvisory Council, ADS helped t o coordinate and
promote various activities for the UN Day which included:
o a virtual open house held by Dame
Marjorie Bean Hope Academy, Special Olympics at the National Sports
Centre,
o a One Special Night’s Dance, and
o the WindR each Common Ground
Conference focusing on employment;
3. Hosting two information sessions to parents and carers of persons requiring receivership
for their adult children .
4. Provision of information on the services and
supports offered by ADS for adult protection in
recognition of World El der Abuse Day .
5. Participation in the Department of Health’s Wellness Week; and,
6. Participation in a town hall meeting about the
National Plan for Adults with Intellectual Dis abilities .
Mr. Chairman, ADS continues to engage with
partners on key issues impacti ng our seniors, such as
financial exploitation, cybercrime, client welfare and receivership.
Case Management

Hon. Tinee Furbert: Mr. Chairman, case management continues to represent the largest staffing com-ponent and primary programme of ADS. The current
team is committed to supporting our seniors and persons with disabilities in the community. This is done
624 1 March 2023 Official Hansard Report

Bermuda House of Assembly through both general case management and adult
protection services, which includes receiving senior
abuse reports as required under the Senior Abuse
Register Act 2008.
Mr. Chairman, case management clients include seniors and persons over 18 years old with a
long-standing disability .
General case management is provided to
these groups if they are not already being supported
by another direct service , such as KEMH, the D epartment of Financial Assistance or the Department of
Health. General case management services include
needs and service identification, system navigation
and support coordination. Adult protection pertains to
ADS case management clients at risk of abuse, ne-glect or self -neglect, which can include but is not li mited to s enior abuse cases.
During the fiscal year 2022/23 ADS received
and opened 257 new cases which included
• 19 case management referrals for persons under 65 years with disabili ties, and 3 reports
of abuse of persons under 65 with a disability;
• 151 case management referrals (general and adult protection) for persons over 65 years of age;
• 84 reports of alleged senior abuse:
o 31 were for financial exploitation;
o 18 were for psycholog ical abuse;
o 19 for neglect ;
o 15 for physical abuse; and
o 1 report of sexual abuse.
Mr. Chairman, t he average caseload per case
manager worker during 2022/23 was 1 to 48, close to
reaching 1 worker per 60 clients at times. As of February 2023, the case management section had already opened nearly 250 cases and is averaging
close to 1 to 60 caseloads.
Due to the increased demand for case management services, the primary focus of case man-agement has shifted to mitigating the immediate risks to client welfare. A s a result, resources will be expanded over time to also focus on needed long- term
case management to help prevent case recidivism and improve the quality of life for clients.
Mr. Chairman, the following advances were
made within the case management programme last
year:
• The case management team was provided four sessions on Adult Protection Specific (APS) training. The APS competency training
focused on intake, investigation and risk assessment and was complemented by inter-view training from the Bermuda Pol ice Se rvice; and
• Staff participated in workshops for the Multi -
Agency Risk Assessment Conference
(MARAC), organi sed by the Bermuda Police
Service for a coordinated domestic violence response that included training by SafeL ives
UK.

Mr. Chairman, collaborat ive partnerships are
essential to ADS case management and its senior
abuse remit. During the past year key partnerships
with the Bermuda Government’s Care Homes, KEMH,
Mid Atlantic Wellness Institute, Bermuda Health
Council and the Bermuda Police Service have i mproved and sustained. These collaborative partner-ships are necessary to ensure timely and effective case and investigation coordination. This includes the
MARAC development process that was highlighted
earlier as ADS will be a member of both for gover nance and implementation.
Another key collaborative effort is the work
with Mid- Atlantic Wellness Institute (MWI) supporting
clients with complex needs due to intellectual disabil ities. ADS currently manages the contract for one adult overseas and does s o in collaboration with the clinical
team at MWI in the Community Intellectual Disability
Team. This collaboration is essential to ensure the client is receiving appropriate services in order to faci litate a transition back home .
Mr. Chairman, ADS received approval to pu rchase a s tructured decision -making framework tool for
its case management programme . This framework is
an evidence- based tool to identify and define popul ations served, service priority and response times, servicing planning, closure and recidivism risk. It will help
social workers in their decision- making to ensure all
decisions are consistent and based on evidence.
Mr. Chairman, ADS has engaged and supported work towards systemic solutions and changes
which include
• development of the Natio nal Plan for Adults
with Intellectual Disabilities, including an a ccessible easy -to-read version;
• consultation on the project development of a
National Disability Register and long- term
care sector development ;
• the re- engagement of the Transition Team to
facilitate system development and case coordination for persons with complex disabilities ;
• the execution of a project plan to deliver on a National Seniors Strategy over the next six
months ; and
• provision of data and information for the Joint Strategic Needs Assessment by the Ministry
of Health.
Mr. Chairman, I want to take this time to
acknowledge the committed efforts of the ADS team. Adult protection work is innately challenging. With an
ageing population, the workload is steadily increasing,
the complexi ty of the cases is rising but despite [this] ,
the team remains focused and supportive of their cl ients with the goal to reduce risk and support the rights of the client which they keep central.



Bermuda House of Assembly K. Margaret Carter Centre

Hon. Tinee Furbert: Mr. Chairman, the K. Margaret
Carter Centre, or KMCC, business unit 96050 (page
B-283) provides direct support for persons with inte llectual disabilities through day programme services.
For the fiscal year 2023/24, K. Margaret Carter Centre
has a budget allocation of $1,736,000, which funds 16
staff in delivering direct client services to 41 service
users, participating in six different programmes.
Mr. Chairman, despite the COVID -19 pandemic challenges KMCC had to navigate through, it
continues to succeed in delivering progra mme s while
ensuring the safety of clients and staff is the number -
one priority. The past year was spent increasing attendance for all clients and now all 41 service users
have the opportunity to attend five days a week. This
results in a 100 [per cent ] return of the client popul ation returning to regular day programming service.
The clients are engaged in various programme s which
improve their quality of life and help build skills for
meeting personal care but also developing both voc ational and life s kills.

Minister, we will pause just to remind
Members that we are now in the Committee of Supply
for further consideration of the Estimates of Revenue and Expenditure for the year 2023/24 under the Mini stry of Social Development and Seniors. Those heads
are Heads 86 and 23.
You may proceed. You may go ahead, Mini ster.

Hon. Tinee Furbert: Thank you.
Mr. Chairman, at the K . Margaret Carter Centre,
• 47 per cent of clients actively engaged in life
skills progra mme s to improve their independence and
teach them meaningful skills, while 19 per cent participated in home economic programme s such as the hot
lunch programme and creating crafts for sales.
• 19 per cent of clients worked diligently on
work projects within their programme , completing
paint can labels, laundry programme s and sorted
COVID -19 test kits from all our community partners
who continue to support us. We were able to expand
the program me this year to include a partnership with
the bus depot, managing their lost and found and r eturning items to the various schools across the I sland.
• 19 per cent of clients took the lead on a
community garden at KMCC. They were recogni sed
for their efforts with the Government Community Garden competition where they took home third prize.
The most rewarding aspect of this programme was
including the produce in the cooking programme s.
Mr. Chairman, during the last year, KMCC f acilitated the following services and improvements:
1. Engagement with the community Intellectual
Disability team. This was a key f actor in the development of clients. It included coordination between case managers and various
members of their team including a psychology
assistant, occupational therapist, physical
therapist and rehabilitation therapist.
These services have been key in identifying
the abilities and skills of clients which can be
used to improve their quality of life and i ncrease their independence.
2. Support for the training of athletes for the
2023 Special Olympics which will take place in June 2023 in Berlin. We are ple ased that
six clients will be attending the games this
year.
3. Completion of training with a clinical ps ychologist who is an expert in the field of inte llectual disabilities. The staff team actively engaged and continues to apply the knowledge
on a daily bas is to improve overall programming.
4. With the support of ADS, KMCC implemented
Penelope, a case management software, to
ensure there is documentation of the ongoing
complexities that families are presented with;
and, to ensure assistance is given to mitigate
those challenges and meet client needs.
5. KMCC successfully hosted a community
dance which continues to strengthen their r elationships with community partners. This also
ensures clients have opportunities to attend
social events outside of the day programme
which helps to increase their quality of life and
access to the community.
Mr. Chairman, I had the opportunity to attend
that [dance]. It was a good time!
Overall, it is anticipated KMCC clients will reengage in community work progra mme s across local
businesses and have access to meaningful emplo yment while relationships are being built with key par tners.
Mr. Chairman, the Ministry of Social Deve lopment and Seniors will continue to implement the
measures needed to improve the quality of life of the
KMCC clients, to increase their independence, and
ensure clients are receiving high- quality care at all
times.

Policy Development

Hon. Tinee Furbert: Mr. Chairman, I will move on to
business unit 96060, Policy Development on page B -
283. For fiscal year 2023/2 4 [a sum of] $154,000 was
allocated for policy development. This is a decrease of $5,000, or 3 per cent, compared to $159,000 allocated
in fiscal year 2022/23.
The policy development section has one full -
time equivalent as shown on page B -284. This policy
resource supports the Ministry’s policy commitments
626 1 March 2023 Official Hansard Report

Bermuda House of Assembly which include Throne Speech initiatives and the Go vernment’s platform promises.
Mr. Chairman, $2,940,000 has been allocated
for the fiscal year 2023/24 for b usiness unit 96070,
Grants to the Third Sector , as shown on page B -283.
This is an increase of $267,000, or 10 per cent compared to the fiscal year 2022/23 [with an] original allocation of $2,673,000.
Mr. Chairman, the breakdown of the budget
allocation for grants can be seen on page C -21 of the
Estima te Book. In financial year 2023/24 the following
charities and organi sations will receive a grant from
the Ministry of Social Development and Seniors for
providing our community with the resources, support,
and services it needs to assist our residents:
• Age Concern programmes consist of information, advice, and referral services via their call centre. Other support and services pr ovided are financial support for groceries, pr escription drugs, and minor home repairs. A grant allocation of $25,000 will be pro vided.

• To uphold the Ministry’s commitment to our senior population, grants totalling $1,445,000 have been allocated to rest homes. These
rest homes are Packwood Home, Matilda
Smith Williams and Lorraine’s Rest Home.
• The Women’s Resource Centre has been a llocated $75,000 to enhance the lives of women in Bermuda and its vision is to be the leading resource and voice for women in Berm uda.
• Care of the Blind, now known as Vision Bermuda, is the only organisation on the Island to
provide a full range of special ist services for
persons within our community with low or no vision. They will receive a grant allocation of
$15,000.
• A $50,000 grant has been allocated to Meals
on Wheels, which supports vulnerable me mbers of our community through the lunch ser-vice of Mea ls on Wheels.
• The Centre Against Abuse will be allocated a grant of $150,000 as they continue to provide
crisis support services for victims of domestic
abuse and sexual assault .
• Salvation Army . The government is com mitted
to our homeless population and to ensuring
they have accommodations and services. A grant of $550,000 will be given to Salvation
Army Shelters.
• The Summer haven facility provides residents
of our community who have physical disabil ities the opportunity to live independently and
will be giv en a grant of $600,000 to support
their operational costs.
• Tomorrow’s Voices provides services to individuals in our community who are diagnosed
with autism or are on the autism spectrum. A grant of $30,000 has been allocated as financial support .

Subject ive Analysis of Current Account Estimates
Hon. Tinee Furbert: Mr. Chairman, I will now discuss
the combined subjective analysis of current account estimates for the Ministry as found on page B -283 of
the Estimates Book.

Salaries

Hon. Tinee Furbert: Mr. Chairman, the budget all ocated for salaries is $2,211,000 in fiscal year 2023/24,
a decrease of $6,000. This salary allocation covers
the Ministry’s 27 full -time equivalents.

Communications

Hon. Tinee Furbert: Mr. Chairman, communications,
inclusive of phones, courier, and postal costs, are
budgeted at $52,000 for financial year 2023/24, which
represents a slight increase of $2,000, or 4 per cent
over the budget allocation for 2022/23.

Professional Services

Hon. Tinee Furbert: Mr. Chairman, professional services of $1,686,000 for fiscal year 2023/24, which is
an increase of 25 per cent . This includes funding for
overseas treatment not available on the Island for vulnerable persons; increased funding for the National
Seniors’ Regime; and a new S tructured Decision -
Making tool for Ageing and Disability Services.

Rentals

Hon. Tinee Furbert: Mr. Chairman, $103,000 has
been allocated to rentals for fiscal year 2023/24. This
increase of $93,000 in rent resulted from the office
relocation of the Ministry Headquarters.

Repair and Maintenance

Hon. Tinee Furbert: Mr. Chairman, in fiscal year
2023/24 repair and maintenance has been allocated
$114,000 or a 2 per cent decrease over the budget
allocation for 2022/23. This decrease in funding r eflects a reduction in t he cost of cleaning services.

Materials and Supplies

Hon. Tinee Furbert: Mr. Chairman, $125,000 has
been allocated for materials and supplies for fiscal
year 2023/24. This represents an increase of $12,000
or 11 per cent which reflects the extra costs of mater ials and supplies associated with the office move.




Bermuda House of Assembly Other Expenses

Hon. Tinee Furbert: Mr. Chairman, $8,000 has been
allocated for other expenses which is a decrease of
$2,000 representing a reduction in costs for food sup-plies.

Grants and Contribu tions

Hon. Tinee Furbert: Mr. Chairman, grants and contr ibutions were addressed earlier in my presentation.
The allocation increased by $267,000 or 10 per cent.
Increases are budgeted for Matilda Smith Williams
Home, Packwood Rest Home, Tomorrow’s Voices
and the Centre Against Abuse which was budgeted under Administration (business unit 96000) in the prior
year and is now shifted appropriately to Grants.

Employee Numbers (Full -Time Equivalents)

Hon. Tinee Furbert: Mr. Chairman, on page B -284,
you will no te that there are 27 full -time equivalent positions for the Ministry of Social Development and
Seniors Headquarters for financial year 2023/24.
These cover: three full -time equivalents for Headquarters Administration; one full -time equivalent for Policy
Development; seven full -time equivalents in Ageing
and Disability Services; and 16 full -time equivalent
employed with the K. Margaret Carter Centre. There
was no increase in the number of FTEs compared
with financial year 2022/23.

Performance Measures
Hon. Tinee Furbert: Mr. Chairman, performance
measures, for business unit 96000 —General Admi nistration are outlined on page B -285.
Mr. Chairman, I would like to take this opportunity to thank the Ministry Headquarters team for
their diligence and for remaining committed to delivering the requisite services for our community.
Mr. Chairman this concludes my budget
presentation for Head 86 —Headquarters .

Thank you, very much, Minister.
And just to remind Members that we are in the
Committee of Suppl y for further consideration of the
Estimates of Revenue and Expenditure for the year
2023/24, and we have doing Heads 86 and 23.
Carry on, Minister.

HEAD 23 —DEPARTMENT OF CHILD
AND FAMILY SERVICES

Hon. Tinee Furbert: Thank you, Mr. Chairman.
I now wis h to present fiscal year 2023/24 estimates of expenditure for Head 23 —the Department
of Child and Family Services, which are found on
pages B -287 through B -294 of the Estimates Book. Mr. Chairman, the mission of the Department
of Child and Family Services is protecting children by
strengthening families . The objectives of the depar tment are to
• minimise and eliminate those social, psychological, or other conditions known to cause or
contribute to physical and emotional illness and sometimes socioeconomic problems;
• promote growth and directional change in
people, and their social situation;
• assist in facilitating or improving social support for those in our population who are at
risk;
• provide treatment or curative services to address dysfunction and thereby as sist people
to function better in society;
• restore individuals to a healthy condition or useful capacity.
The department carries out its objectives by
providing investigative services; day care services;
care and protection services for children; residenti al
and home- based services for families; assessment;
intervention and counselling services for children, adolescents and families.
Mr. Chairman, the current account estimates
for Head 23, begins on page B -288 of the Estimates
Book. A total of $18,814,000 has been allocated for Head 23 for financial year 2023/24. This represents
an increase of $1,148,000 or 6.5 per cent.
Mr. Chairman, the Department of Child and
Family Services (DCFS) continues to focus on devel-oping an integrated service that allows children, ado-lescents and families to receive services that are appropriate, coordinated and meet challenges they face.
These challenges can include but are not limited to uninvolved parenting; limited parenting capacity; s ocial and life skills; housing; employment; budgeting; abuse of substances; antisocial behaviour; cognitive debilities; education; mental health conditions and
anger management.
Mr. Chairman, in order to meet these responsibilities, the Department of Child and Family Services
operates five progr ammes
• Programme 2301— Services to Children and
Young Persons;
• Programme 2302— Services to Individuals
and Families;
• Programme 2303—Residential Treatment
Services;
• Programme 2304— Administration;
• Programme 2305— Mirrors Programme.
Mr. Chairman, in fiscal year 2022/23, with the
transition to living safely with COVID -19, DCFS r eturned to providing full -service delivery with all in -
person services to children and families. Safety prot ocols continue to be reviewed and updated as needed, to not only ensure safety but to maintain consistent
performance quality with best practice standards and
accreditation.
628 1 March 2023 Official Hansard Report

Bermuda House of Assembly Mr. Chairman, the US Council on Accredit ation has approved the Bermuda National Standards
[Committee] which is used locally for accreditation of
entities including DCSF who manage children. The
Bermuda National Standards Committee provides that
review and accreditation. I am pleased to report that in
quarter 3 of 2022, in accordance with the requir ements from the Council on Accreditation Standards,
five sections with in DCFS (Intake and Investigations,
Assessments, Counselling and Life Skills (CLS), Family Preservations and Foster Care) all successfully
completed their re- accreditation self -studies and anti cipate receiving feedback before April 2023.
Mr. Chairman, serv ice improvements have a lso been achieved by the Department of Child and Family Services implementing a strategy that begins
with the enhancement of a Structured DecisionMaking [Assessment] tool, designed specifically for
Bermuda taking into account our cu ltural identity and
social norms.
Mr. Chairman, since 2013, the use of the
Structured Decision- Making Assessment tools allow
staff to objectively determine safety and risk for all
children and their families who are referred to the
DCFS. This tool utilises a comprehensive assessment
that ensures clients receive the appropriate support
and/or services from the appropriate agency. This process reduces referral duplication, closes previously
identified gaps in service delivery and increases overall efficiency and effectiveness of programmes. Util isation of this tool has resulted in an improved, comprehensive service delivery system that has increased response time to initial referrals. Also, this tool further enhances appropriate prioritising of referrals accor ding to risks and ensures that the highest risks are addressed first resulting in better responses and positive
outcomes for clients.
Mr. Chairman, I will now address each pr ogramme and business unit for DCFS as set out on
page B -288.

Services to Children and Young Persons
(Programme 2301)

Hon. Tinee Furbert: Mr. Chairman, the Happy Valley
Child Care Centre, business unit 33010, has a budget
for the fiscal year 2023/24 of $1,061,000. The output
measures for the Happy Valley Child Care Centre are
found on page B -288 of the Estimates Book.
Mr. Chairman, Happy Valley Child Care Ce ntre is the only Government -operated Child Care facility
on the Island that provides high- quality childcare for a
maximum of 44 children whose ages range from three
months to four years of age. Priority is given to chi ldren referred by helping agencies such as DCFS,
Teen Services, the Department of Health, the Child Development Programme and the Department of F inancial Assistance. These agencies along with fam i-lies experiencing various challenges account for
60 per cent of the Centre’s intake.
Mr. Chairman, each year there is increased
demand for [childcare] placement at the Happy Valley
Child Care Centre. For the school year 2022/23, [there were] 172 applications received for the 16
available spaces that included
• infant spaces —6
• toddler spaces —5
• pre-schooler spaces —5
The application process for the 2023/24
school year begins in April 2023.
Mr. Chairman, the estimated revenue for the
fiscal year 2023/24 on page B -289 is $192,000, the
same as in 2022/23. The monthly fee for each child
enrolled at Happy Valley Child Care Centre is $400;
however, the actual cost per child is approximately $2,009 per month. A subsidy is built into the actual
fees which are considerably less than private chil dcare facilities. Despite the low cost to parents, Happy
Valley Child Care Centre is a first -class facility specif ically designed to meet the comprehensive needs of
young children. It provides an extensive curriculum of
high academic standards with trained teachers who
are continuously involved in professional growth and
development. The Centre offers enrichment pr ogrammes that encourage family and community i nvolvement and builds upon child development.
Mr. Chairman, Happy Valley Child Care Ce ntre continues to operate at best practice standards.
This fiscal year Happy Valley Child Care Centre r eceived its third accreditation from the Bermuda N ational Standards Committee, the local accrediting body of entities who manage children.
Mr. Chairman, in July 2022, [there were] 17
children who graduated from the programme and
were all well prepared to attend preschool. Their accomplishments were celebrated with an outdoor lea ving ceremony at the National Sports Centre.
Mr. Chairman, during the 2023/24 budget
year, t he Happy Valley Child Care Centre will continue
to uphold its commitment to partnering with communi-ty resources including the Child Development Pr ogramme [CDP], the Department of Health and Fire and Life Safety Associates. Happy Valley Child Care
Centre wi ll continue to serve as a community service
site for public and private schools.
Mr. Chairman, I take this opportunity to thank
the staff of the Department of Public Lands and Buil dings in the Ministry of Public Works for maintaining the
physical facility of Happy Valley Child Care Centre throughout the year. I also thank all the staff at the
Happy Valley Child Care Centre, the Centre’s active
PTA, volunteers and community partners for their con-tinued dedication to Bermuda’s most valuable treasures, our chi ldren, our future.





Bermuda House of Assembly Services to Individuals and Families
(Programme 32302)

Hon. Tinee Furbert: Mr. Chairman, I will now speak
to programme 32302, Services to Individuals and
Families found on page B -288. The activities covered
in programme 2302 are
• Busine ss unit 33020—Investigating and
Screening;
• Business unit 33030—Foster Care;
• Business unit 33200— Counselling and Life
Skills.
Mr. Chairman, the total budget for these three
business units for fiscal year 2023/24 is $6,059,000. This represents an increase of $169,000, or 3 per
cent, compared to fiscal year 2022/23.
Mr. Chairman, the Investigation and Screening section is responsible for providing comprehensive
investigations and assessments to children who are
referred for services. The budget for this business unit
33020 for fiscal year 2023/24 is $2,273,000. This represents a decrease of $73,000, or 3 per cent, compared to fiscal year 2022/23.
Mr. Chairman, this section provides services
and support for children and families referred for abuse or neglect. The department is committed to
partnering with stakeholders to promote the safety
and health of families while protecting children from
abuse, and neglect. This is achieved through the i nvestigations and assessments process. When r equired, referrals are made to counselling and support
service organisations.
Mr. Chairman, when a referral is made to
DCFS, a screening is conducted to determine if it
meets the threshold for abuse and/or neglect. The
Structured Decision- Making Assessment tools are
utilised to desi gnate the timeframe required to initiate
contact with a child and/or their family. The perfor-mance measures for intake and assessments can be
found on page B -291.
Mr. Chairman, the Screening, Investigations,
and Assessment teams have a combined total of 18
staff and are mandated to provide these types of ser-vices and thus operates 24 hours a day. After regular
working hours, the weekends and holiday coverage is
provided on a crisis basis to ensure that assistance
can be given to the police, the hospital and members
of the community. In 2022, this section responded to
38 on- call or call -out referrals.
Mr. Chairman, the investigation team received
984 new referrals in 2022. This is an increase from
2021, when 918 new referrals were reported to DCFS.
The depart ment has one central screening system
which allows investigations to be processed and assigned in an expedited manner. All mandated referrers are provided immediate feedback on whether the
referral meets the threshold for investigation, and they
are given the designated response time. Mandated reporters made 793 referrals and 191 were from other
sources in the community.
Mr. Chairman, it should be noted that out of
984 new referrals in 2022, [there were] 512 incidents
reported occurring in the children’s home either by a parent, guardian, or caregiver. [There were] 190 r eported incidents occurred out of the home and were
identified as a non- caregiver. Mr. Chairman, 282 referrals were for behaviour problems, service requests,
child-on-child inappropriate interactions and suicidal
ideation.
Mr. Chairman, the team is required to respond
within 24 hours, 5 days or 10 days depending on the
nature of the referral and the designated timeframe.
The department received 207 referrals that required a
24-hour response; 486 referrals required a five- day
response; and 35 referrals required a 10- day r esponse.
Mr. Chairman, in April 2022, a MASH (Multi agency Safeguarding Hub) was established between the department and the Bermuda Police Services to
review all referrals receiv ed. Through the weekly
MASH consultations, the team determines the invest igation approach that is needed for each case. They
stipulate who will be involved and decide if a joint i nvestigation or forensic interview is required.
Mr. Chairman, the investigati on social workers
completed 434 safety assessments. Engagement with
parents allows the team to ensure that the children
are safe while working to preserve the integrity of the
family. Risk assessments are always completed after
conducting a home visit and prior to a case being
transferred or closed. The team completed 336 risk
assessments. Investigations that are referred for
abuse outside of the home do not require the Structured Decision- Making Assessment tools as the a lleged perpetrator is not living in the home and ther efore the household is deemed safe.
Mr. Chairman, the Investigation team partic ipates in multiagency team meetings such as the Sex-ual Abuse Response Team (SART) and the Child Pr otection Team (CPT). Senior staff were involved in the
MARAC ( Multi Agency Risk Assessment Conference)
initiative for Bermuda which is dedicated to ending domestic abuse through a collaborative approach.
Mr. Chairman, the Investigation team also
participated in numerous trainings throughout the year
that ranged from understanding child abuse, interviewing children with disabilities, best practices in suicide and assessment to trauma- informed courses.
Mr. Chairman, as a result of the trends in exposure to family violence, DCFS will continue to be
involved in the implem entation of the MARAC to r eview and reduce the risk of exposure for children. To
that end, $96,000 was budgeted in financial year
2023/24 to assist with this programme. DCFS will engage in further specialised sexual abuse interviewing training for social w orkers who conduct forensic interviewing. Families (both the parents and children) are
630 1 March 2023 Official Hansard Report

Bermuda House of Assembly presenting more multifaceted mental health issues
and DCFS will explore training that will further assist
staff with understanding mental health.
Mr. Chairman, the Depar tment of Child and
Family Services has taken on the additional tasks of vetting requests from employers who hire individuals
to work with children (such as day care providers).
Individuals who wish to foster or adopt a child locally
or overseas must also demonstrate that they do not
have a child abuse history and are not listed on the
Bermuda Child Abuse Register. The request requires extensive research and is conducted by the Senior
Programme Manager for Investigations, along with the
Intake Coordinators, on an overtime basis since this is
a task outside their current duties.
In 2022, Mr. Chairman, 264 requests were
completed, for local and overseas agencies. The number of requests for 2023 is expected to rise signi ficantly since these organisations are now implementing the vetting process as part of their organisation’s safeguarding policies and procedures. DCFS supports universal vetting of all individuals who work with or
volunteer through an organisation [to work] with chi ldren.
Mr. Chairman, the assessm ent team for bus iness unit 33020 consists of a Clinical [Supervisor]
who has a doctorate in Counselling Psychology, and three social workers, one of which has obtained a
doctoral degree in Clinical Psychology and the other
two have a master’s degree. This team is responsible
for conducting comprehensive assessments on chi ldren and families who are experiencing issues incl usive of cognitive challenges, domestic violence, substance abuse, behavioural problems, and emotional
concerns. The purpose of the assess ment process is
to produce a comprehensive report that provides recommendations to empower the family. Families or
individuals are provided an overview of the asses sment process as well as the consent forms required for engaging in services. As participati on in the assessment is voluntary, clients can decline services
following the referral or can withdraw from services, at
their discretion, at any point in time during the as-sessment process.
Mr. Chairman, the assessment team receives
referrals internally from within DCFS and externally, from the Family Court and Supreme Court.

Good evening.
You may continue, Minister.
Hon. Tinee Furbert: Thank you, Mr. Chairman.
Mr. Chairman the assessment team receives
referrals internally from within DCFS and externally,
from the Family Court and Supreme Court. Service
provision entails three main areas —individual a ssessments (child and/or adult); family assessments;
and consultations.
Mr. Chairman, a total of 227 assessments
were administered collectively by the team. The time frame for the completion of assessments ranges from
a minimum of 45 days to a maximum of several months depending on the time required to build rapport, the complexity of the case, the degree and consistency of client engagement, receipt of the requ isite
information from collateral sources, and the length of
time it takes to administer, score, interpret, and write
the assessment report. A feedback session is held at the completion of the assessment process with parents, the child/adolescent (as appropriate) and if consent is given, with case management workers from
other departmental teams as well as schools.
Mr. Chairman, I take this opportunity to thank
the staff of the Screening and Investigations Team and the community stakeholders for their commi tment
for being the first response in promoting the safety
and health of families while protecting children from
abuse and neglect. I also thank the Assessments
Team for empowering families through the compr ehensive assessments completed on at -risk childre n
and families.

Foster Care
(Business Unit 33030)

Hon. Tinee Furbert: Mr. Chairman, the Foster Care
section is responsible for providing alternative living
arrangements for children under the age of 18 years
old who are in need of “out -of-home placement. ”
The budget for business unit 33030 for fiscal
year 2023/24 is $2,641,000. This represents an i ncrease of $100,000.
Mr. Chairman, during the 2022 calendar year,
a total of 63 children occupied foster care beds, four fewer than the previous year. The team was also r esponsible for case management duties for the chi ldren’s birth families and foster families. Last year, the Foster Care Programme serviced a total of seven
therapeutic foster children. The children in this category have a variety of physical, cognitive, emotional and
behavioural challenges. Out of those seven children,
one was adopted and one was transferred from Foster Care to Residential Treatment Services. By the end of
2022, a total of 15 children left the foster care pr ogramme. Four were plac ed into Residential Treatment
Services. Four aged out of DCFS. Six were reunified with their birth parents and one was adopted.
Also, 2022 was a very busy year for Foster
Parent Recruitment. The Foster Care Coordinator i nterviewed 26 interested persons for foster parent r eBermuda House of Assembly cruitment. Out of those, six were approved. In May
2022, Foster Care Month, the foster care team r esumed hosting in- person the Annual Appreciation Tea
for Bermuda’s foster parents. This event was held at
the Royal Hamilton Amateur Dinghy C lub.
The Foster Care Programme ended 2022 with
Christmas gift donations for all foster children. Items
were generously donated from anonymous members
of the public, the RenRe Insurance Company and the
Pembroke and Hamilton Rotary Clubs. Each child was
gifted with multiple items for the holiday season. The
organisation of gift donations from members of the
public was fully arranged by the executive of the Foster Parent Association which is a registered charity.
The “Angel Tree” was publicised and on display at
Rosa’s [Cantina] restaurant. Members from the public
selected “angels” from the tree which had the wish list
items of foster children on them.
Mr. Chairman, DCFS would like to
acknowledge the foster parents of Bermuda. These are our unsung heroes who pr ovide loving, stable
homes to children who have experienced significant
trauma. Appreciation and recognition must also go out
to the Foster Parent Association which works in par tnership with the foster care team. They provide extra
support to foster childr en and foster families in the
form of financial support for educational trips, specialised recreational programmes, laptops for senior
school and tertiary education scholarships for foster
youth post high school completion.

Counselling and Life Skills
(Business Unit 33200)

Hon. Tinee Furbert: Mr. Chairman, the purpose of
the Counselling and Life Skills (CLS) business unit is to advance and promote the emotional well -being of
youth up to the age of 18 years of age and their fam ilies. The budget for busines s unit 33200 for fiscal year
2023/24, is $1,145,000. This represents an increase
of $4,000 compared to fiscal year 2022/23.
Mr. Chairman, CLS counsellors rallied around
a collaborative approach in 2022. The team increased
their availability to engage in pr ofessional case conferences with other teams within DCFS. This collabo-ration assisted in solution- focused service plans that
promoted wellness for families and their children. CLS
continues to work diligently with external stakeholders
with the intent of being supports and advocates for
families who may feel displaced in a society that can
discount their future and potential.
Referrals are mainly received from external
entities such as the Department of Education, Child
and Adolescent Services [CAS], and the public. These
referrals are screened through the department’s i nvestigation/screening section and a decision on appropriate interventions are determined by the use of the Structured Decision- Making tool and then assigned for services. Mr. Chairman, the number of referrals that
were received for 2022, was 107, a slight decrease
compared to 2021. Of this total, 105 received services
and two were denied. The referrals that were denied
were based on clients being involved in external ser-vices prior to the ref erral.
Mr. Chairman, in 2022, the number of chi ldren/adolescents who were serviced because of do-mestic violence was similar to 2021. Since post -
COVID -19 and the lifting of restrictions chi ldren/adolescents who had experienced anxiety and depression are now trying to re- adjust back to in -
school learning experiences and in- person socialis ation.
The CLS team noticed that in 2022 “vaping” is
still a trend continuing among adolescents. Substanc-es such as marijuana and alcohol are still also prev alent among adolescents. Young people are still choosing to use substances as a coping strategy for the
purpose of self -medicating to deal with life stressors,
trauma, and grief. The complexity of their family sy stems and their experiences of having to deal with a
global pandemic have impacted adolescents and their
ability to emotionally regulate. Hence, the increase in
substance uses as a coping strategy.

Residential Treatment Services
(Programme 2303)
Hon. Tinee Furbert: Mr. Chairman, I will now speak
to programme 2303, Residential Treatment Services,
found on page B -288. Mr. Chairman, the activity co vered in programme 2303 is Residential Treatment
Services which include Family Preservation, the
Brangman Home, Youth Development Centre, Observatory Cottage (also referred to as Oleander Cottage),
the Psycho- Educational Programme and Youth Res idential Treatment. For the year 2023/24, this pr ogramme has a budget allocation of $7,783,000. This
represents an increase of $188,000, or 2 per cent, as
compared to 2022/23.

Family P reservation
(Business Unit 33060)

Hon. Tinee Furbert: Mr. Chairman, the budget for
business unit 33060 for fiscal year 2023/24 is $1,508,000. This is an increase of $97,000.
Mr. Chairman, the Family Preservation team
operates under a sound case management and assessment model, which comprehensively assesses
family and child needs and develops service plans
with the family, the child and stakeholders to maxi mise intervention and positive outcomes for children
and their families. The team is responsible for provi ding ongoing intervention to monitor and ensure the safety of children at risk of abuse or neglect, assist families to improve family functioning, increase child
well-being, reduce the need for placement in out -of632 1 March 2023 Official Hansard Report

Bermuda House of Assembly home care, and enable children in out -of-home care to
return safely to their families.
Mr. Chairman, in order to achieve its goal,
Family Preservation Services requires its social wor kers and social work assistants to manage cases in
compliance with the Council on Accreditation Child
and Fami ly Services standards, the policies and pr ocedures of the department and the Structured Dec ision-Making assessment system for child protective
services. The social worker’s frequency of contact
with a family is determined by the family’s assessed risk leve l. The higher the assessed risk for future
abuse or neglect, the higher the level of intervention
and engagement required monthly.
Mr. Chairman, the Family Preservation Section has been accredited by the Bermuda National
Standards Committee in accordance w ith the Council
on Accreditation Standards from 2018 to 2022. Being accredited means that the Bermuda National Standards Committee has determined through a rigorous
assessment of evidence that the Family Preservation
Service meets the standar ds of the Council on A ccreditation, that they follow best prac tice and pr ovide
quality service to the community. In October 2022, the Family Preservation commenced the rigor ous reaccreditation assessment. We await the out come of that
asses sment.
Mr. Chairman, the Family P reservation Team
currently consists of two coordinators, seven social
workers, seven social work assistants and one admi nistrative assistant.

[Inaudible interjections]

Hon. Tinee Furbert: Is it loud in here?

Members, can you keep it quiet a bit?
Folks are having problems hearing. Thank you.

Hon. Tinee Furbert: Mr. Chairman, for the calendar
year January through December 2022, the Family Preservation team served a combined total of 143
families and 232 children. Caseload complexities and risk levels remained high throughout 2022, thus r equiring a high number of face- to-face contacts, mult iple court appearances, family conferences and con-sultations with community and government stakehol ders.
During 2022, 66 new cases were referred to
Family Preservation. Throughout the year a total of 43
cases were closed. All closed cases were void of child safety or child protection issues at closure. Six cases were transferred to out -of-home services (Foster Care
and Residential Treatment Services) due to increased
safety risk in the home.
Mr. Chairman, Family Preservation workers
attended 67 court hearings over the year. The court
appearances were for Domestic Violence Protection
Orders, Protection Intervention or Emergency Protec-tion Orders, Custody/Acces s matters, Supervised Vi sitation, Juvenile Court, Supervision Order Applications and Reviews, and Care Order Applications, Reviews
and Discharges.
Mr. Chairman, needs assessments completed
during 2022 have identified the following as the top three areas of need affecting our parents/caregivers
and children. Interventions must be targeted to i mprove outcomes in these areas.
[There were] 325 parent or caregiver asses sments completed during the calendar year. Of these
assessments 48 per cent of households assessed had
coping skills/mental health/cognitive functioning ident ified as a need. This is defined as parents/caregivers
having difficulty coping with stressors in their life
which creates situations that places the children in
their care at risk. This may be demonstrated by per iodic or at times severe mental health symptoms i ncluding but not limited to depression, apathy or consistent use of a negative coping mechanism that exacerbates the problem.
Fifty-three per cent of households assessed
had parenting sk ills identified as a need. This is d efined as improvement of basic parenting skills as
needed by the parent/caregiver in order to ensure
safety and appropriate discipline of the child. In addition, improvements are needed to meet the emotional
and developm ental needs of the child.
Thirty -two per cent of households assessed
had Resource Management identified as a need. This
is defined as parents/caregivers facing challenges with resources being insufficient or not well managed and/or including debilitating debt. As a country we are
still feeling the financial impacts as the country normalises after the pandemic. Many households conti nue to be challenged meeting the basic needs of their
families in areas such as food, clothing, and medical
needs.
Mr. Chairman, 314 child assessments were
completed during the calendar year. Family Preserv ation service plans and intervention with families have
very specific goals or objectives that the parents and
children are expected to achieve through the services
provided by F amily Preservation with the goal of eli minating or reducing the risk of harm and future harm to
their children.
Mr. Chairman, in 2022, [there were] 13 staff
[who] became certified Train- the-Trainers in Crisis
Intervention for Families and Crisis Interventi on with
Children with Developmental Disabilities. Trainers from Cornell University were on Island in April 2022 to facilitate this training. All successful trainers are now
certified to facilitate parent groups as well as trainers
to train other professionals in the method.
The goal for 2023 is to provide Therapeutic
Crisis Intervention for Families for both parents, foster
parents and professionals working with families.
Mr. Chairman, I will now speak to the Brangman Home, business unit 33070; the Youth De velopBermuda House of Assembly ment Centre, business unit 33080; and the Observat ory Cottage (referred to as Oleander Cottage) business
unit 33090.
Mr. Chairman, the 2023/24 budget allocation
for business unit 33070, Brangman Home, is $1,213,000, the same as budgeted for the 2022/2 3
fiscal year.
Business unit 33080, Youth Development
Centre, received an allocated budget of $246,000.
This is an increase of $87,000, or 55 per cent compared with 2022/23. This reflects a realignment of the
department’s staff resources.
Mr. Chairman, Obs ervatory Cottage, business
unit 33090, was allocated a budget of $1,368,000 which is a minimal increase of $1,000.
Mr. Chairman, Residential Treatment Services
(RTS) provides group living intervention services to children between the ages of 12 and 18 year s. These
are adolescents who are deemed to be at risk in the
community and require care and protection in a safe
and structured residential environment. All children placed in this service have had their situation and ci rcumstances considered by the Family Court, where it
has been deemed appropriate for them to be placed
on a care order and as such become the responsibility
of the Director of Child and Family Services.
Mr. Chairman, the RTS programme provides
services 24 hours [a day], 365 days a year. The young
ladies are located at the Brangman Home while the
young men receive services at Oleander Cottage. The
Youth Development Centre is utilised to provide oneto-one in special management of residents based on
their needs as indicated by ongoing evaluation, and if
they are placed in the care of the director as a result
of criminal behaviours.
Mr. Chairman, RTS provided inhouse/residential services for 19 adolescents in 2022.
This total included 8 males and 11 females. The girls
remain the typical “at -risk” group of enrolments at
RTS. This is evident through research that indicates girls have more identified risk factors than boys , for
example, puberty changes, negative thinking styles
such as rumination and low self -esteem, as well as
some interpersonal factors. The low enrolment of
males remained consistent through the fiscal year with
zero enrolment in the last two quarters. The first quar-ter was the highest enrolment with two young boys,
ages 12 and 13.
Mr. Chairman, I am happy to report the low
number of boys in care created opportunities for these
boys to receive intensive services such as, closer observation, mentoring and therapeutic interventions. Mr. Chairman, 14 of the 19 residents have been ide ntified as long- term as they have no plausible family
reunification plan. However, alternative family plac ements have been found for seven residents in care. During the 2022/23 budget year, seven of these res idents turned 18 and, out of those, three were eligible for the independent living option and four found alternative placements with community supports.
Mr. Chairman, RTS has successfully met the
majority of the performance measures, as outlined on
pages B -291and B -292. Statistical data and the performance quality improvement process has been consistently used to monitor quality and to determine
changes needed to improve the service provided. The
2023/24 budget is designed to continue providing r esources that allow this programme to provide a quality service to children and families.
During the 2022/23 budg et year, the DCFS
administration worked in partnership with the Ministry
of Public Works, specifically the Department of Public
Lands and Buildings, to enhance RTS physical structures. All buildings utilised by RTS have received se veral maintenance upgrades.
Mr. Chairman, also during the 2022/23 budget
year the Brangman Home had renovations completed
that have increased capacity and has provided more
efficient use of space to accommodate therapeutic
programmes for individual and group interventions for the girls and their families. The security systems at
both the girls’ and boys’ homes continue to be assessed and enhanced to ensure the care, safety and
protection of the residents and the care team.
Mr. Chairman, I would like to take this opportunity to thank the staff at the Residential Treatment Services and community stakeholders for their co mmitment in providing trauma responsive services to
the residents of group living, with the aim of restoring
hope and building resiliency in their lives.

Psycho -Educa tional Programme
(Business Unit 33100)

Hon. Tinee Furbert: Mr. Chairman, the PsychoEducational [Psycho- Ed] programme was developed
to clinically address children who could not be effectively treated in Bermuda or those who had exhausted
all available loc al therapeutic/treatment services. The
budget for business unit 33100 for the fiscal year
2023/24 is $2,108,000, the same as in the previous
year.
Mr. Chairman, our local psychologists, ps ychiatrists, and educational therapists have demon-strated an improved ability to diagnose various ps ychological, behavioural, and educational problems.
However, more Bermudian children are being ident ified with various psychological, social/emotional, and psychiatric conditions beyond the ability of our local service provi ders. The Psycho- Ed programme allows
DCFS to have external input concerning clinical therapeutic intervention and aftercare services.
Mr. Chairman, overseas therapeutic pr ogrammes utilised by the Psycho- Ed programme are
selected based on specific areas of expertise and
specialised services they are licensed to provide. All
therapeutic facilities are accredited by the Joint Co m634 1 March 2023 Official Hansard Report

Bermuda House of Assembly mission, national quality approval organisation, and
vetted yearly by the Director/Assistant Director and
Psychological Educational C oordinator (Psycho- Ed
Coordinator).
During 2022/23, nine overseas facilities were
vetted and approved. Mr. Chairman, the Psycho- Ed
programme provides children with protection, care,
and nurturance by licensed and accredited therapeutic
overseas facilities. The Psycho- Ed programme pr ovides a safe, supportive, and therapeutic environment for each child while working collaboratively towards either family reunification or an alternative permanency option.
Mr. Chairman, the Psycho- Ed Committee is
comprised of representatives from Child and Adolescent Services; Ministry of Education; Department of
Child and Family Services; and Ministry of Health.
The Psycho- Ed [committee] met virtually once
a quarter during the first and second quarters last year
to review the st atus and make decisions on children
referred for overseas placement or clinical asses sment.
Mr. Chairman, in 2022, the Psycho- Ed pr ogramme had a total of 12 clients who received ser-vices in overseas therapeutic programmes for a co mplexity of issues identif ied across the Diagnostic and
Statistical Manual of Mental Disorders (DSM- V) Crit eria of Mental Disorders. All Psycho- Ed clients serviced
overseas received the Global Assessment of Functioning (GAF) with a scoring range of 20 to 50.
A score of 50 is define d as having serious
symptoms or serious impairment in social, occup ational, or school functioning and 20 is defined as ha ving a danger of hurting self and/or others. The result
of low Global Assessment of Functioning (GAF)
scores required that all Psycho- Ed clients receive i ntensive clinical treatment with a longer duration of
treatment options coupled with one- to-one staff interventions, psychotropic medications, frequent team meetings, psychiatric hospitalisations, family intervention programmes, and over seas therapeutic visits.

Youth Residential Treatment
(Business Unit 33110)

Hon. Tinee Furbert: Mr. Chairman, business unit
33110, the Youth Residential Treatment budget for financial year 2023/24 is $1,340,000, an increase of
$3,000, due to a realignment of staff within the organ isational structure.
Mr. Chairman, Youth Residential Treatment is
the Administrative and Professional Services section
that provides the necessary accounting, management,
counselling and clinical services to all of the residential homes and programmes
Mr. Chairman, a new residential programme
that will become fully operational during 2023/24 is the Independent Living programme.
Independent Living Programme

Hon. Tinee Furbert: Mr. Chairman, in the 2022/23
budget, capital funding was allocated for the establishment of an Independent Living Housing regime. In the 2023/24 current account budget, more than
$300,000 has been allocated to fund staffing for the
operations of this programme. The Independent Living
Programme is the first of its kind in Bermuda, whereby
we are providing a “lifeline/safety net” to young adults
ageing out of the care of the director, affording them the best opportunity for success as they transition into
adulthood.
Its mission is to empower, encourage and edify our young people as they transition into adulthood
to achieve their goals and become independent and
self-sufficient, utili sing the community resources to
achieve success. The programme is housed in St.
George’s and has the capacity to accommodate up to
12 young people.
Mr. Chairman, the Assistant Director and C oordinator travelled to the 34
th Annual National Ind ependent Living Conference in August 2022 to partic ipate in workshops and network with other agencies who are providing this support to young people. This
conference provides resources and training to professionals around a variety of evidenced- based practices
and how to promote improved outcomes for our young
adults. The conference was also geared towards supporting young adults currently in independent living
programmes providing them with leadership and team
building opportunities and highlighting those who have
had success despite their circumstances.
Mr. Chairman, I am pleased to report that following that conference, the coordinator and staff have
become certified Independent Living Specialists.
Over the next fiscal year, the Independent Li ving Programme anticipates having the final phase of renovations of the physical plant completed and to be fully staffed whereby client needs are met and they
are guided through this transition as they become self -
sufficient, productive citizens of Bermuda.

Administration
(Programme 2304)

Hon. Tinee Furbert: Mr. Chairman, I will now speak
to programme 2304, Administration, found on page B -
288.
Mr. Chairman, programme 2304 covers A dministration business unit 33120, and Grant Funding,
business unit 33130. The fiscal year 2023/24 budget
for these two programs is $3,159,000, reflecting an
increase of $377,000 or 14 per cent.
Mr. Chairman, the Administration sect ion of
DCFS is responsible for the general supervision of the
sections within the department and the oversight of
the Psycho- Educational Programme and the Mirrors
Programme. The budget for business unit 33120 for


Bermuda House of Assembly fiscal year 2023/24 is $2,613,000, an incre ase of
$281,000 more than the previous year.
Mr. Chairman, all staff development and trai ning is delivered via this section to ensure that the staff
at DCFS remain skilled and current with best practice standards. The Administration section has continued
their membership with Relias Learning Systems as
the core training vehicle for staff professional development in the field. Relias has become a web- based
training partner for DCFS. Orientation training has been custom designed for each section within DCFS based on the core needs of each section.
Mr. Chairman, the Administration section is
also responsible for reviewing all policies and proc edures and making the necessary recommendations that will expand the capacity, scope and quality of our
social service d elivery system. Mr. Chairman, the A dministration team continues to look for opportunities of performance quality improvement. This section will
continue with modernising the department’s strategy
of providing comprehensive assessments of all refer-rals so t hat clients receive the appropriate service
from the appropriate agencies thereby reducing refer-rals and enhancing outcomes, so each section mai ntains their accreditation status.

Grant Funding
(Business Unit 33130)

Hon. Tinee Furbert: Mr. Chairman, the budget for
Grant Funding, business unit 33130, for fiscal year
2023/24 is $546,000, an increase of $96,000. Mr.
Chairman, the grant funding will provide $375,000 to Teen Services; $75,000 to fund a cross -ministry initiative to assist families in crisis; and, $96,000 to hire a
domestic violence specialist and promote education
and awareness for the introduction of a MARAC model for Bermuda.
Mr. Chairman, as outlined in the 2022 Speech
from the Throne, the Government, in partnership with
SafeLives UK, will intr oduce a Multi -Agency Risk A ssessment Conference [MARAC] model in which there
is a cross- ministry national approach to increase pu blic awareness of the damaging effects of domestic
abuse and family violence on public health and to i mprove the island’s syste mic response to domestic
abuse and family violence.
The Bermuda Police Service, the Department
of Child and Family Services, and Centre Against
Abuse in partnership with SafeLives UK (specialists in
domestic violence in the UK), have commenced a collaborat ive initiative to assess the prevalence of domestic abuse on the Island, identify and map services
that support victims and perpetrators of abuse, and to
seek public and stakeholder feedback on the services
and needs for both victims and perpetrators currently available on Island.
Mirrors Programme
(Programme 2305)

Hon. Tinee Furbert: Mr. Chairman, finally, pr ogramme 2305, the Mirrors Programme, business unit
33140, found on page B -288.
Mr. Chairman, following a Management Consulting Services Review it was determined that the Mirrors Programme was most aligned with the pr ogrammes and services offered by DCFS. In August 2022, Cabinet approved the establishment of the Mi rrors Programme within the Department of Child and
Family Services as a substantive permanent pr ogramme.
Mr. Chairman, the budget allocated for the
Mirrors programme for 2023/24 is $752,000. Now
more than ever, we as a community understand how important it is to demonstrate empathy and resilience,
build relationships and collaborate to support positive
youth development and strengthen families. The COVID -19 pandemic exacerbated feelings of isolation,
stress, loss and more, as such Mirrors continues to
focus on socio- emotional skills development, building
students’ relationships with peers and a dults, helping
youth feel a sense of belonging, building leadership skills and providing youth influencer trainings collectively to support student well -being and development
across the Island.
Mr. Chairman, Mirrors continues to produce
results in the shor t-, medium - and long- term to make
better learners and to build a resilient community of young adults with positive life outcomes in education, employment and lawfulness. Everything they do is
based on evidence from data collected since Mirrors
inception.
Mr. Chairman, to date Mirrors has served
7,199 youth and trained 7,452 adults including parents, teachers and volunteers in positive youth development. Mirrors entered its second year of implemen-tation of the PeerForward programme in both public
senior scho ols, with ongoing support from the Mirrors
Alumni and Friends Association, Centennial Bermuda
Foundation, Bermuda Community Foundation and
Charities Aid Foundation. This support allowed anot her year of partnership with Berkeley Institute and C edarBridge Ac ademy to build a college and career -
going culture in the schools using peer leads as the
driving force to increase students registering to the
overall goal of three or more colleges and completing
scholarship applications.
Mr. Chairman, Mirrors readjusted programming to in- person services and worked with schools to
meet their needs. Students highlighted their appreci ation for in- person workshops and coaching services.
The current Community Programme cohort remains active with their life coaches for the next four months.
[There were] 401 middle school students who partic ipated in programming with 54 students participating in a one- off school training. Mr. Chairman, 13 students
636 1 March 2023 Official Hansard Report

Bermuda House of Assembly participated in the drop- in and out -of-school suspe nsion services. Across three sch ools, there were 13
middle school students who participated in a one- day
prefect leadership training. [There were] 136 students
who participated the Annual Art and Digital Compet ition themed “Big Dreams, Small Island.” The art competition provides over $10,000 worth of prizes to st udents and schools as a contribution to the arts. Most
of the winning pieces are framed and either provided
for auction or donated to sponsors as a means to
showcase budding Bermudian artists in our communi-ty.
Mr. Chairman, 44 vol unteers have been
trained to date and are active in supporting Mirrors programming which relies heavily on volunteers to deliver its work. We thank our volunteers for their co ntinued commitment and dedication to Bermuda’s youth. We could not have serviced students without
their support and service. We encourage more volunteers to register with Mirrors so they can reach more
youth and families.
Mr. Chairman, Mirrors experienced challenges
with the availability of local facilitators this year and had to rely on the partnership with Quantum Learning
Global to support the Community Programme in O ctober and the SuperCamp Junior Forum in February 2023. Mirrors staff have performed to international standards and two members have been offered the
opportunity to trai n and deliver services in Singapore
and South Africa with Quantum Learning Global. Ms.
Todd has put in an exceptional level of work towards
her certification and has been awarded Facilitator
Foundation Training Certification, Facilitator Certific ation and Academic Facilitator Certification. She has
demonstrated a standard of excellence in the transformation methodology and Ms. Todd is in the process
to achieve the Lead Facilitator Certification and the
Train -the-Trainer Certification over the next few years .

[Desk thumping]

Hon. Tinee Furbert: Thank you.
In the current year, Ms. Todd provided Qua ntum Learning workshops for 142 Department of Youth,
Sport and Recreation staff, 10 Endeavour staff me mbers and 15 new recruits at the Bermuda Fire Service.
The f eedback was positive on the experience and
content of the training with 100 per cent responses in
the excellent and good categories.
Mr. Chairman, we expect to service all M1
level middle school students and some P6 students in the All In! 8 Keys of Excell ence programme for the
2023/24 school year, and to provide teachers with
Quantum Learning Excellence in Teaching. With the
support of Mirrors we are expecting teachers to continue to provide eight months of character develop-ment lessons in advisory for students over the school
year. Mirrors will increase the focus on getting parents
to attend the parent workshops by connecting with the parent -teacher associations for improved parental i nvolvement in the 8 Keys principles to extend the work
from school to home. To date, 440 parents have participated in parent workshops. It was noticed that the
return to in- person workshops resulted in a decrease
in parent attendance in comparison to the past two
years. The focus is to explore more ways of engaging
parents to expand the principles of the 8 Keys of E xcellence in families. Additionally, 30 students co mpleted the recent Mirrors middle school SuperCamp
Junior Forum held over the February school break and 28 parents attended the workshop.
Mr. Chairman, in 2023/24, t he Mirrors Alumni
and Friends Association will continue to support the programme through the volunteer recognition scheme,
the annual Bermuda- themed art competition entitled
“My Happy Place”, the community service project at
the Mirrors Field of Learning at Southlands and the
college and career readiness PeerForward pr ogramme.
Mr. Chairman, I would like to take this opportunity to sincerely thank the volunteers, corporate
Bermuda, the Alumni Board and the Mirrors team for
their commitment to the development of Bermuda’s
youth.

Subjective Analysis of Current Account Estimate

Hon. Tinee Furbert: Mr. Chairman, I will now discuss
the subjective analysis of current account estimates for the Department of Child and Family Services
(DCFS). They can be found on page B -289.
Salaries

Hon. Tinee Furbert: Mr. Chairman, the budget all ocated for salaries is $9,852,000 for fiscal year
2023/24, an increase of $611,000. The addition of six
Mirrors staff accounted for $478,000 of this increase.
The remaining $133,000 is the combined cost for the
salary of a Residential Care Officer and staff salary
increments.

Other Personnel Costs

Hon. Tinee Furbert: Other personnel costs budgeted
at $129,000 reflect a decline of $7,000 due to a reduction in staff allowances related to CO VID-19 health
requirements.

Training

Hon. Tinee Furbert: Mr. Chairman, the budget for
training is $184,000, an increase of $50,000. This i ncrease is due solely to the training cost associated
with the Mirrors Programme which will be a DCFS
programme effective April 1, 2023.





Bermuda House of Assembly Transport and Travel

Hon. Tinee Furbert: Mr. Chairman, the increase in
transport and travel costs of $2,000 and $3,000, r espectively, is due to the Mirrors Programme costs for
travelling to workshops and training camps.

Communications

Hon. Tinee Furbert: Mr. Chairman, communications,
inclusive of phones, courier and postal costs, are
budgeted at $192,000 for fiscal year 2023/24. This
represents an increase of $9,000 for the addition of
the cellular and postal costs for the Mirrors P rogramme.

Advertising and Promotion
Hon. Tinee Furbert: Mr. Chairman, the $12,000 i ncrease in 2023/24 relates to the costs for promoting
and advertising enrolment in the Mirrors Programme.

Professional Services

Hon. Tinee Furbert: Mr. Chairman, profess ional se rvices budgeted at $3,962,000 for fiscal year 2023/24,
increased by $428,000 or 12 per cent. This comprises
$303,000 that will fund the staffing requirements at the
Independent Living Programme; and, $125,000 for
hiring local contractors for the Mi rrors Programme
training/camps.

Rentals

Hon. Tinee Furbert: Mr. Chairman, the estimate for
Rentals for 2023/24 is $1,415,000, an increase of $40,000. This additional amount is the rental cost for
facilities that will house the Mirrors’ camps and pr ogramm ing.

Repair and Maintenance

Hon. Tinee Furbert: Mr. Chairman, in fiscal year
2023/24 repair and maintenance has been allocated
$547,000, a decrease of $7,000. This decrease in
funding relates to the reduction in cleaning maint enance as required to suppor t COVID -19 protocols.

Materials & Supplies

Hon. Tinee Furbert: Mr. Chairman, the cost of mat erials and supplies decreased by $7,000 to $370,000.
There was a reduction in the purchase of supplies
such as testing kits due to the reduced COVID -19 pr otocols.



Grants and Contributions

Hon. Tinee Furbert: Mr. Chairman, the budget for
grants and contributions is $1,336,000, a decrease of
$4,000 which reflects a net difference between a r eduction in foster fees and the added grant for the
MARAC initiative.

Empl oyee Numbers (Full -Time Equivalents)

Hon. Tinee Furbert: Mr. Chairman, on page B -290,
you will note that there are 105 full -time equivalent
positions for the Department of Child & Family Ser-vices for financial year 2023/24. The additional seven
full-time equivalents represent six staff in the Mirrors
Programme and one Residential Care Officer needed for the DCFS residential homes.
Mr. Chairman, this concludes the budget
presentation for Head 23, the Department of Child and
Family Services. However, I will take a few minutes to
share that DCFS has a rich database of Performance
Quality Indicators (PQIs) and key information about each of its programmes offered that paints a detailed
picture of the important and critical work that they do
for children and fami lies. These PQIs keep the work
on track and in alignment with best practices. What I
have presented today is just a snippet of the database
information and certainly would require more time for me to share everything.
Nonetheless, I was pleased that my honour able colleague, MP Susan Jackson, accepted our inv itation last month and attended the 4
th quarter and annual presentation of PQIs for DCFS. I am sure she would agree that based on the presentation of the
PQIs that the work carried out by DCFS is highly extensive and critically needed for children. At this time I
thank all of the staff at DCFS for their deep commi tment to the children and families of Bermuda. While it
may seem to be the most thankless professional work, the impact each staff member has when assisting
those they come in contact with is priceless. I am
grateful that they do not hold back from functioning in
their various gifts and callings. Thank -you to DCFS
staff!
Mr. Chairman this concludes my budget
presentation for the entire Ministry of Social Develo pment and Seniors, Head 86 and Head 23. Thank you.

[Ms. Lovitta F. Foggo, Chairman]

Thank you, Madam Chai rman.
638 1 March 2023 Official Hansard Report

Bermuda House of Assembly That was a wonderful, comprehensive and
thorough brief that the Minister gave and I much appreciate that. I, too, would like to give full credit to the
staff within her Ministry. Having had the opportunity to
be exposed to them and to hear their performance
over the past year, I really can understand the courage, perseverance, patience, [and] the expertise that
is required to keep the Ministry as successful as it is.
I am going to go back to t he beginning, and I
will try definitely not to repeat much, but I do have
some questions. So, I am going to start with Head 86 on page B -281. And there is not a lot that we can say
about the financials because we are in a very tight
budget season. But I wo uld like to speak to value for
money. And the National Senior Strategy is something
that is part of the Headquarters under Head 86. It has
also been mentioned by the Minister as being part of
the policy, but we will keep it right under Head 86 for
simplicity.
There has been quite a number of years that
the Minister has mentioned the development of the
National Senior Strategy, and certainly we are at a
state in which we really have too look at how we are
going to best manage and develop this population. I
am very close to, and half of the population, up to
46 per cent, will be seniors in the not -too-distant f uture. And so the National Senior Strategy is something
that we need to take a really good close look at. It has
been in development for a number of ye ars and certainly we need to look to see how we might be able to
put it into action.
The Minister had mentioned last year the
needs of the seniors [for an] independent living env ironment and also looking at alternate housing sol utions for seniors. And so it would be aspirational for us
to move in that direction in the near future.
And just because I feel like the Chairman is
going to mention it, the Minister also mentioned it on
page B -283, under Administration, 96000, the Natio nal Senior Strategy there as well.
It was mentioned already today that the financial need to support our rest homes ––the Minister of
Health had mentioned it under her Ministry ––is not
sustainable. And one of the mission statements of the Ministry of Social Development and Seniors speaks to
coordinating services [and] creating partnerships as a part of the department objectives. And so I am just
putting it out there that it would be in our best interest
to start to really actively look at how we can coordinate and partner with other s takeholders in order to
begin to develop this community.
So, with the seniors, we have a number of
properties around the Island, some of them are government -owned properties where we have rest
homes, where we have residential buildings which we
could look at developing into senior communities. And I feel strongly that it is time for us to find a way in
which we can develop our seniors and put them a si tuation where they are able to, if not age at home, age in a place that feels like home, where they can hav e
some independent living but still be in a protected,
community environment. And we certainly do have
properties on this Island where we could expand, that
we could look at private- public [partnerships], and we
could see how we could develop a situation w here
communities are built around our seniors.
I would also like to make an observation
around how we can be more efficient when it comes
to seniors and the buildings in which they live, especially those that are rest homes and those that are nursing homes , and the possibility of coordinating with
other government departments so that we can develop some efficiencies, and so one of the conversations
that I was having with one of the rest homes is how to
make energy more efficient. And certainly I am aware
that the Public Works Department is looking at solar
panels and the development of energy -efficient
sources and so there then evolves this question of,
Well, could some of these rest homes be able to par tner with Public Works? Maybe get in on part of a
shipm ent of solar panels and have those panels i nstalled on their roofs so that they can bring down the
[cost of] electricity. Because I did notice—

Member, can I just make a suggestion to you? And I think you are trying to do a very
good job in trying to keep everything in context as it relates to the heads that you mentioned, but I think
that perhaps maybe you should put some of that as a
question to the Minister to find out if in fact she i ntends to . . . and it is okay for you to give suggesti ons.
I am not trying to say you [can’t]. But I think also you
need to put those by way of questions so that it gives
the Minister opportunity to respond to you. As we
have heard from her brief, we have heard what this
Ministry intends to do, we heard where the money is
being spent and I do not think that while . . . I think we
understand where you are going with this, I do not
think we should be giving our own submissions.

So, I would like to ask the
Minister what is being done, or what can be done to
make our nursing homes (in particular) and our rest
homes more cost -efficient? What can be done to i mprove the sustainability of rest homes and nursing
homes (in particular) that are struggling to sustain
themselves over the long term? And what can we do
as a nation or as a government to continue to build
communities for seniors’ standard of living?
Under the National Seniors Strategy there has
been quite a bit of education around the various kinds of living standards and . . . (what is t he word?) some
of the age- related illnesses and lifestyles that have
certainly evolved in our recent times. And so I would like to ask the Minister whether there has been much
legislation or consideration around legislation for de-mentia care, in particular ? You know, protecting the
rights and monitoring the conditions of the facilities,


Bermuda House of Assembly housing clients with dementia, legislation around
community -based services, legislation around discri mination against carers, legislation around advance
care directives, protection for our seniors, especially
those who are unable to fend for themselves.
I heard earlier, yesterday afternoon, that there
is work being done of the Office of the Public Guard ian. But if the Minister wouldn’t mind giving an update or indication of its progress and maybe a timeline for
the legislation around the Office of the Public Guardi-an.
I am also curious whether there will be any
additional legislation around development and the
building of protections for senior abuse.
I would like to move on to page B -285, the
Performance Measures. I noticed in the performance
measures that the total senior abuse cases that are
estimated for 2023/24 are 90. And this is up 61 from in
2021. So we are clearly estimating and projecting that
our seniors are going to be more vulnerable in the
future. And so what we might be able to do—

Hon. Tinee Furbert: Madam Chairman.
Sorry. I just want to make a correction.

So the target outcome, but
we are still looking at, and if we look at the actuals on page B -285— if we look at the actual outcomes for
2021/22, we are still seeing a total of 84 seniors who
have had reports of physical abuse, psychological
abuse, sexual abuse, financial abuse and neglect. So this is a lot of people. And those are just the people who have been reported.
So, I would like to ask the Minister whether we
are working on legislation and any other projects, pr ogrammes, ways in which we might be able to identify and protect our seniors. And with that, certainly the
cases where we have had senior abuse cases, I am
not sure and if the Minister could let me know whether any of these have actually gone on t o the police,
whether they have gone to the courts and what the procedure has been around that.
On page B -284, the ADS, which is the Ageing
and Disability Services, that is 96040, there are seven employees who I am guessing a few of them are the
case managers. The Minister had mentioned that
there are three case managers. So, I would like to ask
the Minister whether there is any possibility that a
couple more, maybe two or more case managers will
be able to be hired in the future. The Minister has mentioned that the status quo would be one case
manager to every 25 clients, and yet today she has
reported that there is one case manager per 60 cl ients. And we are looking at 250 cases that are out
there.
So clearly we have a lot of vulnerable seniors
who are i n our community. And I would like to know
what the Minister and the Ministry are developing
around its National Senior Strategy, in particular, to
lower the case numbers, identify the exposure that
many of our seniors have and make things better.
I would like to now move on to page B -283,
Ageing and Disability Services, 96040. There were
151 cases, I thought I heard the Minister report. I am
just having a look here. There were 151 reported cases. And I would like to know, of the reported cases to Ageing and Disability Services, how many of those were either reported to or added to the Senior Abuse
Register? And if I might be able to get a bit of an update on the activity, the use of the Senior Abuse Register and where we are with that?

[Hon. Derrick V. Bur gess, Sr., Chairman ]

So, there is a r eport of
$980,000 for Ageing and Disability Services for this
year, which is up $171,000. And we are clearly down
on staff, and prices are going up as far as maint enance, administration, operations. I would like to ask
the Minister how she is hoping to dev elop the seniors
section of her Ministry. It seems that there are very few people [working there]. There are seven of them according to page B -284. There are seven members
of staff in Ageing and Disability Services. But yet we
have got this growing populat ion of seniors, and we
clearly have a growing vulnerable community, sub -
community within the senior population. And I would
like the Minister to give some indication, some hope that this is going to be a developing department within
her Ministry.
640 1 March 2023 Official Hansard Report

Bermuda House of Assembly On page C -21 . . . well, let us just stay here
for a minute. On page B -283, line item 96070, Grants
to the Third Sector, and they are listed again on page
C-21. I would like the Minister to give some indication
on again how the Ministry might be working with some
of the rest homes in an effort to either be able to build
up and substantiate the actual rest homes the mselves, or what we can do to help them, because
clearly it is going to be difficult to sustain themselves
as the cost of living is going up. They have t he exact
same cost proportions as we do, so, food, electricity,
maintenance, all of that has risen for them as well. But the grants have remained the same.
So, there is just no way (as I am looking at
this) that the rest homes are going to be able to mai ntain that same level of care if they are receiving the same amount of money, knowing that right now costs
are so high. And as I said earlier, if the Minister has a
programme or a committee that she is working with,
people who are trying to come up with way s in which
we can just be more efficient, ways in which we can
help these facilities to reduce their costs and be able
to maintain a higher standard. Because otherwise, we
are going to see neglect, and the last thing any of us
want is to see neglect coming out of either gover nment rest homes and nursing homes, or any of the
rest homes that we are providing grants to.
So this would be an opportunity for us to
make sure that we put these homes in particular on solid ground so that they do not find themselves in
despair and finding themselves unable to care for
those who are in their premises.
The Minister had mentioned that the rest
homes had programmes during COVID -19 that had
been suspended. And so I know that one of the big
ones that many of the rest homes —really, they lost
revenue on them —are the day care programmes. And
so I would like to ask the Minister whether she knows whether the rest homes are fully back up and running,
whether their day care programmes, the respite o pportunities for family members to be able to provide
their elderly with a place to stay for a couple of weeks while the families are doing other things. And whether they are fully back up and operational or whether
there are still restrictions based on COVID -19.
I would like to come back to page B -283,
96000 Administration. The $280,000 . . . Okay. So,
the Minister answered that. So the vulnerable adult treatment is getting $160,000. And I am wondering if
the Minister might have a moment just to explain what
the vulnerable adult treatm ent is?
And then on page B -283, 96060 Policy Deve lopment, last year the Minister mentioned a homeles sness strategy. I did not hear it this year. But I was just curious, given the fact that there is quite a bit of an
effort within the community, whether th ere are any
developments to build a homelessness strategy for
Bermuda? I know that there is a partnership and
grant, whether there is any indication that the Minister at some point will include a charity into her grants and
contributions that will include the homeless?
I mean, on page C -21, we have 70487, Salv ation Army Shelters, of which much credit needs to go
to the Minister for the developments that she has done there. It certainly has progressed. And I would
love to have a bit of an update on where th at pr ogramme is to date. I remember that it was completed.
But if there are any indications or any statistics of the
numbers of people who have been in the shelter and
how that partnership is going with the Salvation Army. But is there is going to be future development in that
space or will we just be maintaining the grant to the
Salvation Army and leave it at that?
Page B -282. This is just a general question
under Head 86. Last year the Minister spoke about the Children’s Commission. And we passed some leg-islation. And I was just wondering whether the Minister
has any update on how that is progressing? And this
was the council or commission that we put together
where children within DCFS [Department of Child and
Family Services] would have a place to go to speak to and have an advocate on their side. And I would love
to have an update to see how that is doing.
Page B -282 again, the Head 86. There was
not much mention within the Minister’s brief about the Charities Commission. But I understand that the Charities Commission does come under Head 86. And so I am just curious whether the Minister could give us a
bit of an update on the Charities Commission. I know
that there were some thoughts at least last year to
simplify the application process f or charities. And if
maybe she can give an update on any advanc ement —

[Programme] 6932. So this
year the Minister has introduced the Centre Against
Abuse. And I am just wondering whether the Minister
might be able to give us an ind ication of how she is
hoping to partner a little bit, what her intentions are for
partnership and coordination with the Centre Against
Abuse? And I guess what my real question is whether
there will be any legislation coming through to further
protect our v ictims of domestic violence and whether
she will be partnering, coordinating, consulting with
the centre in order to progress any legislation in that
space?
And then the other is 7093, Tomorrow’s Voi ces. I am just curious about that. So, again, I am look-ing at the fact that we do not have a lot of money. This
particular charity is getting an estimate of $30,000 this
year. But they are looking for a new location. And they
have been quite vocal. And I am just wondering
whether the Minister is willing to work with them in
partnership under the mission of the Ministry to in any
way help them. And if I can ask the Minister whether there have been any conversations to help them to
find a location at government buildings and any other
opportunities for us to give service in kind and to pr ovide them with the value for money, given the fact that
there are not any real cash windfalls as far as grants
are concerned.
On page B -283, come back over to the subjective analysis. I am curious, there is travel for
$24,000. And is this the travel that is for staff to go
and visit children in the overseas facilities? Or is that
travel for conferences or training? And that is on the
subjective analysis on page B -283.
I have another question. See, that is sort of
where I get real ly kind of confused. There is Energy. I
am still under subjective analysis on page B -283. And
last year it was budgeted for $91,000 for Energy. It
has gone down to $57,000 for Energy. And we bud geted back up to $91,000 for Energy. And I am just c urious how . . . And back in 2021, it was only $26,000
for Energy. So basically we have gone from $26,000
up to $91,000 for energy costs. So, you know, I am
just curious whether the Ministry is aware of the fact
that many of these charities, rest homes and folk in
the community, we are still giving [them] the same
amount of money. And these are huge increases. And
I just really wanted to show and reflect the difference
in the costs associated. And there they are written in
black and white. And whether we are being sensitive
to that and helping because that is our job.
The Minister had mentioned to me, and I
know it is very clear, and I am still on page B -283. I
am under Professional Services. It is listed in the su b-jective analysis. The Minister did mention that a go od
bit of the cost was going to assist in some overseas treatments and some equipment for ADS. But she has
mentioned before the litigation guardians are separate. They are independent. They are with the courts. But are they still paid under the Professiona l Services
within the Ministry? Or has it completely broken off?
Because certainly last year it was still under the Mini stry. So, I am just curious whether the litigation guardians are still being paid under the Professional Services on page B -283.
Also, on page B -283 under Professional Services, the Minister did not mention this year some of
the costs associated with foster parents. But I just notice when reviewing the brief last year that she had
mentioned that insurance coverage for children who
are liv ing with foster parents, that this amount of money comes out of the Professional Services and subjective analysis.
And so I have a question, and it certainly
came up at the presentation that children who are part
of the family within foster care are not c overed by an
insurance policy. And I am curious whether the Mini ster and the Ministry have been working to try and find
a solution so that we can create some sort of policy or
programme for our children who are in foster care to
be insured without having t o pay —

I would now like to move
over to Head 23, Child and Family Services, page B -
288. Under 33070, the Brangman Home, if the Mini ster could just give us an indication . . . she had mentioned that children will age out, transition away as
they reach the age of 18 and they age out. I am just
curious where those children go. Do we just release
them? And I know that the Transitional Living Pr ogramme is about to launch. But I am just curious. If
children either are not wishing to go there or if the f acility is not quite ready yet, where do the children go if
they are not being reunited with their families?
And also, well, I guess for any of the children
or young adults who are in the Brangman Home,
since we are under that line item, are any of them i nterested in moving to the Transitional Living Pr ogramme? Is there any indication that they are willing to go into contract and become me mbers of that res idence?
My other question for the Minister is [regar ding] 33100, and we are on page B -288, the PsychoEducation Programme. There was a committee that
was going to be created to assist with the determination of assessments. And the Minister did speak to it a
642 1 March 2023 Official Hansard Report

Bermuda House of Assembly bit. Last year she had mentioned that the Chief Medical Officer would be joining that committee. And I am
just curious whether that committee is now fully populated with various members from throughout gover nment and whether the Chief Medical Officer has now
joined it.
And I believe if the Minister could just confirm
the number of children who are overseas just now. I think that I heard her say something like 13. If that is
the case, it seems like there are quite a few children
who are in a crisis state [if] they would need to be sent
overseas for treatment, and what more we can do to .
. . I do not know, just to stop that increase in the number of children who are in crisis like that.
And certainly, with a larger population of chi ldren overseas, I am just curious how the Ministry is
managing the oversight. If there are a number of chi ldren who are overseas right now and what we are
doing to either visit them, what we are doing to check
to make sure that the facilities, the residential s chools
that they are in are appropriate for the individual chi ldren who are there, make sure that we are monitoring
their welfare and keeping the children safe while they
are overseas. And certainly who and how often people
from Bermuda, whether there are family members or
members of the Ministry who are actually visiting,
physically visiting the schools, the residences to make sure that the children are safe and are benefiting from
the programmes that are available to them.
And if there are any children w ho have been
brought home, you know, I would like to know if the Minister could let us know whether any children are
struggling who are not finding that it is working well for them and how the Ministry is dealing with that.
Whether we look to transfer the children or whether
we look to bring them home and find another solution
for them. The Minister mentioned that it is some
$2,000, I think, a day. It seemed like quite a large
amount of money —it is a lot of money. If I could ask
the Minister again the cost per child to send them overseas. Because it seems like it is a huge amount
of money.
If we just look at the cost of the budget allotment at $2,108,000, and if we are even looking at a
dozen children, $2 million is a lot for one year, right?
And it is ever y year across the board. So I would like
to make sure that those children are being well cared
for.
And I think with that, there is 30 minutes. So I
am going to take my seat because I think others have
questions.

Thank you, Mr. Chairman. And
thanks to the Honourable Minister.
Honourable Minister, I caught both the begi nning and the end of your presentation, but I did miss a
little bit of the middle. Therefore, I apologise if my very
brief—I have three very quick questions. If you answered them in your brief, I apologise that I am asking
you again.
All three are on the gra nts. So it is page C -21,
C-21 at line item 96070, Grants to the Third Sector.
And I have three questions. The first question is in
relation to [programme] 6912, the Rest Homes line.
And there is a decrease of some $440,000- odd. And if
you could just explai n the reason for that if you have
not done so already.
My second question is about the two items
below, 6930 and 6932. And it is a two- part question.
One is if you could explain the reduction for the Cen-tre Against Abuse, which has gone down by
$100,000. And then secondly, but still about those two
items, what thought if any has gone into the synergies
between those two organisations and the potential that they could work together or merge, if any?
And my third and final question is three more
lines down under the Salvation Army Shelters, 7048. And the question I have there, the grant there is being
maintained at the same amount, namely, $550,000.
And we knew from the Legal Affairs debate the other day that Legal Affairs also gives a grant to the Salv ation Army Shelters under 7048 for the sum of $50,000.
And I am just curious if you know why there are two grants from two different ministries, and why those would not be just one grant under your Ministry. And I
guess, and I do not know the answer. But I gues s it
might have something to do with its falling under N ational Drug Control and whether that is a drug treatment programme to which the $50,000 is specifically allocated.
And those are my three questions, recogni sing that my second question was in two parts.
Thank you, Honourable Minister, and thank
you, Mr. Chairman.

Yes. Good afternoon,
Mr. Chairman.
I just had a couple of questions, some of them
were already asked, that we can get the answers on. In regard to Head 86, business unit 96040, I note that
under the Ageing and Disability Services, the number
of full -time employees remains constant. I just wanted
to know what the intention was in regard to covering
the increased number of seniors for whom we have to
have adequate staff within that department.


Bermuda House of Assembly I think this was touched on as well. Head 86,
page 283, in regard to the target outcomes for repor ted cases of senior abuse. Our population is increasing. I just wanted to know what was the intention of
the Ministry in regard to encouraging people to report senior abuse cases. I note we had 31 cases, I thi nk, of
psychological abuse. We had 19 cases of financial
abuse. And I just think with some more encouragement, we can find ourselves in a situation where there
are many more people out there who either are afraid
to report and there is a significant degree of under -
reporting. So what programmes or what do we have in
place to encourage reporting?
The other one was Head 23, page B -288. And
it was relating to —I think this was touched on by Ms.
Jackson, in regard to the psycho- educational pr ogramme. I know som e time back previously there was
some talk about creating a programme in Bermuda, which was very, very challenging based on the different types of issues that we had for the students who
get sent away. So I guess my question is, Is there any intention— I know we cannot cover all of the issues. Is
there any intention whatsoever of this Ministry of look-ing at any type of facility or services that could be l ocated in Bermuda?
I know it is very challenging, and I know in the
United States and other places wher e people get sent
they have very specialised facilities. I did travel to a
number of the facilities, and certainly [seeing] the specialties in the various facilities I know it would be very
difficult to create them in Bermuda. But at the same
time, these y oung people do travel overseas. They
complete a programme. They do very well in the pr ogramme. And they come back to Bermuda. And very often, there is not, I guess, appropriate follow -up with
the programmes because these are very intensive
programmes.
But I do acknowledge the number of people
who have actually travelled overseas and have actua lly returned or actually continued to education and did
not come back to the same neighbourhood and the
same environment. But the same reasons why we
moved them out of Bermuda was because of the fact of family, neighbourhood, environment, et cetera. But
they come back to that same environment.
I understand there was certainly much talk
about the rest homes and the grants to the rest
homes. I do declare I do run a nurs ing home. But certainly —

In regard to the su pport with the specific grants, I think most of the rest
homes and actually all of the third sector certainly a ppreciates the support of the grants from the gover nment. It is c hallenging for everyone. I guess my question is whether or not a home can anticipate not just a
grant . . . I know it is not within the control of the Mini ster, but if they can anticipate any other support that
can be given besides financial grants, just m oney?
Any other support that can be provided for them? And I think those are my questions. There
were quite a few questions already asked by the other
side.
Thank you, Mr. Chairman.

As I was listening to the sort
of duplicate of the Salvation Army, on page C -21, I
had a similar question as well. And i t is fine. I am just
curious how and why it is done this way. But 7056,
Packwood Rest Home, on page C -21. So they get a
grant. But then under 6912, under Rest Homes, the
Minister had listed them as well. So I am just curious
why it would not just be one li ne item for Packwood
Home with the full amount versus splitting it into two
line items.
I have one final question, too. And this is
about the Mirrors Programme. And I certainly have very, very much respect for the Mirrors Programme
and welcome Mirrors to DCFS.

And my question is around
the statistics, the data. Because one thing I really admire about Mirrors is that they have always had like
amazing data, probably some of the best on the I s644 1 March 2023 Official Hansard Report

Bermuda House of Assembly land. But one of my questions is that over the years,
because now it has been like decades that they have
been in existence, one, how those data have mixed in
together because they have had a number of different
models. They have had the 18- to-24-year-old youth,
they have had the middle school. They continue with
the middle schools.
So with all of the data that they have collated,
I am just wondering how that is being analysed and whether the Ministry is or will be offered an opportunity to research, to really delve into those data and see whether there is any useful knowledge that we can get
out of that to help us to understand more fully the
younger populations between sort of middle school
and age 24.

Thank you, Ms. Jackson.
Any further speakers?
Minister.

Hon. Tinee Fu rbert: Thank you, Mr. Chairman, and
thank you, everyone, for asking all of the questions.
I do want to share that I had a long version
and a short version of my brief. And Mirrors does have
an extensive record. (I will start with Mirrors.) Mirrors
does ha ve an extensive record of data. I think if I
would have read it all, I would have not had the opportunity for my colleagues to ask questions. But I do
have extensive data in regard to the efforts of the Mi rrors Programme.

Right.

Hon. Tinee Furbert: And item number 7056. The reason that they are not included in the Rest Home line
number is because that particular rest home was serviced under another Ministry before it transferred over
to the Ministry of Social Development and Seniors. So they have their own line item because of that reason.
Then there was a question . . . sorry. I might
go out of order in regard to the questions that were asked. There was a qu estion in regard to the rest
homes and the increase or the decrease in numbers. I
just wanted to remind colleagues, because I did bring
a Ministerial Statement to this House where I spoke of how this Ministry supported our rest homes with har dship benefits when they were going through difficulty
in COVID -19. So you will see that number reflected in
the book of what [additional amount] we had given. You can work out the calculations, but we gave [addi-tional amounts] to our nursing homes, which I think
was approximated at about $500,000.
There was a question in regard to the Salv ation Army, line number 7048. The Ministry in conjunc-tion with the Ministry of Public Works supports the
shelter, the Salvation Army shelter. We provide an operational grant of $550,0 00, and Public Works pr ovides more of a public works or structural assistance
to the shelter. And so you would have heard the Mi nister of Legal Affairs speak to their grant, and it is what
you had mentioned for the Harbour Light Addiction &
Lifeskills Prog ramme, which is under NDC [National
Drug Control].
For the differences [between] line number
6930, Women’s Resource Centre, and 6932, Centre
Against Abuse, the Women’s Resource Centre, the
funds for that are actually going toward the new Transformational Living Centre. Okay? So they are
going toward that particular programme. And the Centre Against Abuse, we are not decreasing the amount.
What you will see reflected in the Budget Book again
with that particular charity having been supported pr eviously under another Ministry, we have had to pr ovide funds for that particular charity now within the Ministry of Social Development and Seniors. And because it was not budgeted for that 2021– 2023, we had
to assist them with funding which you will see as that
$250,000 fund. But this year they have been allocated
for the $150,000.
I want to speak to, I believe, MP Simmons -
Wade had mentioned in regard to whether or not the
Ministry is doing any works with potentially providing services or Psycho- Ed sort of services here in Berm uda. I believe the Ministry of Health is actually in talks
with MWI [Mid -Atlantic Wellness Institute] in regard to
forensic cases. And they are currently in talks in r egard to any progression with providing support ser-vices for a forensic group o f persons.
And also programmes overseas, the problem
that MP Simmons -Wade mentioned in regard to persons returning back and maybe not necessarily having the same support services that they may have had
within the psycho- educational programme overseas,
that is not an issue that is unique to Bermuda. Actually, when I was out visiting on one of the trips to one of
the facilities, this is actually a common concern that is happening globally when people have to transition
back out of therapeutic facilities back into their own
environments. But we do try very hard to provide them
with services that they need to help with support services once they do return back. We do not just leave
them. We do provide them with care and services.
There was a question in regard to . . . Sorry, I
am going to go back to, Mirrors data analysis is based


Bermuda House of Assembly on age group. They collect data for persons between
the ages of 14 and 18 years, and 10 and 13. And
these data are used to drive prevention programming
at lower age groups.
There was a question in regard to whether or
not children overseas are being monitored. Children overseas have weekly face- to-face treatment team
meetings, monthly reports, quarterly meetings, visits
every six months. And the department representative
in each faci lity is vetted annually. I believe I mentioned
this in the brief as well.
Just some clarity in regard to the rest homes
on page C -21. When we speak of those rest homes,
we are only speaking to Matilda [Smith Williams Nur sing Home] and Lorraine [Nursing Home].
There was a question in regard to how we
encourage persons to report senior abuse. We do this
through education initiatives, collaborative public
events, through the sharing of information and r esources, also via mandated reporting and encoura ging an onymous reporting if persons do not want to be
identified as the reporter. We also do a seniors radio talk show programme called Golden Hour, where do
take the opportunity to explain to persons in our community how they can report senior abuse, which is
also education for [everyone to understand].
But you can imagine within our close- knit
community, sometimes it can be very challenging for people to make reports, particularly if the accused is a
child. And the parent or the older adult does not want
to report offences for many reasons. It could be b ecause they help them in their home, it could be because they do not want to receive any sort of bac klash. So there has to be a supportive structure around
that to make people feel secure in reporting.
I also wa nted to thank Age Concern as well,
because they do also assist persons with helping to
navigate what to do if they want to be able to report
incidents.
There was a question in regard to how many
children are overseas. In 2022, there were 12 chi ldren. Five children completed assessments and r eturned to Bermuda with treatment recommendations.
One child went on to long- term care therapeutic
placement. And one child is receiving local case man-agement.
There was a question in regard to how we are
supporting the homeless. I did mention as indicated
on page C -21 that we provide a grant to the Salvation
Army shelters by giving them that $550[,000], and we also are giving a grant to the Charity Home, which we
did also give last year. This year we have allocated $50,000 to the Charity Home.
In regard to the senior strategy and actions
related to addressing the growing seniors population, we have had difficulty executing upon those due to the Ministry’s current resources. However, we have r ecently developed a National Senior Strategy fram ework, where we are looking to execute the develo p-ment of the strategy over the next six months because
we do have support of the Bermuda Health Council,
as well as Cabinet recently approved a position as far
as a policy analyst. So, we will be working on this with
the Ministry of Social Development action plan to i mplement over a three- year period.
But this plan will also highlight actions to address abuse and prevention of dementia. There are
also initiatives being led by other agencies such as
MWI regarding capacity related to legislation as it r elates to adult protection.
There was a question in regard to the cost
centre as it relates to vulnerable adults and what that
meant. It means that the Ministry is supporting vulnerable adults. We see new treatments overseas. So
there are monies for supporting vulnerable adults for
treatment facilities overseas. As local resources were extensively exhausted prior to transferring the vulnerable adult overseas, as the individuals require reh abilitative supports and services that are currently unavailable locally.
Where do children go when they age out?
Children who age out of DCFS are considered to be adults, and they can opt out of any further involvement
with DCFS, and some do choose to do t hat. Children
can remain with their foster parents, or they identify
community supports or extended family members that
they want to go and live with. And now they have the option of the independent living centre if they choose
to use that option as well. So they are not just put out
on the street! They do have a plan for somewhere to
go.
Is the department or Ministry working on av enues to obtain insurance for children in foster care? We have tried very hard to work on this in the past.
Unfortunately, we h ad been unsuccessful. So [to]
those insurance companies who are out there, help us.
For children in care to date, we are extremely
thankful to the foster parents who have made sacrifi ces to place the foster children in their home on their
own personal ins urance. Their foster parents, they are
able to put foster children on their own insurance. So
we are thankful that they [can] do that. But other than
that, we as a Ministry are paying for personal medical insurance —sorry; we are paying for medical care.
In regard to updates for the work of the Office
of the Public Guardian, I believe the Minister, the A ttorney General, had mentioned in her report as the
work being done is under the Ministry of Legal Affairs,
with much encouragement and anticipation of the Mi nistry of Social Development and Seniors. And they are
conducting research on the framework. And it is being
identified that a public receiver is required, and it is a
matter of priority to assist with existing welfare cases
prior to the development of an overall framework. So
this is happening as we speak.
In regard to the question for litigation guardians, litigation guardians are paid by the Ministry and
646 1 March 2023 Official Hansard Report

Bermuda House of Assembly they are paid by the Ministry’s Headquarters Professional Services.
There was a question in regar d to the Chi ldren in Care Advisory Board. As this is a new financial
year, actually some of the new members are undergo-ing vetting. So we should be announcing the board in
the next upcoming weeks in regard to the Children in
Care Advisory Council.
There w as a question in regard to resources
for ADS and whether or not they had enough staff to
be able to manage their caseload. It did mention in the report that at times the caseload was up to one to si xty. We have recently approved two positions by way of
social workers, in addition to the three case managers
that they do have, as well as a policy analyst. If we
understand the process of getting positions, we have
to know what is available to us of positions that we
can utilise to be able to increase the staff levels within
ADS. So we are anticipating that we will be able to
have those positions in place.
There was a question in regard to day care
and respite care in homes. There have been r estrictions on day cares previously in place [because
of] COVID -19. They have been removed, but only a
couple of homes have resumed these services due to
staffing levels and other factors. But the majority of
the homes have restarted respite, but it also is de-pendent on their bed availability.
There was a question in regard to the Senior
Abuse Register. For 2022/23, there were three people
added to the Seniors Abuse Register. And the Ageing
and Disability Services works very closely with the
Bermuda Police Service on senior abuse cases. So depending on the case, some cases go through the
courts pending DPP [Director of Public Prosecutions]
approval. But also joint investigations are made with
ADS and the Bermuda Police Service and other rel evant agencies. And oftentimes the difficulty lies in seniors not wanting to press char ges in cases [involving
a] loved one, or there is some inefficient evidence to formally press charges.
There have been some proposed amendments to the Senior Abuse Register Act to strengthen
that particular Act. There will also be some upcoming
changes to the Human Rights Act as well; which also
includes age discrimination. But we are overall looking
to improve and build upon the Senior Abuse Register
Act.
There was a question in regard to making
nursing homes more efficient and improving sustain ability. The Ministry is currently partnering with the
Bermuda Health Council in developing solutions for
long-term care that includes a financial assessment of
the nursing homes to improve efficiency and sustai nability. We can all appreciate that every home is di fferent. They have different overheads. They have di fferent levels of debt. And currently their financial st atus is being evaluated.
I think that is it, Mr. Chairman. I just want to speak to the National Senior
Strategy, sorry.

Any objections to that?
Agreed.

[Motion carried: The Committee agreed to rise and
report progress and sought leave to sit again.]


Bermuda House of Assembly The Chairman: I am going to ring the bell for the
Speaker.
Mr. Speaker.

House resumed at 8:00 pm

[Hon. Dennis P. Lister, Jr., Speaker, in the Chair]

REPORT OF COMMITTEE

ESTIMATES OF REVENUE
AND EXPENDITURE FOR THE YEAR 2023/24

Good evening, Members.
Are there any objections to our forwarding
back to the House?
There are none.
The other items are being carried over?
Deputy, none of the items are being done t oday?
Okay, good.
Would you like to move us into that goinghome period?

ADJOURNMENT
Hon. Walter H. Roban: Yes, Mr. Speaker.
I do move that we adjourn until Friday ,
[March 3] at 10:00 a.m.

Surely.
Mr. Speaker, thank you for allowing me this
time to speak on something that is . . .well, everything
is passionate to me most of the time, but in particular
this one. It is fitting, though, because three weeks ago this was my prepared motion to adjourn. And unfort unately, I was unable to deliver it because the electric ity went out. And to be quite honest, for what I wanted to speak about, it was fitting. I have raised this matter
with my colleagues, so they know. And I think this is
something that needs to be known even across colleagues from both sides of the table. And the fact that
the electricity went out kind of really put what I am
speaking about to highlight it.
And it was to do with something as simple as
phone service. Over the past few months I have been
just looking into the new fibre phone service that one
of the Bermuda service providers is doing. So if you
have a landline phone, you are being asked to convert
your line to a fibre phone line. And in the grand
scheme of things, you might think that this sounds
great and wonderful, and it is technology, and also it is modernisation. But what I have learned and been able
to research over the past few months is that som etimes technology does not work for us. And in this particula r instance here, what I have been able to find is
that phones do not work when the electricity goes off.
And that is a very serious matter.
I have talked about it over the past few
months, Mr. Speaker, but I lived it when our electricity
went off here. And one of the reasons, and let me
state early, is my mother who, not thinking, thought
that she was going to get her phone fixed and she
went to a fibre phone line. But on the day that the
electricity went out, you have someone who has challenges, whether t hey be health or other, there are two
things that happen. You cannot call them, and they
cannot call you. And they can make no phone calls.
So imagine if there was either a medical emergency, an accident via fire or something else, and that person
cannot use their phone.
We think in terms of seniors all the time for
this, but it could be anyone. If there was a fire in your home, Mr. Speaker, and you had converted your line,
you would not be able to call 911. Okay? So those are things, though, Mr. Speaker, that I would like to take
my time on motion to adjourn to let people know how
serious it could be. And the fact that I ended up ha ving to experience it —and I think it was February 3 or 4
when the electricity went out —it actually made me
even more passionat e about speaking about it and
letting people know the disadvantage of converting
our phones to a fibre phone line.
648 1 March 2023 Official Hansard Report

Bermuda House of Assembly Mr. Speaker, in addition to the phones not
working when the electricity goes out, there are cha llenges of having more than one box in your home at
one time. Just think of something— an elevator. Elev ators use a land line. But if they were switched to fibre
and the electricity went out, what would happen? And
years ago we might have thought, Well, electricity
does not go out like it does now . But if you think about
it, we had an Island- wide outage in December 2020,
and then we had an Island- wide outage in 2023. So
the occurrence of your electricity going out outside of
a hurricane or a storm is quite possible as well.
And just think, Mr. Speaker , in the event of a
hurricane, we have seniors who are living by them-selves who could need medical assistance, and they would be unable to call for it. I know that there are
some who have said, Well, they could get a cell
phone. That is an additional expense for our seniors
who are already living on a fixed budget, who are struggling to pay for their prescriptions, who are def initely struggling in terms of affording the food that they
need to eat to now take up another bill for in the event
of.
So, Mr. Spe aker, when you go and you do
some research on this, I even asked, What other inc idents could cause these phone lines to not work? Because it could be electricity, bad weather, and then I
was also told, for whatever reason, we have rodents
that are eating at these lines. So, there have been
some outages as a result of the rodents eating [the
lines].
We all understand business and business
decisions. But we also have a body that would and
should be watching out for us. Mr. Speaker, I did even
do some researc h in terms of our Regulatory Authority
[RA] because they would have been the ones that
would have heard or discussed this or even approved
it, I should say, before it happened. So I go and if you
have a look on their site, they do talk about consulting.
And if you allow me to read, Mr. Speaker, this is all on
their site.
It actually speaks to “Consulting with the public to get their feedback is an important part of the regulatory process” . . . (This helps) “to maintain
transparency and preserve good governance.” They
also have a directory on their site of C onsultations
Directory , they call it. And you can go in there and you
can see where and what they would have discussed
during a consultation. It goes back to 2013, I believe,
Mr. Speaker. But consultati on on the fibre phone lines,
either it did not happen, or it may not be on their site at this time. Because I believe it may have happened about two years ago. And, Mr. Speaker, I also believe
that if it had been a consultative process, and maybe I
stand t o be wrong, but if this was something that
would have been mentioned, it definitely should have
had some workaround solution.
I did find out that our local service provider is
trying to test battery -operated phones to see if in the event of power failure, the phones could switch to battery. But the test has been going on for almost two years, and it has not [produced] a positive outcome at
this time. So while the testing is still going on, in the
event of an electricity [outage], remember what I said to yo u. In my mind, it particularly [affects our] seniors.
But as you go farther down this road, it could be each
and any one of us or any one of our constituents who
have no ability to phone service at a time that they
may well need it.
Mr. Speaker, our Regul atory Authority —and
we know who they are and what it is that they do. I made sure to spend some time on their webpage, Mr.
Speaker, just to make sure that I am familiar with what
it is that they do. And they do talk about why public
consultation is important. And everything that I am
reading can be found on the website, so there is no need for me to disclose a document because it is right
there and readily available to you. Also, they speak
that “Public consultation aims to:
• Gather input on large- scale proj ects affecting
the public
• Provide valuable information, evidence and
opinions from industry stakeholders and consumers . . .”
So we can see the need and why they would
choose to consult on particular matters.
And I also went and had a look at who are the
RA? And they speak to this, Mr. Speaker. “The RA is
an independent regulator established under the Reg ulatory Authority Act 2011” . . . “to promote and pr eserve competition; to promote the interests of res idents and consumers of Bermuda.” So there are other statements, but I particularly highlight that one, “to
promote the interests of residents and consumers to Bermuda.”
How they choose to accomplish their goals,
Mr. Speaker, they say that “the RA’s Vision, [Mission] and Values ensure the public interest is the core focus
of the regulated sectors.” So I am going to read that part again because I think that is the key here. “The RA’s Vision, [Mission] and Values ensure the public interest is the core focus on the regulated sectors.”
And in point number one on the very same thing about
how they accomplish their goals is that “Consumer/Stakeholder focus will ensure the RA works to bring
value to the community and its stakeholders.”
So I think, Mr. Speaker, what you can see
here is that they are tasked with s omewhat ensuring
that the public is protected, that our interests are
looked at and considered. They promote the interests of the residents. And more importantly, they consult.
Mr. Speaker, what I hope to accomplish today
is that we actually look at this matter, someone external to us here in this House and those who sit in this
House for the seriousness that is attached to it. It
would be unfortunate because the Regulatory Author ity were able to put out a statement on February 4 with
regard to the recent BELCO outage. And in one se nBermuda House of Assembly tence in there that I read, that is because if you want
to read the whole thing, you can, Mr. Speaker. But it
says, “ Risk to life and limb are the primary concern
with such incidents and the RA is pleased to note there were no reported harm to anyone. ”
I would hope that every statement could read
this way, Mr. Speaker. But what I do not want to do is
take the chance of saying absolutely nothing and that
no one hears what you are saying. And we have a
situation where someone does not have phone service, whether it be a senior or any one of us who may need assistance, any one of of our constituents who
we are tasked with representing and ensuring that
they are safe. And we here could be ignorant of that.
But you would not be ignor ant after I have spoken
about it today.
Mr. Speaker, this in my view is important. It
covers all sectors of our Island. And it actually, while
we sit in this space of having no solution to it, I would
encourage each and every one of us and persons
who are outside of this Chamber, to make sure that
incidents where there may not be any electricity, to
please check on either a senior or your loved ones.
Because it was not a nice feeling not being able to call
to my mom or have my mom be able to call me.
And you go there and you have a senior kind
of sitting up in the dark, waiting for someone to come.
So I know I cannot be alone in this. Actually, I
know I am not alone in it. Because I was able to look
at social media the very next day. And there were
severa l people who complained about the fact that
they had no phone service during the power failure.
Part of it, too, Mr. Speaker, was a bit of education. Because many did not realise, once your phone is
converted from the copper line to the fibre line, this
will happen. I probably —you know, I grilled the person
when they called me. And I said, Well, I’m not going to
do that this time. I think I’ll wait. And I think that what I
will wait for is the solution of a battery that does not put me in any harm’s way. And if I can avoid that, then
I will definitely do that.
People will make their own minds up, and
they will decide. But they will decide being informed.
And I am hoping that they will consider the implic ations of these new phone lines. I am not saying that modern technology is not great and wonderful, Mr. Speaker, because it is and it can be. But also it has to
work all the time, not part of the time, not some of the
time. And definitely not [fail] at a time when we critica lly need these phones to work.
So, Mr. Speaker, I am going to close on that. I
thank you for allowing me to have this time to share
this matter. I hope my colleagues can take this away
and maybe even have their own discussions so that
we raise this to a level of finding a solution very qui ckly.
Thank you, Mr. Speaker and listening audience.

Mr. Speaker, after last Fr iday—last Friday, you know, they say, that day —after
they said that they were going to bring back the TA
[travel authorisation] and after they said that they were
going to tax people for health, I was like, Whoa. Then
afterwards they said they did not know about it. Only one person knew. And th en they said they need to
change the leader, then they said they were going to
stick by the leader.
So do not go anywhere. Just . . . this one is
for you. This one is for you, Mr. Simons. This is worth
it. This is worth it. Give me five minutes.
So, Mr. Speaker, I was planning on kicking
the OBA down, but momma said, Don’t kick a man
when he’s down. Help him up. So today I am going to
take a different tack. And I am going to, at the risk of losing my PLP card, give the OBA some advice.

[Inaudible interjection]

Yes, he has returned. Let
the record show that the Opposition Leader has r eturned to the Chamber. We have a quorum.
My first advice to the OBA: Embrace who you
really are. No sense trying to say, We’re not the UBP.
Because out of nine parliamentarians, six MPs and
three Senators, that is nine parliamentarians, five of
them come right out of the UBP. That is a majority.
Five out of nine is a majority, right? So you are the
UBP. No sense saying, No, we’re not, or, Yes, we are.
Yes, you are. Right? The more you deny that you are,
the less credibility you have with some of the public.
Advice number two: There was this fable
called “Chicken Little.” Anybody know “Chicken Li ttle”? He used to go around saying, The sky is falling
in! The sky is falling in! The sky never fell in. There is
a former OBA Senator that once a month comes out
and says, The sky is falling in! The sky is falling in!
And the world is coming to an end because the PLP is
in charge and because David Burt is stil l Leader of the
PLP! Again, it goes back to credibility.
650 1 March 2023 Official Hansard Report
B ermuda House of Assembly As we have heard during this Budget Debate,
there is an increase in IB [international business] activity in this country. There is an increase in construction activity. Now, these are not the only i ndicators.
My Minister, Jason Hayward, said 13 out of 16 indic ators are on the up. So on one hand you have this for-mer Senator saying the sky is falling in. But on the
other hand you actually have (what do they call that
stuff?) credible evidence that it is not. So again, credi-bility.
Right. Last piece of advice for the OBA: Do
not waste energy trying to influence the PLP, the Members, the delegates, as to who is going to be the
leader. Just do not. Because by the same token, we
could have taken advantage and we could have said,
You all need to change your leader. But you all need
to sort yourselves out, and we will let you do that. And
quite frankly, we like Cole. At least I do.
Do you guys like him?
[
Inaudible interjections]

More importantly, Mr.
Speaker, here is the thing. Despite what the public may think, the OBA and the PLP are not up here at
each other’s throats every minute. We actually get along pretty well. There is this room upstairs called the Common Room that, two hours ago, any [person from the] public would have seen that, they would
have been like, Am I seeing what I am seeing? OBA
sitting down cracking jokes with PLP and talking about
how their families are related and comparing family trees and all this type of thing, right? Any of my guys around seeing that?

Okay. All right, Mr. Speaker. I am going to move on.
Let us go to a little history lesson. Mr. Speaker, 870 miles to the southwest of us there is an island
chain called the Bahama Islands. Anyone ever heard of them? Mr. Speaker, I recently had the privilege of speaking to some historians from the Bahamas, the Commonwealth of The Bahamas. Dr. [Keith] Tinker,
Dr. Taylor, Dr. Curry and Honorary Dr. Butler. You
see, Mr. Speaker, for those who do not know, on both sides of the aisle and both countries, the Bahama I slands were first inhabited by the Lucayan Indians, the tribe of the Arawaks and the Caribs and Taino. Right?
Then along came Columbus and genocide happened.
Columbus went on his merry way because he could
not find any gold in the Bahamas.
Then from 1648 the Bahamas was inhabited,
populated by Bermudians. Many people do not know that. There were these folks called the Puritans. They
wanted religious freedom. They did not want to follow
the Church of England. So Captain Governor William Sayle sailed down to the Bahamas to this Island called Eleuthera. (I know I pronounced that wrong.) He got shipwrecked. Sound familiar? So anyway, along with his religious freedom, he was carrying enslaved Africans. That is the irony. He wanted religious
freedom, but he was carrying enslaved Africans, en-slaved Black Bermudians at that point.
And then subsequent to that, there was a
governor in Bermuda who started saying, Hey, there are way too many coloured folks here. We need to
ship some of them out. Let us ship them down to the
Bahamas. So over the course of 150 years, there
were several ships, untold numbers of ships of Black
Bermudians sent to the Bahamas. Not only Black Bermudians, but they sent undesirable Whites. This


Bermuda House of Assembly was in their history book, right? And they sent rebellious slaves.
For those who do not know, there were several slave rebellions in Bermuda. And anyone they
thought was even remotely connected to that rebe llion, some they killed and put their heads at Gibbons
Island, and some they shipped down to the Bahamas.
Particularly Eleuthera and Long Island, also a new
province which we now call Nassau.
So, Mr. Speaker, down there when you as a
Bermudian speak, they say, Hey, you sound a lot like
a Bahamian. And you have to say, No. You all actually
sound like us because you came from us. That is the
reality. Right? The names Lightbourne, Tucker, A dderley, Burrows all of those are common names in the
Bahamas. Well, guess what is even more common,
Mr. Speaker? Everywhere you go, whether it is a fine
dining establishment, fast food, corner bar, you find
Barritt’s ginger beer. That is the only ginger beer you
find in the Bahamas. So I said to this lady, I said, You
know where this comes from?
She said, Oh, yes. It comes from the factory
around the corner.

[Laughter]

I said, No. Read the fine
print. And on the fine print it says, Smith’s, Bermuda.
Also they have down there CG Isles. Anyone
know what that means? Colonial Insurance. So while
they are telling us, Hey, you have nothing to do with
Bahamas, those people are different from you. Some
folks have been down there investing f or decades.
The irony.
But even more closely related than that, Mr.
Speaker, as I close up, the ruling party in the Commonwealth of The Bahamas is the Progressive Liberal
Party formed in 1953. It was formed 10 years before
our Progressive Labour Party, Mr . Speaker, which
was formed in 1963. You see, Mr. Speaker, not the founder, but one of the main proponents of the PLP,
of both PLPs, I should say, they went to school t ogether in London. A gentleman by the name of Sir
Lynden Pindling, and there is a lady w e all know as
Dame Lois Browne- Evans. They and others worked
behind the scenes, in front of the scenes, on the front-lines to build their parties.
Mr. Speaker, this weekend we are going to be
celebrating our [PLP] Founders Day. And the guest speaker is goi ng to be Ms. Ariana Caines who is the
granddaughter of Dame Lois Browne- Evans.
So you see, Mr. Speaker, from 1648 right up
until today, Bermuda and the Commonwealth of the
Bahamas are one people. The PLP [Progressive Li beral Party] in Bermuda and the PLP i n the Bahamas
are one party.
We have the same slogan, Mr. Speaker. Does
anybody know what the PLP slogan is? All the way !
That is the slogan of the PLP in the Bahamas. So I say all of that because as Bermudians we
need to learn more of our history, not t he history in the
small little book that was given to us in primary school,
because they left all of that out. Take some time,
speak to the elders, both in Bermuda and in the Commonwealth of The Bahamas to learn our history,
Mr. Speaker. And on that note I say, thank you to all
of those founding fathers and founding mothers of the
Bermuda Progressive Labour Party.
PLP all the way!

[Desk thumping]

Go right ahead.

MAKING BERMUDA SAFER

Hon. Michael A. Weeks: Mr. Speaker, like the Me mber who just took his seat, he said his mom taught him not to kick someone when they are down; unfortunat ely I am on a simil ar tack as he is.
Mr. Speaker, last Friday I was not able to
make my contribution because of the sheer numbers.
We decided to cut our speakers short. But, Mr.
Speaker, I was eager to speak then, as I am now, because as I was listening to the Opposition Le ader in
his Budget Reply, on page 2 of the Budget Reply, Mr.
Speaker, like many of his misleading comments
throughout, one thing he said that I have to address
was that this Government was not a caring gover nment and was not doing anything to address the s ocial and antisocial behaviour that was happening.
I was going to wait until Friday when we have
our full budget debate on the Ministry of National S ecurity, but I figured I would just give a little synopsis
now to clear up what the Opposition said and t o assure the public that this is a caring Government and
there are some things that the Opposition Leader
needs to know and the Opposition, because there are some things that we are doing to curb our country’s
rise in violence and antisocial behaviours.
So, the mission statement of the Ministry of
National Security is Working to keep you safe. And
this budget by the Honourable Premier and his team
reflects that. Mr. Speaker, this budget this year for my Ministry, the Ministry of National Security, was
$131 ,000,000 and $5 million in capital, all with the
intention of keeping us safe. We have 1,100 public
servants in this Ministry and their focus collectively is
keeping everyone safe. This budget, Mr. Opposition
Leader, was to provide for the safety of our communi-ty and I look forward to presenting it in more depth on
Friday.
652 1 March 2023 Official Hansard Report

Bermuda House of Assembly But before I get into the budget items, I need
to remind the Opposition of this, Mr. Speaker: that this
Minister and this Ministry keep our ears to the ground.
But just a reminder, Mr. Speaker, I held a two- day
workshop to bring together all of the relevant agencies
within government and the private sector. Ironically,
Mr. Speaker, the Opposition and Members of the O pposition were invited to take part in this very important
workshop. So one could imagine my dismay when I
was sitting here on Friday and the Opposition Leader
was saying that this Government was doing nothing to address the social ills of this country.
I just heard someone ask, Well, did they
come?
A few did show up, Mr. S peaker. I am not too
certain . . . I can’t remember whether or not the Opposition Leader came. But I remember seeing a few of the Members of the Opposition.
The Government is allocating significant fun ding under its capital budget and current account budget to make Bermuda safer. And I need to stress this, Mr. Speaker, because as the Minister of National
Security, it is important for me that every chance we
get we let the country know what it is that we are doing. Mr. Speaker, I had spoken late last . . . I think it
was Wednesday or maybe even Friday (I’m not sure
of the date), and I informed this Honourable House
and the public of our new CCTV cameras that were on
the way. This Government has set aside $1 million for
the CCTV upgrades. And after a competi tive pr ocurement process, this contract will shortly be awar ded to a local company. This Government understands the urgency. So this project will begin shortly.
The system will include newer features to assist the police in tackling road traffic offences and vi olent crime. So, this CCTV system that we are starting
[increases] safety , again, for our community. As a
functional CCTV system it will aid [with] the identific ation of suspects in the event of criminal activity and provide a deterrent.
Also, Mr. Speaker, we will be using a lot of our
capital budget to acquire new equipment. And this includes vehicles for the Bermuda Police Service, Corrections, the Fire Service, and to replace vehicles
that are at the end of their service life. This will include
four replacement fire trucks for the Bermuda Fire and
Rescue Service. So, Mr. Speaker, you may be asking
why am I talking about this kind of stuff right now. It is
simply because I was taken aback, and I was called
and I got emails and text messages wonderi ng . . .
challenging me as to what this Government, our Go vernment, the Burt Government, was doing to keep Bermuda safe.
Over 40 posts are being refunded this year
throughout my Ministry. In this fiscal year beginning April 1, we are looking to attract more than 100 new
recruits. This will not only provide job opportunities for
Bermudians, but it will make our community safer.
This Government is constantly looking out for the s o-cial welfare of our people. These numbers will include
a number of qualified in vestigators for the Bermuda
Police Service to tackle our outstanding cases. There
are some 30 murders that are open and under investigation, Mr. Speaker. And no one has yet been charged. There were 171 attempted murders between
January 2009 and June 2022. There are 127 open
and under investigation. The impact of these unsolved
serious crimes is that there are as many as 157 crim inals who use firearms to either kill or attempt to kill another person and they have not yet faced justice. So when this Government’s attempt . . . [our] job and
our duty is to keep Bermuda safe, that is why we are
bringing in qualified investigators, because bringing
these persons to justice will make a dramatic impact
on the community’s safety, Mr. Speaker.
So please, Mr. Oppositi on Leader, do not
make our people feel unsafe.
Funds will also enable the recruitment of officers who are embedded in the community as parish officers. It is important that in our fight, in our strategy
to combat crime, we reinstitute the parish constable. So some of this year’s funding will be to reinstitute our
parish officers. That in itself will increase neighbourhood security and confidence in the police service,
and hopefully just the presence of these parish police
officers will help to deter crime. Once we increase
public safety, public confidence, then obviously, as we
note, then more and more people will come forward
and help us to combat crime as a community.
Moving right along from the police, Mr.
Speaker, we have even decided, or we have made
funds available, to sufficiently fund the coast guard.
What does this have to do with public safety? This will
enable improved service across marine areas, including search and rescue, enforcement and deterring
criminal activity in the maritime environment .

—because now you are getting into
cost centres and things about how you intend to
spend your revenue . . . make your financial expenditures.

Hon. Michael A. Weeks: Well, I was trying not to get
too . . . I just want to give an overview of something
that I wished I’d been able to do on Friday to combat
the obvious misstatement by the Opposition Leader
that this Government was not doing anything to combat the antisocial behaviour. So I will be going more in depth, Mr. Speaker, on Friday, but my intent today

B ermuda House of Assembly was just a 5 or 10 minute overview. So if you could
indulge me for a few more minutes . . .

I am just saying that I do not want you
to get into your budget now at this time. That’s all.
Hon. Michael A. Weeks: I really don’t mind, but I
think, Mr. Speaker, as much as I can I want to let the
country know that this Government is looking out for the social welfare of its people. In a few more minutes I will be done, Mr. Speaker.
Corrections, we have also given more money
to Corr ections. And I will tell you why. So that when
young men are incarcerated, Mr. Speaker, they are able to get . . . they should be rehabilitated. So what
we are doing with this year’s budget is putting educ ational courses and programmes in the prison and those programmes that were dormant we are reinst ituting them. So this is another piece of the puzzle of
facing our social ills.
So when Friday comes, I will not be able to go
into all of that, so I am just giving a little overview. I
know the time is late, but I have to get this out, Mr. Speaker.

No problem. All right.
Hon. Michael A. Weeks: Mr. Speaker, Corrections
will be given the additional funding not only to upgrade their facility and the educational portion of addressing
the needs of those who are incarcerated, we have 30
new officers that they will be trying to recruit, adverti sing. That is more jobs for local Bermudians.
Mr. Speaker, we have heard [the tourism department] talk about an increase of ships and tourists coming to Bermuda. We have to make sure that Customs is ready. And the job of Customs is to deter crime and to try to keep drugs and weapons off our
shores. We talked about the Bermuda Fire Service ad
nausea , Mr. Speaker, since I have been the Minister.
So I will skip over what we are doing there. But even in the Fire Service we are making sure that the airport
is adequately serviced and manned to keep our air-port open.
Mr. Speaker, that is it in a nutshell. And all this
here was in response to what the Opposition Leader said. But before I take my seat, I must make it clear
that even though I have spoken about different pr ogrammes that this Government has seen fit to finance and this Ministry has been given the task to impl ement, I must stress that money alone is not going t o
make us safe, and we cannot police our way out of [the] situation that we are in. The antisocial behaviour
that we are facing is a community issue and it has got
to be a community solution. So we must all do our part, Mr. Speaker.
As I take my seat, I want the Opposition to
know that we can’t politicise something that we are facing right now with the antisocial behaviour with the increase of violent crimes and such. So, I would ask
that people volunteer for our community, giving back,
helping those that are vulnerable, not just seniors,
because there are a lot of vulnerable people out there who I encourage people to look out for. And for those who like to sit on the side and criticise, get off the wall. Come out of the barber shop, and wherever else that
people congregate, at Leopards [Club] and the like,
and get involved. Because if you are up for the cha llenge, a rewarding career, Mr. Speaker, join the uni-formed services and together we can make a differ-ence in our community.
Thank you, Mr. Speaker.

Thank you, Minister.
Does any other Member wish to make a contribution at this time?
No other Member? The House . . . Deputy,
deputy. I am acknowledging you, because you beat everybody up, Deputy. You were on your feet, Deputy.
I am acknowle dging the Deputy. Nobody else moved,
so, Deputy, you speak.
Hon. Walter H. Roban: No, sir, I don't have much to
say other than we can adjourn.