March 7, 2022

That now leads us, Members, to the
purpose for our sitting today, which is the actual start of the Budget Debate. For the listening audience, the
last two weeks we have done the Budget presentation
and the Budget Reply, which concluded with the open
economic debate on Friday.
Today we start the individual debates on the
department heads that are down for the debate today.
For the public, the listening audience, again, each day
is scheduled for eight hours of debate on the particu-lar heads that are going t o be debated on that day.
For those eight hours the House is in Committee of
the whole House, which means that the Speaker will
not be present during that eight -hour period. When we
are in Committee the House is chaired by [a panel of]
Chairme n, which is headed by the Deputy Speaker .
His panel of chairs will relieve him during the particular debates. The proceedings will not resume in the House until the eight hours are over. At that time the Speaker will return to the Chair.
So, during this next eight -hour period you are
in the hands of the Chairman, the Deputy Speaker,
and his panel of chairs.
We now call on the House to resume the debate on the Estimates of Revenue and Expenditure for
the year 2022/23, and at that point they will be in the
hand of the C hairman for the rest of the day.
Mr. Premier, would you like to move us in?

Hon. E. David Burt: Thank you very much and good
morning, Mr. Speaker.

MP Foggo is in the Chair this morning.
MP Foggo is one of the Members that sit on that panel
of Chair men that I just referred to. And she will be
chairing the first session this morning.
So, the House is now going into Committee
and it is in the hands of MP Foggo as the Chair man.
MP Fo ggo, you now have the mike.

Honourable Members, we are now in
Committee of Supply for further consideration of the Estimates of Revenue and Expenditure for the year 2022/23.
The Heads 21, 22, 24 and 91 are now to be
debated. And this is under the Ministry of Health. So,
I, therefor e, call on said Minister in charge to proceed.
Minister, you have the floor.

MINISTRY OF HEALTH
Hon. Kim N. Wilson: Thank you, Madam Chairman,
and good morning.
To initiate consideration of the Heads, Madam
Chairman, I move that the following Heads: 21, Ministry of Health Headquarters; 22, Department of Health; 24, Hospitals; and Head 91, Health Insurance be tak-en under consideration.

Thank you, Member.

Hon. Kim N. Wilson: Thank you, Madam Chairman.
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 at pages 149 to 154 of the Budget Book.

HEAD 21 —MINISTRY OF HEALTH
HEADQUARTERS

Hon. Kim N. Wilson: Madam C hairman, the mandate
of the Ministry Headquarters is to make Bermuda
healthier.

Expenditure Overview
Hon. Kim N. Wilson: Madam Chairman, the Headquarters allocation constitutes approximately 8 per
cent of the budget allocated for the Ministry as a
whole. A total of $15,890,000 has been allocated for
this Head for 2022/23, which represents an increase
of $6,482,000, or 69 per cent, over the original budget
of 2021/22. The majority of the change is due to right -
sizing the pandemic response budget. The fundi ng will
allow the Ministry to continue to have in place the ser-vices required and the mitigation efforts needed for


Bermuda House of Assembly the COVID -19 virus, inclusive of the operations of the
Bermuda Molecular Diagnostic and Research Laboratory.
Bermuda, the pandemic is not over. We must
remain vigilant and prepared and not let our guard down. Therefore, the increase in funding will provide
for any actions we must take for the potential onset of
new and dangerous variants and to even manage the
so-called “non- dangerous” variants that could still
cause deaths.
I will now speak on each of the sectors and
business units under this Head, Madam Chairman.

General Administration and Corporate Services

Hon. Kim N. Wilson: Madam Chairman, the business
unit 2101, General, comprises a team of 10 persons
and a budget largely dedicated to grants, the national
health emergency for the COVID -19 pandemic, and
the universal healthcare initiative. Over $3.6 million of
the unit’s total budget of $14.678 million is for grants, and $7.8 million i s for the national health emergency.
Three point three million dollars is the balance
which supports the strategic and operational compo-nents of the Ministry through the accounts section and our corporate services policy directorate.
Madam Chairman , under head 31000 General
Administration, the Government is committed to a healthier Bermuda, which is reflected in our commitment to universal health coverage. The aim is to ensure equitable access to necessary healthcare services, contain healthcare costs, and engage prevention and health promotion strategies to produce better health outcomes. The transformation to universal healthcare—
The Clerk: Good morning.

An. Hon. Member: Morning, how are you today?

The Clerk: I am fine, thank you.

An. Hon. Member: Good.

Madam Clerk, would you please turn
off your microphone.
Madam Clerk, your microphone is on.
Continue, Minister.
Hon. Kim N. Wilson: Thank you, Madam Chairman.
The transformation to universal health coverage through the Bermuda Health Plan is rooted in the
organising principle of integrated care and will be delivered via a single- payer mechanism. Integrating
health services across the continuum of care that is public health, mental health, acute and post -acute
care and community services will contribute to improved health outcomes and greater resiliency. It is intended and anticipated that the integrated service model will reduce duplication, enhance information sharing, and realise synergies, efficiencies,
and economies of scale that cause savings to be real-ised with respect to our healthcare costs.
For this, Madam Chairman, there is an allocation in the Ministry’s Headquarters’ budget in the
amount of $750,000 for consultants, and an allocat ion
in the Department of Health’s budget of $323,456 for health promotion resources.
Madam Chairman, the Ministry has an initial
high-level year roadmap to strengthen our health system and achieve universal health coverage. The recently released Bermuda Health Strategy 2022- 2027
provides the strategic principles the Ministry will follow in executing this key Throne Speech initiative.
Madam Chairman, the Ministry of Health will
focus on the year one priorities of the roadmap in the
upcoming year. This wi ll begin with establishing the
transition governance structure needed for our health
system’s transformation, including setting up new
working groups for stewardship and collaboration. A
key element of this is the Project Management Office ,
which is necess ary to drive the change. This year the
Ministry will be working with our partners along several concurrent work streams. We will develop and pilot
integrated essential care pathways, working with
stakeholders to determine which patient journeys to
pilot. T his patient -centred approach enables Bermudians to get the care they need when they need it and
to have quality care provided at fair value.
The Ministry will also establish the necessary
baseline of our current health condition, which means bringing our health accounts up to date and determining our population’s health needs. In parallel, we can
begin identifying and prioritising efficiencies and cost
saving projects across the health system.
Madam Chairman, part of ensuring future efficiencies is havin g a national digital health strategy to
fully take advantage of technology and create options
for consolidating the Government’s health plans. This
is an Island -wide effort to create a more efficient and
value- driven health system where residents enjoy better health outcomes. It starts with each of us doing
what we can to live a healthier life. Living healthier lives reduces the burden on Bermuda’s health system
and produces economic benefits.
In the upcoming financial year, the Ministry of
Health will also continue to receive a budget allocation
for the COVID -19 pandemic response in the amount
of $7,767,803 which will also support the operation of
the Bermuda Molecular Diagnostic and Research Laboratory. From the 1
st of April the MDL will come within the fold of the Department of Health, which already
operates the Government’s Central Laboratory.
As I mentioned prior, Madam Chairman, the
pandemic is not yet over, but changes to our border
policies, largely enabled by good vaccination rates
both in Bermuda and in our gateway cities, should
546 7 March 202 2 Official Hansard Report

Bermuda House of Assembly decrease the pressure on the Island’s health system
and allow for efficiencies in the management of our
response. These anticipated efficiencies are reflected
in the reduced budget for the pandemic response.
The Ministry of Health, with the start of health
system transformation at its core.
The Ministry has a busy year ahead and cannot do this work alone or function in decision- making
silos. That is why we value building on our community partnerships with organisations such as the Bermuda
Health Council, the Bermuda Hospitals Board, the
Bermuda Medical Doctors Association, BermudaFirst,
Allied Health Professionals, the Island’s private insurers, the Chamber of Commerce, local and international businesses, our union partners, and patient advocacy groups. We look forward to collaborating with the
wider community to make this a success.
Madam Chairman, regarding business unit
31015 Grants Administration.
Madam Chairman , I invite you to look at page
C-18, which lists the Ministry of Health’s grants to a
number of agencies, providing essential frontline services to aid public health and social assistance. These
are as follows:
• $2.5 million for the LCCA [Lady Cubitt Compassionate Association] to cover overseas
medical care for uninsured and underinsured
persons;
• $125,000 for the Bermuda Nursing Council to
support the regulation of nurses and midwives;
• $1 million for the Bermuda Health Council;
• $10,000 for SART, Sexual Assault [ Response]
Team.
Charities and other supporting agencies provide the Ministry of Health with supporting services
that are vital to the community and complement the
Ministry’s mandates.

Hon. Michael H. Dunkley : Madam Chairman . Sorry,
to disturb the Minister, just a point of clarification.

Minister, at C -18 it quotes $9,000 as
opposed to $10,000.
Hon. Kim N. Wilson: I will clarify that. That may very
well be a typo, but I will clarify that during the course
of the brief, Madam Chairman.
Hon. Michael H. Dunkley: Thank you very much.

Hon. Kim N. Wilson: Madam Chairman, charities and
other supporting 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, the Bermuda Nurses Council, and the Sexual Assault [Response]
Team are all critical services and they are fundamental to the success of the Ministry.

Office of the Chief Medical Officer

Hon. Kim N. Wilson: The Office of the Chief Medical
Officer, Madam Chairman . This can be found on pages B -150 through page B -154 of the Estimates of
Revenue and Expenditure.
Madam Chairman , business unit 2102 under
Head 21 is the Office of the Chief Medical Officer
(OCMO), and that can be found at page B -150 of the
Budget Book. Its total budget for fiscal year 2022/23 is
$1,212,000, which funds two cost centres: 31030
Healthcare Registration and Regulation, and 31040
Epidemiology and Surveillance Unit. The office ordinarily consists of eight full -time equivalents, and one
part-time consultant pharmacy inspector, and a relief
pharmacy inspector providing a combined service of 0.25 full -time equivalents.
With the onset of the COVID -19 pandemic, an
additional 39 staff members were assigned to the Of-fice of the Chief Medical Officer to urgently assist in
the management of the widespread impact of the
COVID -19 pandemic, including the dramatic loss of
human life and the unprecedented challenge to public
health service delivery in Bermuda. This assistance
included the formulation and support of a myriad of
activities relevant to management of a global pandemic, including the establishment, development and
maintenance of essential contact tracing and testing
teams, as well as the deliv ery of a quality vaccination
programme, the equivalent of any other country
across the globe.
The remit of the Office of the Chief Medical
Officer consists of four primary duties: (a) registration and regulation of healthcare professionals; (b) pharmaceuti cal drug control; (c) epidemiology and surveillance; and (d) statutory public health responsibilities. Over the past eight years, the Office of the CMO has
undergone significant reorganisation of its structure in
order to facilitate optimal efficiencies an d to ensure
deliver y of an effective and robust statutory service.
Previously, the OCMO registered all
healthcare professionals besides the nurses and psychologists, as well as registering healthcare facilities
namely, hospitals, pharmacies, clinical labor atories as


Bermuda House of Assembly well as diagnostic imaging facilities. From 2020, the
office transferred the majority of its registration and
regulatory 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 initial registration of allied health professionals, dental health professionals, opticians and
optometrists and pharmacists. The OCMO also provides administrative suppor t to the health professional
statutory boards and councils, with the CMO acting as
an executive officer of the Bermuda Medical Council.
The office also retains functions relevant to medical
practitioners 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 pro-tect and support the delivery of ongoing high- quality
medical and pharmaceutical care in Bermuda.
Madam Chairman , the Office of the CMO’s
pharmaceutical drugs control responsibilities include ensuring that annual inspections of pharmacies are
conducted 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. The office also
ensures that Bermuda stays within the assigned quotas of controlled drugs, and reports on controlled drug
importat ion to the International Narcotics Control
Board (INCB), which is in Vienna, Austria. The INCB
monitors compliance with the United Nations International Drug Control Conventions.
Health protection and community health assessment are two essential public health functions
carried out by the Office of the C hief Medical Officer ’s
Epidemiology and Surveillance Unit (ESU). The ESU monitors the occurrence of diseases on the Island,
both infectious or communicable diseases , and select
chronic non- communicable diseases, to help prevent
and control their spread and impact. The ESU also
receives reports from individual healthcare providers
and laboratories and will investigate unusual disease occurrences. The provision of contact tracing and case management functions and services are integral
to preventing and/or mitigating any future outbreaks of
disease.
Periodic community health surveys are conducted to monitor and document the health of Bermuda’s population. The STEPS to a Well Bermuda sur-vey, which is planned for 2022/23, is just one example. Data from community health surveys provide
population health information which is essential to setting health system priorities and for planning.
Madam Chairman, additional functions of the
Office of the CMO are to facilitate l egislative functions,
advise government departments on health matters
and to support the essential regulatory work of statutory boards and councils. The Office also serves as Bermuda’s public health focal point for communica-tions from regional and internat ional authorities such
as the World Health Organization [WHO], the Pan American Health Organization [PAHO], and the Caribbean Public Health Agency (CARPHA). Essential 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 prevention, mitigation and management of public health
emergencies, including preparedness for disaster management and extreme weather ev ents.
Madam Chairman, [part] of the Office of the
CMO’s budget, $621,000 is allocated to healthcare
registration and regulation. Over the past year the
section has ensured the administration of a variety of
professional services relevant to more than 200 r egistered medical practitioner professionals, processed
over 130 requests for controlled pharmaceutical drug
licence requests, and completed 54 pharmacy inspections.
The Registration 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 2022/23, $591,000 is budgeted
for the work of the Epidemiology and Survei llance Unit
[ESU]. Capacity -building in public health, which was
supported by CARPHA, PAHO and Public Health England in 2020, has assisted the staff of the ESU, as
well as the staff in the Department of Health to meet
the challenges of preventing and contr olling emerging
diseases such as the novel coronavirus pandemic,
and in managing outbreaks of vaccine- preventable
diseases such as whooping cough.
Through the tireless work of the Public Health
Emergency Response Team (PHERT), the Office of
the CMO coordi nates 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 have proven to be priceless for the efforts
of mitigating the COVID -19 virus during this past two
years plus.
Madam Chairman, to date there have been
over 11,000 cases of COVID -19 identified in Bermuda
and, sadly, 123 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.
Madam Chairman, 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 Chief Medical Officer’s entire
work force has dedicated their lives to the response to
548 7 March 202 2 Official Hansard Report

Bermuda House of Assembly the COVID -19 pandemic, which has spread around
the entire world and has spared no country. Throughout 2021/22 the ESU has overseen an extended team
providing case management, contact tracing, traveller
and school surveillance as well as data management and analysis support to the incident command structure that was established to manage and coordinate
our response to the COVID -19 pandemic.
This also included, Madam Chairman , the investigation and response to more than 10,000 labconfirmed cases of COVID -19 and their associated
contacts, the surveillance of over hundreds of thousands of travellers, and the weekly reporting to international public heal th agencies. To this end, the ESU
continues to work closely with public health partners, including WHO, PAHO, CARPHA, and the new United
Kingdom Health Security Agency (UKHSA).
Madam Chairman, we continue to see a decrease in reported communicable diseases other than
COVID -19 in 2021, which may indeed be related to
the public health measures implemented to control the COVID -19 pandemic, such as physical distancing and
mask wearing.
The ESU has, in addition, managed 225 individual case reports of communicabl e diseases in addition to managing the COVID -19 period.
Madam Chairman, the OCMO has also provided 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 Government House and the
UK to assist us with the supply of these critical vac-cines at this most challenging of times.
As of the 26
th of February, Madam Chairman,
our vaccination teams have administered over
125,000 vaccinations, 85.6 per cent of our residents
over the age of 65 years a re fully immunised with two
doses, 72.2 per cent of the general population are
immunised with two doses, with 71.5 per cent of those
eligible for a booster having received their booster.
Madam Chairman, if I could, I would stand
here today and use the enti re five hours allocated to
this Ministry to applaud and salute the tireless efforts and contributions of the entire health team across the Island, including our volunteers and all of our partners.
Not only, Madam Chairman, have we held our own
against this powerful foe, but we have also managed,
at the same time, to sustain delivery of essential 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 collaboration 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 dedicat ion and effort to overcome
the long- term impacts of the pandemic in the future.
Madam Chairman, finally, the development of
the important Chronic Disease Register continues to
evolve and be refined. In 2019, the initial Phase One
of the Register was completed. This phase piloted the
process of collecting data on diabetes and chronic
kidney diseases in three entities: Bermuda Hospitals
Board, the Bermuda Diabetes Association and the
private endocrinology practices. Progress with this work has slowed wi th the onset of the pandemic in
2020, and it is our intention to restart this initiative as
soon as we have capacity to do so.
Madam Chairman, this ends my presentation
on Business Unit 2102, Office of the Chief Medical
Officer.

Bermuda Health Council
Hon. Kim N. Wilson: Turning now, Madam Chairman,
to the Bermuda Health Council. This is the last one
with respect to Head 21. And I want to highlight, Madam Chairman, the work of the Bermuda Health Council, which is a quango under the Ministry of Health.
They receive operational funds in part from a Ministry
grant and are positioned to continue to advise and
make recommendations to the Ministry on health system matters.
Madam Chairman, the Bermuda Health
Council’s mandate is to regulate, coordinate and enhance the delivery of health services. The grant for
the Bermuda Health Council can be found on page C18, object code 6895 under the Ministry of Health. In
2022/23, the Health Council’s grant will be $1 million.
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, Madam Chairman, in progressing the
Bermuda Health Plan reform goals and strategic initiatives around digital health.
These projects are in addition to the daily activities that they perform around data analytics and
outcome research, health system strategy and part-nerships, health regulation and policy, long- term care,
kidney transplant coordination, public health research
and programmes, registration and compliance, and
communication and education.
Madam Chairman, the Health Council’s total
revenue is primarily supplemented by a transfer from the mutual reinsurance fund [MRF], licensing fees
paid by health insurers, and licence and registration
fees paid by regulated facilities and health professionals, for a total budget of $3.1 million for 2022/23.
Madam Chairman, in 2021/22, the work of the
Health Council centred on four strategic areas: regula-tion, quality and standards, and finance and economics, with oversight by audit and governance. Some of


Bermuda House of Assembly this year’s achievements, Madam Chairman, are as
follows:
Regulation: As the primary regulator of the
health system, the Council facilitated the administrative functions of health pr ofessional bodies and health
professional conduct committees and licensing functions in respect of select health facilities, namely, diagnostic imaging facilities, laboratories, hospitals,
nursing homes and residential care homes.
As part of the pandemic r esponse, the Health
Council used this registration framework to support the identification of healthcare entities that could be
provided exemptions due to the critical nature of their
services. The Health Council used a paperless process for the registrati on of over 650 non- physical,
non-nursing health professionals. This modernisation
of processes and the change [which] management required to be effective has had its challenges as any
process transformation would have. However, these
interventions do align with the Health Council’s objective to reduce the administrative burden of statutory
board members so that they have increased bandwidth to strategically enhance the specialised fields
towards improvement of population health in Bermuda.
As part of their regulatory framew ork, the
Health Council enhanced the alignment of inspection
criteria to the standards in the Care Homes Code of Practice and made the associated inspection reporting
more transparent and action oriented.
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 operation. In
addition, in respect of long- term care regulatory activities, the Health Council continues to work collabora-tively on streamlining the complaints reporting and
handling processes, which involve partnering with the
teams of Ageing and Disability Services under the
Ministry of Social Development and Seniors, as well
as the Bermuda Nursing Council.
In response to concerns about the affordability
of prescription medication, the Health Council contin-ued to work with relevant stakeholders towards the
implementation of the Bermuda Dr ug Formulary. This
work has also involved consultation with the World
Health Organization to best define a list of essential
and effective medications, and with local stakeholders
to address concerns with the regulation of the market. The work with various local and international stakeholders for sustainable implementation will continue in
2022/23.
Again, the goal of this work is ultimately to
create a more cost -effective prescription medication
market by setting the prices of select medications,
monitoring compliance with regulated pricing, and negotiating the price at which medications are imported.
Similar interventions are being undertaken across the globe. And with an ageing population it is imperative
that Bermuda stays ahead of the curve when it comes
to having an efficient prescription medication marketplace.
Quality and standards: Madam Chairman,
within its goal to enhance the integrity and best use of
local health system data, the Health Council is finalising the development of unique patient identifiers for
individuals and national provider identifiers for
healthcare businesses and professions. While this
transition towards greater standardisation is still evolv-ing, we believe that this modernisation of data will
lead to a much better understandin g of our population’s health needs going forward. Data enhancement
efforts are ongoing as the Health Council continues to
work with health system partners to identify gaps in
data collection and reporting and the resources re-quired to close these gaps.
Madam Chairman, having participated in
regulatory oversight of various health professions and facilities, in response to an obvious pandemic -related
need, the Health Council led in the development of standards and criteria for the operation of COVID -19
testin g facilities and the selection of COVID -19 tests
available publicly, established the close to home vaccination programme, provided reimbursement guidance to health insurers and businesses, supported the
directorship transition process for the government lab,
and provided advice on a variety of other health related activities.
The Health Council also manages the programme in support of kidney transplant coordination.
Through this programme, education on kidney trans-plants is being conducted and comprehensive coordination is provided to those who have been designated
to receive a new organ. Through this programme we
have seen additional patients put on the kidney transplant eligibility list and successful transplants taking
place.
Right now, Madam Chairman, dialysis costs
approximately $135,000 per patient, per year, and
collectively we have 200 patients, [so] close to $30
million a year we are spending on dialysis. Each
transplant that is done is estimated to save as much
as $700,000 over a 10- year period for each of those
kidney patients transplanted. This is what the Health
Council coins as “value- added investment” in the
healthcare system that produces better health for our
residents and savings for our healthcare system.
The Health Council is working with the Ministry of Health to update legislation that would allow more individuals to have the opportunity to obtain a
transplant.
Madam Chairman, financing and economics:
The Health Council continues to publish annual national health account reports. These r eports detail total health system expenditure during each year. The latest figures have healthcare spend at $736 million,
including more than 12 per cent of that spending be550 7 March 202 2 Official Hansard Report

Bermuda House of Assembly ing in overseas care. During the year the Health
Council continued to regulate the prices of standard
health benefit services. The prices of these services continue to be guided by the Resource- Based Relative Value Scale, or the [RB]RVS structure. The
Health Council receives and adjusts pricing and coding on a regular basis to maintain i nternational consistency. The RBRVS structure was also used in guiding reimbursement pricing for COVID -related activities, which both providers and insurers found to be extremely helpful during a rather chaotic time when uncertainty was global normative.
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 innovations or progressive challenges. The Health Council has a st ructure for reviewing such opportunities
through its health technology assessment process.
Madam Chairman, this process includes a review of peer review research and market literature from around the world, an analysis of local utilisation
demand data, an d a discussion by local experts on
potential advantages and disadvantages of change.
The Health Council has worked closely with the Pan American Health Organization on a health technology
assessment process and is also in the process of adding the calculat ion of quality -adjusted life years to its
cost assessment portfolio.
The Health Council in 2021/22 continued to
refine this process so that there is more evidence-based decision making involved in the financing of
local healthcare. In 2021/22 the Health Council became part of the Executive Committee of the newly established Caribbean Health Economics Association.
This body is made up of leading health financial ex-perts from the region with the goal to ensure that in-vestments in health are done strategically and that
research on the impact of investment is properly car-ried out and reported for the other jurisdictions to learn
from. In addition, the Health Council continued to be a
valued part of the Health Reform Steering Committee,
even as reprioritisation a ctivities were taking place
due to COVID.
Madam Chairman, the Health Council also
worked on updates to claims regulations, standard
premium rate legislation, health insurance licensing
regulations, and the initiation of the maternity benefit
programme. The latter being a programme intended to
ensure, Madam Chairman, that inequities which exist
in child -bearing due to a family’s economic position
are eliminated by providing each person equal access
to the resources that are known to reduce risk and
complicat ions during pregnancy and delivery.
Madam Chairman, Audit and Governance:
The 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 an unqualified audited financial state-ment. The Health Council’s annual reports and financial statements have faced some delays during the
pandemic, but are close to completion and being processed by the auditors respectively. The Health
Council has continued to meet i ts legislative requirement to submit financials to the Office of the Accountant General within three months at the end of its fiscal
year. The Health Council continues to have a successful paperless office, with the vast majority of all
information sharing occurring via electronic means.
The Council also continues to review and enhance its
information technology tools so that it can continue to
become more efficient and thus being a cost -effective
resource to both the Government and the health system alike.
The future: Madam Chairman, looking forward
to 2022/23, the Health Council will continue with its wide remit of performing functions that improve 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 involvement and solution generation through the innovation programme,
the Health Council also looks to support the next generation of health professionals through education,
mentorship and exposure programmes.
Of note, Madam Chairman, for 2022/23, the
Health Council will continue its work on creating more structure and planning for long- term care, support
frameworks that are effective in reducing risk and pr eventing disease, identifying ways to better manage healthcare financing, listen to the concerns of the public, and ensure that patients, providers and business-es are afforded fairness, privacy, and protection in
their dealings.
Lastly, Madam Chairman, I would like to
acknowledge the reappointment for 2022/23 of Ber-muda Health Council Board Members whose expertise will continue to contribute to its ongoing achievements: Dr. Sylvanus Nawab is the Chair and he provides a paediatric clinical perspective; Mr. Anthony
Richardson is the Deputy Chair who provides expertise in public -private partnerships; Mr. Anthony Santucci who brings a view of the integration of healthcare and social determinants of health and community; Ms. Cynthia Thomas who brings her legal expertise to the
table; Ms. Kirsten Beasley offers a health system related reinsurance sector perspective; Ms. Ann Daniels
gives the public -private sector financial perspective;
Ms. Shelle Hendrickson who shares the view of overseas healthcare models; Dr. D arrien Ray ensures a
mental health perspective; Dr. Michael Richmond
shares a medical provider and hospital perspective;
and Ms. Keechia Tuckett brings years of experience in
the government health insurance market.
In addition, Madam Chairman, I acknowledge
that the ex -officio members of the Board, namely: the
Health Council’s CEO, Dr. Ricky Brathwaite; the Acting Permanent Secretary of Health, Ms. Shivon WashBermuda House of Assembly ington; the Chief Medical Officer, Dr. Ayoola Oyinloye;
and the Acting Financial Secretary, Ms. Cheryl Ann
Lister.
Madam Chairman, revenues for the Ministry
of Health are projected to reach an estimated $22 mil-lion for 2022/23. These estimates can be found at
page B -151 of the Budget Book. The majority of the
revenues is derived from the anticipated inc rease in
travel foot traffic in 2022/23 and the associated travel
authorisation application.
Madam Chairman, this concludes my remarks
for Head 21, Headquarters.

HEAD 22 —THE DEPARTMENT OF HEALTH
Hon. Kim N. Wilson: Madam Chairman, turning to
Head 22, the Department of Health and that can be
found on pages B -155 to B -166 of the Budget Book.
Madam Chairman, it gives me great pleasure
to present the budget for Head 22, the Department of Health, again found at pages B -155 to B-166 of the
Budget Book. Madam C hairman, the total current expenditure is estimated to be $28,690,000 for 2022/23.
Vision and Mission: Madam Chairman, the
Department 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 285 Department of Health officers, which is found at page B -156, work in 25 programmes
to assure the health and well -being of the general
population.
Madam Chairman, the 2022/23 budget estimate for administration progr amme of the Department
of Health is listed at cost centre 32230 on page B -156
and the budget estimate is $429,000.
Madam Chairman, 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 will refocus on non-communicable chronic disease prevention and
mental health throughout the life course. The Depart-ment has begun to integrate mental health services
into its clinic -based services in partnership with t he
Mid-Atlantic Wellness Institute as well as work with
collaborative partners to develop greater awareness and support, Madam Chairman, of mental health in
our community and remove the stigma.
A life course approach will be used to improve
collaboration for better service integration with assurance of health outcomes to detect and address vulnerabilities and opportunities. And the first 1,000 days
will be an integration project with the health system
and the wider society and community partners.
Madam Cha irman, the 2022/23 budget estimate for the Health Promotion and Wellness Programme of the Department of the Health is listed at cost centre 32240 on page B -156 of the Budget Book
and the estimate is $507,000. Madam Chairman, the Health Promotion and
Welln ess Programme develops and implements policies, programmes and products that will promote
health and wellness in the community in collaboration
with public health partners.
Madam Chairman, Health Promotion annually
sponsors two Department of Health initiatives: The
Public Health Week , and Celebrating Wellness.
Madam Chairman, in 2021, due to the lower
COVID -19 numbers, in- person activities were held
each day for Public Health Week under the theme
“Commit to Change— Small Changes, Big Results.”
Each day of t he week staff promoted a healthy habit
that the public were encouraged to adopt. And these included: choosing to exercise for at least 30 minutes
daily, reducing stress to help mental well -being, drinking eight glasses of water daily (and you see that is
why I keep pausing, Madam Chairman), and eating at
least three servings of vegetables daily.
The Department of Health staff thanked the
public for the role they played in preventing the spread
of coronavirus by adopting and maintaining safe habits like was hing hands, wearing masks, physical distancing, and uploading the WeHealth app.
Madam Chairman, celebrating wellness, however, had to go virtual, and the team adapted the
event to the virtual platform using vFair’s virtual plat-form. And this annual event i s geared toward increasing awareness and promoting measures to address
the epidemic of non- communicable diseases (NCDs),
which continue to severely impact the health, economy and development of Bermuda. The focus for 2021
was “Power through Collective Acti on, In it Together,
Building Healthy Communities.”
The pandemic has clarified how important
health inequities are for the country and how im-portant, Madam Chairman, healthy communities are
for all of us. Achieving health for all means attaining
and sustai ning healthy environments. The build environment, which provides for sidewalks, bike lanes,
community parks and green spaces can influence lifestyles, body weight, and improve mental health. The
Health Promotion team were able to raise awareness,
Madam Chairman, of the Department of Health’s programmes through regular use of radio PSAs, social media posts (such as Facebook, Twitter and Instagram), the Health Promotions Calendar, and online
directory of services.
The COVID -19 pandemic has challenged the
Health Promotion team to be creative in delivering
health messaging, but the team has risen to the challenge, all while working concurrently in areas such as
contact tracing, producing communications and guidance through documents for COVID -19.
Madam Chairman, the Speech from the
Throne 2017 stated, “The Government will lead the
way in wellness by encouraging its employees to
make healthy choices, and will contribute to their well -
being by offering programmes, incentives and educa552 7 March 202 2 Official Hansard Report

Bermuda House of Assembly tion to support the journey to a healthier public service.”
In 2021, Madam Chairman, the Government
of Bermuda Employee Wellness Committee, which is
a collaboration between the Department of Employees and Organisational Development, the Department of
Health, and the Department of Communications focused on mental health and well -being under the
theme “Mental health matters.”
Madam Chairman, research suggests that the
current coronavirus pandemic requires greater focus
on mental health, improving the mental health of public officers, maki ng them more resilient to the stress
from the COVID -19 pandemic.
Madam Chairman, over 900 staff participated
in a workplace stress survey to identify the impact of
workplace stress and the factors contributing to stress that will assist the committee in developing and offering programmes to reduce stress levels. As a result,
Madam Chairman, several trainings for managers and
staff on mental health and mental health well -being
will be offered.
Madam Chairman, the Nutrition Services subprogram me of the Health Promotion and Wellness
Programme is committed to providing sustainable nu-trition community programmes to connect, engage
and strengthen the community’s awareness of strategies to improve healthier lifestyles and healthier eat-ing.
The Grow, Eat, $ ave (GES) programme is
demonstrating significant increases in participation as local food costs increase. The goal for the community
programme is to improve availability and affordability
of healthy food by promoting sustainable food sys-tems for Ber mudians to grow their own food and promote food security. In 2021, Madam Chairman, the
Grow, Eat, $ave programme had 74 graduates com-pleting eight -week virtual classes, practical sessions,
and five- month practice planting sessions. The 2022
Grow, Eat, $ ave programme has 1 03 participants involved already.
This session will pursue an added extension
with the virtual sessions during the five- month practice
planting sessions offering gardening talks twice a month on gardening topics for support.
The Complete Health Improvement Programme (CHIP) provides education for sustainable behaviour changes using lifestyle interventions for a
three- month period. Madam Chairman, in 2021, three
CHIP graduates completed the course, which changed from in- person to vi rtual. For 2022 seventeen
persons are enrolled and committed to attend virtual
courses and in- person demonstrations.
Madam Chairman, Client Referrals had a significant increase during the COVID pandemic. Medical
Nutritional Therapy (MNT) is provided to high -risk persons, the most vulnerable, such as uninsured and underinsured, inmates, senior nursing homes, group
homes, schools, and adult wellness clinic clients. An overwhelming number of referrals are being received
for this programme which only has one of ficer. Senior
homes and prison institutions have nutritional as-sessments performed virtually to ensure that they are
following mandated nutrition components for their res-idents. Nutritionists remain on the COVID -19 taskforce
in the national food security planning under the leadership of Mr. Dean Rubain.
Madam Chairman, the Healthy Schools subprogramme of the Health Promotion and Wellness
programme promotes health in schools through such government departments as Education, the National
Drug Control, Mirror s, community health partners including the Bermuda Diabetes Association, the Bermuda Cancer and Health, the Bermuda Underwater
Exploration Institute, and the Department of Health
school -based programmes such as child and school
health, nutrition services, oral health, community rehabilitation services, and environmental health.
Healthy Schools has been adopted by 31 of
the 33 public and private schools since 2007.
Healthy Schools 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 once per month in schools. Healthy
Schools has provided schools with a list of non- food
fundraisers. All but one public school has a bottlefilling station, making fresh, clean water the easiest
choice. Healthy Schools will continue to work with the
Department of Education’s curriculum officer for PE
and Health to improve the completion of the fitness
ground assessments for P5 to S4 students in terms 1
and 3.
Healthy Schools and the Department of Education’s Facilities Manager, with Environmental
Health, will continue to work closely with the school
custodians and cleaning companies that clean
schools to raise schools’ cleansing standards through
frequent cleanliness inspections and requi red COVID -
19 reopening inspections. Healthy Schools will continue to provide updates to the COVID -19 phases for
school protocols, as required, to reflect Bermuda’s
COVID -19 status and conduct weekly COVID -19
compliance inspections.
Since 2020, Healthy Scho ols has been working with public and private schools to ensure optimum
environmental health in schools by having schools
reduce clutter in classrooms and other school areas
and improve compliance to the Bermuda School Asthma Policy. Healthy Schools has been working
closely with and providing support to school surveil-lance since November 2020.
And finally, Madam Chairman, Healthy
Schools has been coordinating out -of-school camps
since the summer of 2021, providing public health up-dates and visiting camps to conduct surveillance and
monitor compliance to the COVID -19 protocols for
camps.



Bermuda House of Assembly Child Care Regulations

Hon. Kim N. Wilson: Madam Chairman, the 202 2/23
budget estimate for the Child Care Regulation Programme is listed at cost centre 32290 on page B -156
and is $308 ,000.
Significant steps , Madam Chairman, continue
to be made to increase oversight and support quality
child care in our day -care settings, day -care centres
and our home day -care providers. Partnership and
collaboration remain the focus as the Child Care Regulation programme streamlines processes and updates policies based on best practice. Over the last
fiscal year all active and registered day -care providers
(DCPs) have completed the trial STARS inspection, while some day -care providers with provisional registration underwent the trial STARS inspection as they
worked towards full registration. This tool is comprehensive and allows the officers to evaluate aspects of
child care while providing support and guidance
throughout the process. The ai m of the trial period
was to evaluate the new inspection tool with the intention of publishing the STAR ratings of the day -care
providers this year.
Due to multiple waves of COVID -19 infections, all officers guided DCPs and DCCs through the COVID -19 waves , completing risk assessments and
producing Ministry of Health Public Health Measure
letters whilst also tracking statistics —all in an effort to
reduce the spread of COVID -19 infection within the
day-care population.
This did have an impact on officers completing their main duties. The trial stars inspection tool will be a priority for this year. In addition to oversight and monitoring to both DCPs and DCCs, the Education
Officer facilitated a focus group on COVID -19 guidance and phases, created a file des ignated for the
community to keep abreast of the standards and regulations of child- care in Bermuda, and created and
hosted several presentations. Topics ranged, Madam
Chairman, from policies and procedures on registration and licensing, how to complete a risk assessment, to the SCARS training (which is required for all
child-care staff). In order to meet the diverse technology abilities of the group, the officer ensured all
presentations were offered virtually and in person.
The Education Officer’s focus this year is to
work with local and overseas partners to reinstitute educational opportunities in Early Child Care in Bermuda. During this fiscal year 11 complaints were received and investigated regarding DCPs and DCCs.
The majority of complaints were inv estigated within
the allotted time frame.

Child Health

Hon. Kim N. Wilson: Madam Chairman, the 2022/23
budget estimate for Child Health is listed at cost centre 32030 on page B -155, and is $2, 664,000. Madam Chairman, the Child Health Programme consists of four sub- programmes: Immunisation, Child Health, School Health, including Asthma
Education, and Travel Health. The programme provides preventive and curative health services for in-fants, children, adolescents, adults , seniors and the
traveling public. This is conducted through various
clinic, school and community settings.
Services consist of health and developmental
assessments, screenings, referrals, treatment of minor ailments, health education, health promotion, a nticipatory guidance, adult and seniors ’ immunisations
and travel consultation for travel to high- risk areas.
Bermuda’s Expanded Programme on Immunisation (EPI) plans for the needs of vaccines in the
child and adult schedules. The EPI, Madam Chairman, procures most vaccines through the Pan American Health Organi zation’s revolving fund. This mechanism assures safe, effective and quality vaccines.
Universal access for many of the vaccines is provided
through the public and private sectors.
Madam Chairman, all of the programmes in
Child Health, 32030, have been impacted by human
resource reallocation in response to the COVID -19
pandemic . Resources were diverted to support epidemiology and surveillance, contact tracing, COVID -
19 screening and testing, port health , COVID -19 vaccination clinic, and long- term care homes . The few
remaining members of the team have been support ing
school surveillance, development of school protocols
for COVID -19, and health education on public health
prevention measures for students, school staff and parents. The team also did education for the launching of the COVID -19 vaccine in Bermuda to
healthcare providers as well as the private sector.
In spit e of the challenges, data on immunisation coverage was 88 per cent for two- year olds. This
is a four per cent decrease from the previous year and
factors contributing to this may be: the COVID -19 restrictions, reduced access resulting from scheduling
and physical distancing in waiting rooms, perceived
reduced access, closure of satellite clinics due to human resource depletion, and challenges with physical structures for safety and health. Vaccine hesitancy
remains a challenge and has been exacerbated by th e
COVID -19 vaccine roll -out. Persons who were not
previously vaccine hesitant began to question all rou-tine vaccines. The status of the vaccine hesitancy
strategy 2018 to 2021 remains on hold along with the
launching of the Healthy Bermuda app, but the vaccine’s webpage was established.
The 10 to 8 appointment system was set up to
assist clients visiting the clinics. This assists in control-ling the number of clients in the waiting area as well
as physical distancing. It also provides reminders to
reduce mis sed appointments. The Expanded Programme of Immunisation (EPI) online training contin-ues for health professionals in the public, private, institutional settings and allied partners with emphasis on
554 7 March 202 2 Official Hansard Report

Bermuda House of Assembly COVID -19 vaccine and the annual flu vaccine. There
was a h igh demand for the annual flu vaccine with
over 1,250 doses administered through the Flu Express. Flu vaccine was also administered in our clinics
and was distributed to the long- term care facilities and
the private sector.
Intersectoral collaboration prov ided the support necessary for traffic flow and management, facili-ty access, and coordination for Flu Express. The Bermuda Immunisation Information System was populated with back data entry from childhood immunisations. Since 2021, the Electronic Immunisat ion Registration
is used in all Department of Health clinics for vaccines
administered and stocked. The annual flu vaccine
2021 clients were able to sign their consent form
online. This was an important paperless initiative in
collaboration with the paperl ess team.
Madam Chairman, the Child Health programme has realised contact with 91 per cent of all
patients of newborns and 55 per cent of mothers contacted at six to eight weeks after birth. Of those con-tacted at six weeks, 6 per cent were screened for
mental health well -being using the approved tool and
4 per cent were referred for further services. These
were done primarily via telephone due to the health risk COVID -19 restrictions, country status for the disease, and limited staff availability due to reassign-ment.
Child protection has been a concern during
COVID -19 restrictions and is a consequence of the
same. This is and will be an area of continued vulner-ability.
Madam Chairman, the School Health programme did not realise any screening due to the COVI D-19 restrictions. The programme participated in
school surveillance and health education and was provided virtually to some schools for students and/or PTAs.
Travel health was negatively affected by global travel restrictions. However, there were 145 cons ultations conducted in 2021, which is 58 per cent of an-ticipated forecast travel. This reflects the uncertainty
of the COVID -19 pandemic.
Madam Chairman, the 2022/23 budget estimates for Physiotherapy and Occupational Therapy are listed at cost centre 32080 and 32120 on page B -
155 and the budget estimate is respectively,
$1,057,000 and $1,023,000.
Madam Chairman, the remit of the Community
Rehabilitation Services Occupational Therapy [OT] and Physiotherapy services [PT] are to maximise the
functioning potential of individuals with delays in normal motor development or with physical movement
challenges. This service, which spans the age spectrum, is split into three teams: early intervention,
school -based paediatric therapy, and seniors. The
staff is comprise d of nine registered occupational
therapists, eight registered physiotherapists, one coordinator, and one team secretary that is shared with the Speech and Language Pathology programme.
There currently is a vacant post in physiotherapy,
which is being covered by a temporary relief post
while we are waiting for the position to be filled.
Since the arrival of the COVID -19 virus to our
shores, our services have continued to be impacted
and challenged. A number of our staff members were
redeployed to several te ams to help mitigate the virus
spread. For example, our team of physiotherapists and occupational therapists provided support with
contact tracing and assisted in the vaccination centre. As a result, the programme had to shift slightly, reducing the number of home and school visits, prioritising
caseloads, and implementing tele- consults and using
virtual meeting platforms to ensure that our clients had
access to services. Amidst these challenges and
changes the service continued to adapt and strive to-wards providing and delivering a quality and evidencebased service to our community.
Within the Early Intervention team (EI) dedicated specialists, OTs and PTs provide early intervention for babies and young children ages 0- 4 years of
age at risk of development al delays and/or disability.
The OT and PT Early Intervention sub- programme
aims to complete a full assessment on referred clients within 20 working days to ensure the appropriate intervention is provided and mitigate any delays in func-tioning. Approximately 79 per cent of clients were assessed within the established timeframe this fiscal
year and an estimated 91 per cent of clients on the
caseload were making steady progress towards established goals. It should be noted, Madam Chairman,
that cancellations due to COVID -19 and quarantine
status impacted figures, particularly as it relates to
attending therapy assessments this period.
Assessment clinics take place weekly to
quickly identify and provide interventions for babies and young children at high risk of sensory motor delays to facilitate an optimal level of functioning and
quality of life. In addition, parent multi -disciplinary
training sessions were delivered throughout the year in the community. It must be noted that these interventions continue to reduce the number of referrals
sent from EI teams to school -based services, it also
empowers parents with knowledge and strategies to
promote optimal development for their children.
The school -based paediatric team aims to increase early recognition of devel opmental delays and
provide a more equitable service for school -age children 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 learning 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 this reporting period the
team successfully conducted sensory motor screens
for each child enter ing Primary 1 in the government
system. Services were also provided to summer


Bermuda House of Assembly camps with children with complex medical needs,
such as , WindReach and Dame Marjorie Bean Hope
Academy, to prevent regression of skills attained throughout the school year.
The O T and PT school -based sub- programme
aims to complete a full assessment on referred clients
within 20 working days. Approximately 55 per cent of
the referrals received were assessed within the established timeframe and an estimated 80 per cent of
school -aged clients on caseload were making progress towards established goals. It should be noted
that cancellations due to COVID -19 quarantine status
school closures impacted figures, particularly regarding attending therapy assessments this period.
The OT and PT seniors’ team aims to support
clients to remain as independent as possible in their
homes. The seniors’ team conducts home safety and falls risk assessments for all seniors that are referred
to minimise the risk of falls at home. Client and caregiver trai ning was provided to maximise 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 subprogramme aims to complete a full assessment on
referred clients within 20 working days. Approximately
85 per cent of referrals received were assessed within
the established time frames and an estimated 87 per cent of clients on caseload were making progress towards es tablished goals. It should be noted that cancellations due to COVID -19 quarantine status impacted figures, particularly regarding attending therapy
assessments this period.
Madam Chairman, the 2022/23 budget estimate for Speech and Language Services is lis ted at
cost centre 32100 on page B -155. And the budget
estimate is $1,655,000.
Madam Chairman, t he Department of Health ’s
Speech and Language Programme provides speech,
language and feeding/swallowing assessment s and
intervention services across the commun ity. When
fully staffed the programme consists of 14 speechlanguage pathologists [ SLPs ] and one programme
coordinator.
Of these, three speech- language pathologists
provide early intervention services in collaboration
with the Department of Education’ s Ch ild Development Programme for children aged from birth to four
or five years of age. Eight speech- language
pathologists are school based, providing services
across all levels of the Bermuda Government Schools (from ages 4 to 18 years old). One SLP provides services to students with special needs who attend Dame
Marjorie Bean Hope Academy ( for ages 4 to 18
years), and one SLP provides school -based activitie s
to students who attend Bermuda’s private schools and home schools. Three posts have been vacant and are
under recruitment during this period, while one additional post has been under secondment. The post un-der secondment is to be released. Two candidates
have been approved by the PSC, one candidate has
accepted the post and we await a response from t he
other.
Madam Chairman, speech and language
pathologists work closely with parents , school personnel, allied health professionals in private homes and
clinic settings to raise awareness of speech and lan-guage delays and disorders, to promote functional
communication skills, as well as to prevent life -
threatening complications that may occur during eating and swallowing. Speech and Language Pathology
therapy services include the provision of prevention
and promotion information, screenings and assessments , consultations, as well as intervention.
Objectives are measured in terms of provision
of timely and responsive assessments; delivery and
provision of treatment for those identified as needing
intervention; and client improvement , for example, the
effecti veness of treatment as measured by reduction
in the severity of the communication or swallowing
challenges.
Madam Chairman, this year 41 new referrals
were received within the Early Intervention Programme, adding to the waitlist for an initial assessment , and a total of 23 young clients from this waitlist
were seen for an initial assessment. The decline in
numbers is reflective of the measures put in place due
to COVID -19. Agencies such as the CDP and local
paediatricians began conducting screenings, but due to limited in -person contact, many were conducted
online. Oftentimes these screenings were incomplete. Staffing also played a factor in the lower number of children screened during the period as well.
While current programme time guidelines aim
to provi de an initial assessment for young children
within three months of initial referral, the average wait
for an assessment is now running between nine
months to a year.
Seventy cases were referred to the school -
based programme for students attending Bermuda’s
Government schools, while zero new referrals were
received for students attending Bermuda’s private
schools . There were no current referrals for the private sector as we currently have no therapists to support them. Due to COVID- 19 not all of these students
received an initial assessment within the programme’s
time guidelines of 35 working days.
Once identified as needing services, clients
are provided with therapy intervention. Currently, there are no students on a waitlist . Clients are reassessed on a routine basis to assess their status and to
measure progress. Services were also provided to
Dame Marjorie Bean Hope Academy. Currently, 19
students receive support from the speech team. A
combined 430 cases were followed for intervention by
Speech and Language Services this year. Caseloads
can vary between 40 and 68 clients per officer.
556 7 March 202 2 Official Hansard Report

Bermuda House of Assembly The 2022 /23 budget estimates for Community
Health and Community Health Administration are
listed at cost centres 32060 and 32010 on page B -
155, and the budget estimates are $1, 538,000, and
$1,057,000, respectively.
Madam Chairman, community health nurs ing
services is made up of a number of highly skilled
nurses. Staffing is currently down with only four offic-ers when the full complement is nine nursing posts.
We are working on the onboarding of new nurses in
order to meet the community health needs. Communi-ty health w orkers and nursing assistants work in partnership with nurses, ensuring the best care possible
for the adult population, from 18 years until end of life .
We are committed to providing a high standard of pro-fessional care for individuals within the communit y
setting.
We holistically assess and plan appropriate
care and treatment in partnership with our patients. Our care is patient -centred, researched, and evidence- based with the emphasis on empowering individuals to self -care to the best of their abilities . Adult
community nursing works in partnership with the
statutory, voluntary, and independent providers to
meet healthcare needs, offering continued support, health education information, and advice to patients,
families, and their carers and the community population. Our adult preventative healthcare clinic is designed to support and reduce stress while increasing
capacity, educating individuals and families, providing
life skills to enable healthy living practices. Care in this setting also supports indiv iduals who do not have access to healthcare providers or cannot afford their co-payment. Funding for these two areas of healthcare assist s in addressing the community’s social detriments of health.
Performance measures for the year 2022/23
to date is 87 per cent in an effort of servicing individuals within a 48- hour period.
Madam Chairman, the Community Health
Administration consists of Administration Support and
Health Education. The programmes provide adminis-trative support for the programmes operating i n the
main Hamilton health centres as well as the satellite
clinics. Preventative and curative services include:
child, school, travel, immunisation, community, sexual
and reproductive health, nutrition, clinical laboratory,
rehabilitation, speech and lang uage, as well as two
long-term care facilities, vaccine storage, medical,
office supplies and logistics. The programme assures conditions in which the facility can operate safely, effectively and efficiently for clients and staff.
Much of the efforts of t he programme, staff
and education were either directly involved with COVID -19 pandemic response, COVID -19 vaccinations, administration of routine health maintenance to
clinic services. There were leadership changes in
managing teams and services with resource constraints was the focus. The impact of COVID -19 al-tered the flow, function and wait times of clients attending for services. In many instances, services were
assessed, screened and/or conducted via telephone
in the first instance. Attendance was impacted by
space restrictions to minimise potential exposure to COVID -19. Staff wore personal protective equipment
to reduce the risk of COVID -19 transmission from client interactions, and cleaning regimes were en-hanced. These factors required additional investment
of resources, both financial and physical.
In collaboration with Public Works, a portico
was built at the entrance of the Hamilton Health Centre to ensure client protection from the weather elements, both sun and rain. This improved the client
exper ience and averted further complaints. Two ultralow temperature freezers were procured and installed in central stores and then used for the COVID -19 vaccine storage. The Stores sub- programme supported
the initiative of fixed and mobile COVID -19 vaccine
sites as well as the annual Flu Express.
Collaboration across sectors realised the
goals of these initiatives. Community Outreach real-ised 90 per cent of the client referrals for the social
worker within 72 hours. In spite of the chall enges, staff
persevered in less -than- ideal circumstances. COVID -
19 has highlighted the inequities of the Hamilton
Health facility and the need for investment to modern-ise technological approaches, service delivery, and
ensure approved systems for communication, health
education , and documentation practices.
In 2022/23 budget estimates for the Sexual
and Reproductive Health is listed at cost centre 32040
at page B -155 and is $882,000.
Madam Chairman, the Sexual and Reproductive Health Services programme consists of two sub -
programmes: the Communicable Diseases Programme and the Maternal Health and Family Planning
Clinic programme. Under these programmes, services
are available to prevent and control the spread of
communicable transmittable infections including HIV,
other communicable infections and the provision of health education to promote sexual health.
Collaborative services , for example, the Bermuda Assessment and Referral Centre ( BARC ) and
Turning Point are provided for persons with high- risk
behaviours to minimise the spread of infection and
promote education and behavioural change. Services also include collaborative pregnancy care with the
obstetricians for the under - and uninsured, immunisations for pregnant women, family planning, and both
women and men’s health screenings .
Madam Chairman, the HIV programme continues in its success with encouraging medication compliance. Some 97 per cent of the HIV population
in Bermuda are receiving treatment. I n 2019 Bermuda
was reviewed and approved validation for the elimination of mother -to-child transmission (EMTCT) of HIV
and syphilis by the World Health Organization. This
validation is currently being reviewed as we continue


Bermuda House of Assembly to offer the recommended HIV and syphilis testing,
ensuring treatment guideli nes are implemented immediately . Bermuda also continues to work towards
moving to a real time electronic data system to capture all of the EMTCT processes and impact implica-tions.
Madam Chairman, the maternity benefit
commenced on 1 November 2021 to assist antenatal
clients with payment to their assigned OBGYN. We
continue to work in partnership with the Bermuda
Health Council to address the needs of the community in St. George’s. Services at the clinic restarted on 1
November 2021 offering antenatal care, family planning, sexual health screening, cervical screening and
breast examinations. Community Mental Health Well -
being Services, based in the Communicable Diseases (CDC) commenced on 8 October. Ther e have been
14 clients seen by M WI teams to date with more referrals pending.
Madam Chairman, we continue to improve
and provide sexual health services that respond to the needs of our young clients. This includes providing
information on and access to modern contraception,
emergency contraception, HIV and STI testing and
treatment, gynaecology, pregnancy testing and ser-vices, safe terminations and counselling. We work in
partnership with and refer to the Teen Haven and
Child Family Services to provide extra support.
Madam Chairman, the Sexual Reproductive
Healt h Clinics have experienced lengthy challenges
with human resources remaining lower than usual par levels. We have, however, assisted with contact tracing, COVID -19 vaccines, COVID -19 screening for the
Salvation Army, emergency housing complexes and
Lightho use residential facility, Flu Express, and fit
testing essential service workers for the N95 mask. In spite of such challenges, education and the promotion of health and wellness has continued. We have provided all of the usual services to the community an d
will continue to do so.
Madam Chairman, quality sexual reproductive
health services are essential for the well -being of the
community. We plan to continue to meet the people’s
needs for accessible, affordable, client -centred care.
Sexually transmitted infections, including HIV/AIDS
and unplanned pregnancies remain present. Clients
are encouraged to attend at the clinics for education
and counselling on safer sex, women’s health, family
planning advice, and awareness of HIV/AIDS.
Madam Chairman, we want th e public to value
health education, promotion and clinical support, which are important parts of sexual and reproductive
health because sexually transmitted infections including HIV/AIDS have not gone away, and neither have
unplanned pregnancies. The pandemic has had a
devastating financial impact on many which makes our services even more essential. Clients are encouraged to attend our clinics for education and counsel-ling on safer sex, women’s health, family planning ad-vice and awareness of HIV/AIDS.
Mada m Chairman, the 2022 /23 budget estimate for the Clinical Laboratory is listed at cost centre
32090 on page B -155, and the budget estimate is
$268 ,000.
Madam Chairman, the government Clinical
Laboratory is a COLA accredited laboratory situated at the Hamilt on Health Centre. The government Clinical Laboratory supports the programmes within the clinic, such as maternal health and family planning, the communicable disease clinic, the adult health programme, child health and oral health as needed. The
Clinical L aboratory also serves as the Public Health
Clinical Laboratory for Bermuda, assisting with outbreak investigation and public health emergencies.
Madam Chairman, 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 Public Health England La-boratory can be arranged for advanced testing for diseases which have major public health significance.
The government Cli nical Laboratory continues molecular testing for sexually transmitted infections, the most sensitive and specific testing for gonorrhoea and
chlamydia screening. The laboratory will further expand its test menu to support communicable disease screening of tuberculosis, as well as the Ebola virus, if
necessary; the norovirus; and trichomonas in males —
all of which is detected using PCR methodology.
The Government’s Clinical Laboratory will
soon provide a rapid panel, which includes COVID -19,
RSV, and Influenz a A & B, as requested only by the
Medical Officer on duty.
The government Clinical Laboratory continues
to enrol in proficiency testing as a quality assurance
initiative, providing competency and assessing the
capabilities of all who work within the laboratory. The
laboratory will continue to participate in anti -microbial
surveillance as this remains a potential threat world-wide.
Madam Chairman, as supplies are in demand
for local testing for COVID -19, the laboratory continues to support the production of t he testing media.
This operation has allowed Bermuda to continue to
test with rigour amongst a global shortage of supplies.
As we are still in a pandemic, the Hamilton Health
Centre’s Clinical Laboratory continues to support the various needs for the healt h and safety of the public.
Madam Chairman, the 2022/23 budget estimate for Oral Health is listed as cost centres 32150,
32155, and 32160 on page B -156 at the combined
budget estimate of $1,514,000.
Madam Chairman, t he Oral Health s ection
continues to prov ide comprehensive public health
dental services to Bermuda’s children ages 0 to 18
years -of-age and seniors aged 65 years and older.
We have also been asked to assist many more adults
558 7 March 202 2 Official Hansard Report

Bermuda House of Assembly between the ages of 18 to 65 who currently do not
have comprehensive health insurance or are unable
to pay for private treatment.
The COVID -19 pandemic has resulted in
changed clinical care protocols across the Island. We have collaborated to heighten the protection of our
staff and patients. Our service is based on high quality
patient -centric care including dental examinations,
consultations, preventative and dental hygiene appointments, as well as a range of restorative clinical
treatments including extr actions and fillings. There is
an overall strong emphasis on prevention and working
with our community, and we also offer emergency
services during regular working hours. However, in
the last year we have added to our skillset by main-taining patient connec tivity by repurposing current
technology to increase the introduction of teledentistry for assessment and medical history.
Madam Chairman, the school -based programmes are an essential part of the Oral Health Sec-tion’s service . In spite of COVID -19, oral health education is offered to our school children with as little
disruption as possible, limited to our primary schools,
and a school -based fluoride supplementation programme for children aged 6 months up to 11 years of
age. We have been streamlining thes e programmes.
Madam Chairman, Oral Health Month 2022
went forward with the theme “Gateway to Health,” which highlighted the correlation between chronic diseases and oral status. New programmes include first
stages of collaboration with the Mid- Atlantic Wel lness
Institute family, as well as a new programme for our
pre-primary schools, which will highlight the importance of good oral health and diet and the essential role it plays in maintaining optimal general health.
This will also assist us to reengage wit h parents and
families as we look to improve the levels of oral health across the Island.
Madam Chairman, the 2022/23 budget estimates for the Department of Health’s Central Laboratory are listed at cost centre 32200, 32210, and
32220, and are listed at page B -156. The co mbined
budget estimate is $1,272 ,000.
Madam Chairman, the Central Government
Laboratory (CGL) provides a wide range of analytical
services. The forensic programme performs seized
drug and toxicology analysis. The instrument required
to determine the amount of THC in a plant material
and produced was installed in July. The installation
was severely delayed due to the technician who was assigned for the installation, who was based in Trinidad, whose borders remained closed for unauthorised
travel. Special thanks to senior colleagues in the Department of Immigration who assisted us with facilitating the travel request to the Ministry of National Security of Trinidad and Tobago. And this assistance was instrumental in securing the travel plans for the technician to travel from Trinidad to Bermuda to install the
equipment. The delay in the installation of the equipment
resulted in a backlog of cases. The backlog was immediately worked through and I can confirm that all
bail date cases are now up to date.
Toxicology analysis, Madam Chairman, is performed on coroner’s cases, driving under the influence, and urine analysis for stakeholder agencies.
The compounds that are routinely tested for are common drugs of abuse in Bermuda, which include cannabis, cocaine, heroin and ecstasy. There was an increase of 116 cases to 192 cases, equivalent to a 65
per cent increase from the previous year. These analyses are quite labour intensive, and the forensic programme completed 73 per cent of the cases within
three months, which is equal to international standards for turnaround times for toxicology cases.
Madam Chairman, the Water and Food Programme perform analysis of potable drinking and nonpotable drinking samples, dairy products and food. It
is primarily a laboratory support service to Environmental Health, with the results used to identify bacteriological and 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 (or drinking) water samples are analysed with Works and Engineering, Watlington Waterworks, Rocon, private dwellings, restaurants, care
facilities, to name a few. Non- potable water samples
include seawaters, sewage effluent , and water from
animal habitats.
Madam Chairman, there were a total of 3,636
water samples tested during the budget period, representing a decline from the previous fiscal year. This
decline was due to the pandemic, which saw environmental health staff being redeployed to assist with
the response. It also meant that the public and other
non-essential agencies had to shelter in place and
could not access our water testing service. As a re-sult, our revenue for this service declined by 7.2 per
cent. Our current data indicates that we will set a new
record for the amount of water samples tested for the
present fiscal year with revenue also increasing.
It is noteworthy that the water quality of our
main bathing beaches met the United States Envi-ronmental Protect ion 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 programme continues to meet all of its performance
measures. For the 2020/2 1 fiscal year turnaround
times were 5 to 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 [2021/22] fiscal year. Furthermore, all analytics


Bermuda House of Assembly achieved proficiency test scores that met an international standard.
The WHO also recommends the global elimination of trans -fatty acids by 2023. To this end, by
using some of the financial resources from the
2022/23 budget, we will collaborate with Environmental Health to undertake a baseline survey to determine
the amount of trans -fatty acids in various food samples in Bermuda. And this project is supported, Mad-am Chairman, by the United Kingdom’s Department of
Health and Social Care.
This programme also assisted with COVID -19
response in several ways, namely, by vetting online
COVID -19 test kit applications, helping to procure
COVID -19 testing supplies and reagents, collaborating with the Bermuda Molecular Diagnostic and Research Laboratory to ensure their programme deliv-ery, and providing operational support during its transition period.
Madam Chairman, the 2022 /23 budget es timate for Vector Control is listed at cost centre 32190
and is listed on page B -156. The budget estimate is
$1,593,000.
Madam Chairman, Vector Control is a hardworking team that ensures that threats of rodent -
borne and mosquito- borne diseases do not manifest
themselves in Bermuda. It is a credit to the team that as an essential service they managed to continue to maintain an active programme for complaint investigation and proactive baiting and monitoring for pests during 2021 /22, which was a very challenging year.
No doubt 2022 /23 will also prove challenging as the
pandemic continues. However, Vector Control plans to be able to continue to provide the essential ser-vices.
During 2021/22 the unit continued to operate
an increased baiting programme within parks, public docks and other hot spots. Consequently, these areas
are now serviced on a weekly basis. Residents are
reminded that the best way to limit rodent numbers is
to deny rodents access to food sources such as garbage, by using lidded metal trash containers and not
putting trash out on a non- pickup day. In order to reiterate this important message, Vector Control staff
took part in a number of radio and press interviews
throughout the year. Staff also liaised with colleagues
in other jurisdictions through involvement in the Pan
American Health Organi zation and the Caribbean
Public Health Agency . This networking helps in the
training and development of the Vector Contro l staff,
who will continue to collaborate with the PAHO and
CARPHA during the 2022/23 year .
Madam Chairman, the 2022 /23 budget estimates for the Environmental Health section of the Department of Health are listed at cost centres 32170, 32270, 32171, 32172 , 32173, 32175, 32180, and
32285, all found on page B -156. And the combined
budget estimate, excluding Vector Control, is
$2,378,000. Madam Chairman, the Environmental Health
Section is an essential service provid ing monitoring,
investigative and regulator y functions in such diverse
areas as food safety, occupational safety, nuisance
control, water quality and tobacco control . In order to
meet the challenges posed by the COVID -19 pandemic during the year, it was necessary to change the focus of the team. The team was realigned to provide
support to the Port Health function along with colleagues from other sectors from the department at the
L. F. Wade International Airport and the other ports of entry into Bermuda. This work involved ensuring compliance with the quarantine legislation and supporting
the COVID -19 testing regime, which was established.
In particular, the team managed the collection and
transport of samples to the MDL Laboratory.
Madam Chairman, the Environmental Health
team also worked with busi nesses and other stakeholders to produce a range of guidance documents aimed at managing the pandemic in a range of settings. The team also supported our colleagues in the
epidemiology surveillance and case management
units in the investigation of clusters and outbreaks of
COVID -19. The team also assist ed in the investigation
of breaches of quarantine and COVID -19 regulations.
They also helped to monitor compliance with regulations and guidance.
The Occupational Safety and Health team
was rejuvenated with the appointment of a new Occupational Safety and Health Inspector in January 2022.
This will help to enable more proactive inspections
and industry outreach in collaboration to be carried
out. The aim of the unit is to increase adherence to Occupational Safety and Health Standards, thereby
reducing the number of workplace accidents, ill health
conditions, and dangerous occurrences. In order to
enhance safety and health awareness, training courses were organised in relation to asbestos abatement
and safety.
Numerous workplace risk assessments for
COVID -19 have been carried out in association with
the contact tracing teams within the Epidemiology and Surveillance Unit. COVID -19 guidance was produced
for many work categories, and associated advice giv-en to empl oyment sectors and businesses on best
practice. This work will continue in 2022/23.
Accident investigations were carried out in order to identify potential uncontrolled risk and to work with businesses to improve occupational health and safety standards.
Madam Chairman, t he Port Health Unit of Environmental Health assists in the monitoring of persons arriving on Island at the airport and other ports of entry in order to provide controls 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 moni-tors food products arriving on Island to ensure that
they are safe for human consumption. Th e port health
560 7 March 202 2 Official Hansard Report

Bermuda House of Assembly function is central to Bermuda’s complying with international health regulations. During 2021 /22 the number of vessels visiting Bermuda was greatly reduced
from pre- pandemic years and, therefore, the number
of inspections required to be carried out was equally
greatly reduced.
As mentioned previous ly, Madam Chairman,
much more work was required to be carried out at L. F. Wade International Airport and at the ports of entry
to ensure compliance with quarantine and other legislation.
Madam Chairman, a new quarantine and isolation room is now operational within the airport. This enhances Bermuda’s reputation as an international
destination and ensures compliance with the international health regulations. A new Port Health and Preparedness Manager joined the Port Health team in
September 2021. This officer has begun the process
of establishing the new Port Health Unit, which will
comprise of the manager and three port health officers. It is hoped that these port health officers will be appointed during 2022/23.
Madam Chairman, this will greatly enhance
the team’s ability to provide the necessary checks and controls at the Island’s ports of entry and, thereby, strengthen the degree of protection provided to our
citizens from infectious diseases and further enhance
Bermuda’s international reputation.
The department continues to work, Madam
Chairman, with Skyport and other government stake-holders to ensure that the cargo shed is brought up to international standards for processing, where necessary, and inspecting shipments of food, medicines and
human re mains. During 2022/23 it is likely that some
of the work of the Port Health Unit will again be focused on the management of COVID -19. The Unit is
in discussions with other government departments and other stakeholders in preparation for what is
hoped will be a much busier cruise season.
Madam Chairman, the Department of Health
operates two exemplary long -term care facilities,
namely, the Sylvia Richardson Care Facility (SRCF) in St. George’s and the Lefroy House Care Community
(LHCC) in Sandy’s Parish —the w inner of the upcoming Cup Match . (Just making sure you are listening.)

An. Hon. Member : No, no, Minister. Well done, Minister!

Hon. Kim N. Wilson: I thought I might have put you to
sleep.

No, I am not asleep. It took forever
before I turned on my microphone.

An. Hon. Member: Whenever you talk about Somerset, Minister of Health, we are wide awake!
Hon. Kim N. Wilson: Madam Chairman, the 202 2/23
budget estimate for Lefroy House Care Commun ity is
listed at cost centre 32000 on page B -155, and the
budget estimate is $4, 817,000. The 2022/23 budget
estimate for Sylvia Richardson Care Facility is listed at cost centre 32015 on page B -155, and the budget estimate is $5, 713,000.
Madam Chairman, b oth provide care, promote
independence and optimal health for persons aged 65
years and ov er, who have significant nursing and care
needs requiring 24- hour facility -based care.
Madam Chairman, the two facilities are residential care communit ies, provid ing comprehensive
medical nursing, environmental , and recreational services to the resident, respite, and day -care elders . Our
aim is to maintain and improve quality of life for elders and their loved ones. At both facilities, due to the pan-demic, day care services were suspended and all
short -term respite care admissions were curtailed
when necessary. No doubt this has continued to impact families and seniors living in the community.
Both facilities have been closed to visitors at
times during the pandemic, essential visits and outside visits have been permitted. Throughout the pan-demic, residents and staff have undergone regular
COVID -19 screenings and testing as required. Voluntary vaccinations and boosters for those who consent
continues.
Madam Chairman, demand for nursing beds
continues to very much exceed capacity. Sylvia Rich-ardson and Lefroy House continued to work along
with Ageing and Disability Services, Community Health, and the Bermuda Hospitals Board social work team to prioritise and fill the vac ant beds as they become available.
Madam Chairman, internal projects are underway at Lefroy House to provide and/or improve the
recreational area for elders and to optimise the current
space. Plans are also underway to replace the roof
and other much needed internal refurbishments to the
kitchen and dining areas and w ork on these areas will
continue into the 2022 /23 budget year.
Madam Chairman, as LHCC is an old facility
structurally, general repairs and maintenance occur
on a regular basis in order to mai ntain a safe and
comfortable environment for our resident elders . The
HVAC system is under repair, upgrades to the security and fire alarm systems have been done. And Madam Chairman, plans to build a new Lefroy House at a new location were mothballed, unfortunately, during
COVID -19 but they will now be revisited at this point,
Madam Chairman.
Other areas affected by COVID -19 were increased use of overtime in order to maintain safe staffing levels as staff were required to quarantine/isolate as they became ill or were deemed closed
for household contacts. There was also increased need and cost for personal protective equipment.


Bermuda House of Assembly Madam Chairman, the HVAC and fire alarm
systems at Sylvia Richardson Care Facility need to be
upgraded. A new Internet based Cisco t elephone system is currently being trialled and an IT computer up-grade is required. Capital funds have been requested for the necessary upgrades, including upgrades to the
laundry equipment, flooring and furnishing replacement. Transportation is a concern. Replacement of
the ageing CS wheelchair accessibility vehicle is a priority along with the purchase of a new second
smaller vehicle.

Revenues

Hon. Kim N. Wilson: Madam Chairman, revenues for
the Department of Health are projected to reach $3,672,000 for 2022 /23. T hese estimates can be
found on page B -157.
These revenues come from the sale of medications, vaccines and biologicals; fees for clinical ser-vices; pati ent fees from the two long- term care facilities, as well as fees for licences and permits issued by
the Environmental Health Section of the D epartment
of Health.
Madam Chairman, that concludes Head 22.

HEAD 24 —HOSPITALS

Hon. Kim N. Wilson : Madam Chairman, Head 24,
Hospitals, can be found at pages B -167 to B-168 of
the Budget Book.
Madam Chairman, the Bermuda Hospitals
Board (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 outpa-tient services and residential long- term care for seniors, a s well as a range of outpatient residential and
acute services for mental health and intellectual disability service use rs. Services are provided from King
Edward 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, fi-nance and IT in the Craig Appin Building in Hamilton.
As Bermuda’s only hospital, Madam Chairman, in what has been the deadliest year of the COVID -19 pandemic, the BHB has not only managed
to keep services running, but worked hard to improve service delivery throughout t his fiscal year. This has
been due to the 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
Current financial position

Hon. Kim N. Wilson: In a year when all of Bermuda
has felt financial pressures and the economy has been challenged, BHB has continued to work within the envelope set by Government. Ninety -seven per
cent of BHB’s income is reliant on Government. By the end of January net revenues were below budget
by $6 million due to lower than anticipated mutual re-insurance fund funding levels in the first seven months
of the fiscal year 2021/22.
Activity has been lower than projected, related
to the COVID -19 waves. Twice in this fis cal year during the alpha and delta waves, BHB ceased selective
surgeries and postponed non- urgent outpatient appointments. Although emergency and urgent surgeries
and outpatient appointments continued throughout
these waves, outpatient activity revenue was 11.3 per
cent down and inpatient activity revenue was down
10.1 per cent.
Expenses have been well managed and by
the end of January this year, were below budget by
4.4 per cent or $12.7 million. Salary and employee
benefits were down 1.7 per cent and operating expenses were below budget at 6.1 per cent. BHB expenses were also helped by $6.3 million in Government concessions and $4.3 million in EMR -related
salary savings.
Madam Chairman, cash continues to be the
most pressing issue for BHB and the trend of declining cash balances began to turn around only in Janu-ary of this year due to funding increases, receipt of
$11.1 million of the original funding and the receipt of
the MWI’s capital grant of $4.5 million. Over the fiscal
year 2021/22 cash balances have fallen by $11 million. By the end of January this year BHB had cash on
hand of $16 million, of which $4 million is restricted cash and can only be used for specific purposes. This
represents less than 13.4 days of cash on hand to
fund operations. Although this is an improvement from
5.6 days in December, it is also far below last year’s
figures of 41 days cash in hand. Most hospitals aim
for 60 to 90 days. Additionally, there are no longer any
funds in reserve deposits.
Madam Chairman, improving cash bal ances is
critical for Bermuda’s only hospital. This reserve enables investments in maintaining and improvement services. During the pandemic, available cash ensured
BHB could fund unanticipated COVID -19 related costs
and it also is a reserve for all unanti cipated costs in
investments as well as ensuring stability for the organisation.
Madam Chairman, the financial pressures on
BHB did not require it to access its overdraft facility in this fiscal year. It had to draw down $5 million . . . sorry. The financi al pressures on BHB did require it to
access its overdraft facility in this fiscal year. It had to
draw down $5 million, although funds were returned
by the end of January.
Savings Programme. Madam Chairman, part
of BHB’s plan to achieve financial stabilit y has been
the continuation of a multi -year savings programme,
which continues to be a priority for BHB in this fiscal
562 7 March 202 2 Official Hansard Report

Bermuda House of Assembly year. The savings goal in 2021/22 was increased to
$13.8 million, up from $12.3 million, which includes
$1.3 million cost of delivery, or a net target of $12.5
million. The team has now identified $20.1 million in total savings, with $19.3 million highly likely to be achieved.
Madam Chairman, work continues on the balance to ensure that all identified saving targets are met. While savings y ear to date have been successful, BHB must develop savings that are cash releasing to ensure that its cash challenges are reduced signifi-cantly.

Response to the COVID -19 pandemic

Hon. Kim N. Wilson: For the second year in a row,
Madam Chairman, the COVID -19 pandemic has had a
serious impact on our hospitals and group homes.
The year 2021 was by far pressured and more deadly
than 2020 with surges in the spring from the alpha
variant, and late summer and fall from the delta vari-ant, and since December throu gh to today we are
seeing omicron variant cases.
Madam Chairman, throughout the entire two
years of the pandemic, it should be noted that BHB staff have continued to deliver uninterrupted urgent
and emergency care, surgeries and diagnostics
across all ser vices at King Edward and MWI. Where
the impact has been felt most has been in non- urgent,
or elective surgeries and appointments which were ceased twice in this year during the alpha and delta waves.
Madam Chairman, one of the most demanding aspects of t hese surges or waves has been that
each variant has had significant differences in respect
of infectivity, incubation periods, severity, and mortali-ty. Each wave has required adjustments in visiting, quarantine and isolation requirements for staff and
patients at BHB. This impacts how care is given, the
pressures on staffing, and the ability for people to visit.
For example, Madam Chairman, delta caused
the most severe patient surge with over 70 people in
hospital and 17 people in the intensive care unit at its
peak. And staff who tested positive or who had contact with a positive case were off for more days as the
incubation was longer. About 60 staff were off during
the peak of delta.
Omicron has been, by far, the most infectious
of the variants, but the i ncubation period was shorter
and the disease less severe. This meant fewer hospitalisations. More staff were impacted [by] delta, with
about 150 off work at the peak. The constant adjustments have not been easy for patients, visitors and
staff. However, se tting the standards based on the
particular variant is critical for maintaining the safest
possible care environment.
For the less severe omicron, for example,
Madam Chairman, BHB did not cease any services and did not further restrict visitations with the exception of when there were cases in the long- term care
units. There is much gratitude, Madam Chairman, to
the BHB staff who have worked through all the waves
and shouldered the additional pressures that the pan-demic has caused to keep care services running for
all of us in Bermuda.
Madam Chairman, BHB has been cognisant
of the impact of stress on its workers, not only in the
workplace, but those caused by the general impact of
the pandemic on families in Bermuda and overseas. There has been a focus on pr oviding mental health
support, especially to teams on the front line. Along
with mental health advisories, sharing of support materials and videos, and access to the confidential employee assistant programme, staff from the MidAtlantic Wellness Institute also provided support for individuals and teams within BHB, and there has been
a proactive encouragement for staff to take breaks
and vacation to recuperate as the successive waves
have waxed and waned.
Madam Chairman, I would also like to add
that the support for BHB staff during the pandemic
has been greatly appreciated. There have been cards,
gifts, flowers, food and financial donations —all of
which help staff feel connected and supported by the community through some of the darkest days of the pandemic. Over 6,500 meals have been donated between September and December 2021, and this covered some of the most challenging times during the
delta surge when staff were working around the clock
with the highest number of very sick and dying patients. It made a difference to feel cared for and sustained, and BHB staff want the community to know
how much it meant to them and helped them.
Madam Chairman, sadly, however, whilst virulence and infectivity varied between the SARS -CoV-2
variants, we have seen deaths and serious illness in
every wave. There are many in our community who remain vulnerable to COVID -19, even in less severe
forms, such as the omicron variant. People who are not vaccinated have been most at risk of severe illness and death. But also at risk are people who are
immunocompromised, such as cancer patients, peo-ple with transplants, or who have weaker immune sys-tems, such as seniors and those who have comorbidities.

Thank you, Madam Chairman.
Honourable Members, we are in the Committee of Supply for further consideration to the Esti-mates of Revenue and Expenditure for the year 2022/23. This is a five- hour debate on the Ministry of
Health, which will conclude today at 4:37 pm. And cur-rently addressing the House is the Honourable and Learned Minister for Health Kim Wilson.
Minister, p lease continue.
Hon. Kim N. Wilson: Thank you, Mr. Chairman. I can
both see and hear you.
Mr. Chairman, there are many in our community who remain vulnerable to COVID -19, even in less
severe forms, such as the omicron variant. People who are not vaccinat ed have been most at risk for
severe illness and death. But also at risk are people who are immunocompromised, such as cancer patients, people with transplants or who have weaker
immune systems, such as seniors and those with comorbidities. Such people, Mr . Chairman, who may
be family members or colleagues, are reliant on all of
us to help protect them, because vaccines are less
effective for them individually.
Mr. Chairman, many such vulnerable people
are outpatients, inpatients, or long- term care residents
at BHB, so there is a heightened vigilance within our
hospitals to protecting people. This is why there are
still visitation restrictions at BHB, why some people
are still expected to use screens for temperature and
mask checks when entering BHB facilit ies and remain
masked even when visiting loved ones in their rooms,
and why people are asked to call ahead if they think
or know they have COVID -19 but need emergency
services. Additionally, Mr. Chairman, there was a strong
encouragement for staff to get vaccinated at BHB. By
the end of 2021, 80 per cent of all BHB nurses and 85 per cent of all BHB doctors were fully vaccinated.
Mr. Chairman, BHB was able to support Government’s national COVID vaccine programme thanks
to major donations from individuals and companies
through the Bermuda Hospitals Charitable Foundation. These donations helped pay for nurses, facilities
costs, and the supplies needed to deliver the Pfizer
vaccine. The BHB clinic gave 43 per cent of all vac-cinations in Bermuda, which translates to over 50,000
vaccinations.
It is a great testament, Mr. Chairman, to the
hard work of BHB staff that outbreaks in patient units
within the hospital have been limited. Where they
have occurred, they have been picked up quickly and infection prevention processes, such as unit quarantine were implemented immediately. It has helped that
all admissions and transfers between areas are tested
first, but the limited number of outbreaks and how they
have been controlled is also down due to the actions
of many staff in the care environment.
Mr. Chairman, we can begin to look forward
with some hope: a clear majority of people have stood
up to protect themselves and their community by getting vaccinated, and new treatments, such as the antivirals, are proving effective at reducing severe disease in at -risk populations and will make a difference
when enough are manufactured and become available for purchase. This will help us reduce pressure on
our hospitals as well as help us protect those whose
lives remain at ris k from COVID -19.
Mr. Chairman, while the pandemic has been a
major impact on the hospitals, however, the launch of
a new strategy and the focus on key improvement
projects means that a great deal has been achieved to
improve care and improve outcomes for our communi-ty in addition to the COVID -19 response.

New Strategic Plan
Hon. Kim N. Wilson: Mr. Chairman, as was communicated in the budget debate last year, BHB was in the process of developing a new strategic plan that would outline its plans for the fiv e years from 2021 to 2026.
Over 360 leaders and staff from across BHB
attended forums, workshops and filled in surveys, and over 400 community members participated with their insights and perspectives. In April 2021, the new strategic plan was published, and the shift was to focus
BHB on a vision to pursue excellence through improvement, to make Bermuda proud.
The document can be read in full on the BHB
website. The key pillars of the strategy are: care, people, performance and collaboration. Major projects
such as the electronic medical record, performance reporting and an integrated healthcare programme,
are foundational stones of the strategy.
564 7 March 202 2 Official Hansard Report

Bermuda House of Assembly Key performance indicators

Hon. Kim N. Wilson: Mr. Chairman, BHB built on its
performance focus in this year, wi th integrated key
performance indicators tied directly to the new strate-gic plan. This report goes to the Board each quarter to
ensure oversight and governance, and includes clinical, workforce, support and administrative metrics. It
includes trend data as well as monthly data, and highlights where variations require attention.
In the last report made in January this year
with figures up to December 2021, metrics included
patient satisfaction for overall services which saw 90
per cent of patients rate servi ces as satisfactory for
King Edward and 8 2 per cent for MWI.
Elective surgery activity has been active following the postponements during the alpha and delta
waves. Although non- pandemic -related surgery postponements remain a huge inconvenience for patient s
when they happen, the cancellation rate for non-clinical reasons was at 1.8 per cent (which represented 10 cases) in December, and the mean for the fiscal
year was 2.5 per cent . Reasons for non- clinical cancellations include d bed capacity, but also patie nts eating or drinking before surgery, patients cancelling the procedure, patients forgetting to call, patients not
showing up or refusing, or the surgery was postponed
as the surgeon ran out of time.
Mr. Chairman, t he latest performance report
also shows that hospital -acquired infections, which
have always been quite low, were still declining. There has not been an MRSA bacteraemia infection, when
an MRSA infection gets into the blood stream, recorded since February 2021. Improvements made to pres-sure injury processes continued to see relatively stable numbers, mostly on acute rather than long- term
care wards.
Mr. Chairman, t he Emergency Department in
December was seeing increasing numbers with 2,301 attendances. Overall, Emergency is seeing slightly
lower attendances compared to the start of the pandemic in March 2020. Year -to-date up to December
2021, on average it took about 21 minutes for a patient to be triaged after their arrival, and about 30
minutes to see a physician once in an emergency
bed. The average time to complete care for an emergency visit is within three hours for people who are
discharged. Where delays are felt most is in the admission from emergency to a bed. 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. This relates to the very high occupancy rates on
the wards which has been at about 95 per cent most
times.
There is a patient flow board working on improving bed availability, and the implementation of the
electronic medical record which I will cover in this brief
includes a bed management component which will also assist in the efficient management of this pro-cess.
Within Diagnostic Imaging, wait times have
been impacted during pandemic waves when nonurgent elective scans were postponed. Emergency and urgent scans have never been postponed, and
are usually carried out within 24 hours. On average,
the wait time for other scans has been nine days, so
less than two weeks from referral. Cardiac diagnostics were on average 21 days from referral.
BHB’s vacancy rate was 11.6 per cent in January with 12 active nurse vacancies, although 42
nurses are appointed but not yet on Island, resulting in
pressures that were exacerbated by the absences
caused by omicron espec ially.

Accreditation

Hon. Kim N. Wilson: Mr. Chairman, BHB undertakes
a number of specialist accreditation surveys as well as
a hospital -wide process. These are processes in
which external surveys mark BHB’s adherence to pa-tient quality and safety standards. They are checked
through documentation checks, process checks and
interviews. Hospital -wide accreditation is with Accreditation Canada and the next survey is 2023. Last year, BHB’s substance abuse services achieved specialist accreditation with the Commission on Accreditation of
Rehabilitation Facilities. This year, two specialist accreditation surveys were successfully maintained. The
BHB lab was accredited by the Joint Commission International, and its mammography services was accredited by the College of American Radiology.

Primary Stroke Care Centre Certification

Hon. Kim N. Wilson: Mr. Chairman, i n 2018, BHB
entered into an agreement with Johns Hopkins Medi-cine International, part of which was to establish a
primary stroke centre at BHB and to be certified as
such by an accredited body by 2022. BHB has worked very closely with the Johns Hopkins team during this
time, and impressive improvements have been made
that are improving outcomes for stroke patients in
Bermuda every day.
Mr. Chairman, there are about five stroke patients every week who come to BHB, and the response within BHB involves emergency, diagnostic
imaging, pharmacy, critical and acute care inpatient, and rehabilitation services. In 2020, 25 per cent, or
one in four people who had strokes in Bermuda, were
under the age of 60. Seventy -three per cent of strokes
occurred in the Black population.
Mr. Chairman, education has been ongoing
about recogni sing stroke symptoms because the most
important factor in getting effective stroke t reatment is
seeking care within the first four hours. Getting to hospital in time can make the difference between lasting disability and a near -normal recovery.


Bermuda House of Assembly Mr. Chairman, i n addition to education, BHB
has a multi -disciplinary team working with Johns Ho pkins to ensure that when someone does present at
Emergency with a stroke, we deliver the best possible
care. A Brain Attack Team (BAT) has been estab-lished and uses a crisis communication cascade to
quickly respond. In 2021, BHB announced it had
launched the world’s first trans -oceanic telestroke service in partnership with Johns Hopkins. Mr. Chairman, this allows BHB patients to benefit from BHB and
Johns Hopkins clinicians working together in real -time
to make the time- sensitive treatment recommendations .
Mr. Chairman, a local telestroke service was
initially established including Emergency physicians with hospitalists and local neurologists. In December
2020, it went trans -oceanic with Johns Hopkins physicians joining the local team. And in July of this year it
was reported that there had been the first trans -
oceanic transfer from BHB to a comprehensive stroke centre in the US for the removal of a large clot, a sur-gery that is not possible in Bermuda. This is a time
sensitive procedure, as patients have t o be at the
overseas hospital within 16 hours of the onset of
symptoms.
Depression screening for stroke patients has
also been established to cater to the emotional and mental health toll that strokes can have on an individual.
Mr. Chairman, aiming to be c ertified as a primary stroke centre requires BHB to demonstrate ex-cellence in the care of stroke patients across multiple
departments, for staff across the organisation to
demonstrate they can recognise strokes, and for there to be proof of ongoing educati on in the community.
BHB is required to report on key performance indica-tors, including having all clients with suspected stroke getting timely brain imaging, timely treatments and
assessments, admission to a dedicated stroke unit,
avoidance of preventable complications, length of
stay, mortality rates, rehabilitation rates, undertaking timely falls assessments, depression screening, and
cognitive impairment screening.
At the end of February, BHB underwent a certification process with Accreditation Canada as a pri-mary stroke centre. We are looking forward to the results in the near future.

Other clinical improvements

Hon. Kim N. Wilson: Mr. Chairman, breast screening
took a big leap forward at BHB in 2021 with the introduction of BHB’s first 3- D mammography machine
and first breast ultrasound equipment. 3- D mammography offers improved image quality, and breast ultrasound will be offered to women with denser breasts as these are harder to read on mammograms. The earlier breast cancer can be diagnosed, Mr. Chairman, the
better the chances people have of a full recovery, and this improvement in clinical equipment will help us diagnose earlier and improve outcomes for women in
Bermuda.

Integrating care in the community

Hon. Kim N. Wilson: Mr. Chairman, BHB has been
shifting its clinical structure over the last year to better
reach patients where they are in the community. This
shift has been across King Edward and MWI. It is part
of BHB’s strategy to deliver existing services closer to the people who need them, to connect services
around the patient, and to collaborate in the delivery
of care across departments within BHB, and with other organisations and providers in the community.

Supporting people with
mental health issues in court

Hon. Kim N. Wilson: Mr. Chairman, in September of
2021, BHB announced a joint initiative between the Mid-Atlantic Wellness Institute, the Magistrate’s Court,
the Department of Court Services and Bermuda Police Services following a pilot that started in February
2021. The pilot w as for a new liaison and diversion
officer position (LDO), filled by a psychiatric nurse,
who will support people with mental health challenges who are attending court or interacting with the police.
Mr. Chairman, “A ttending court and interacting
with poli ce can pose unique challenges for some people with mental illness es.” This is according to Mr.
Preston Swan , who added : “There are specific methods that can be used to effectively communicate with such persons, but it is complex as the methods vary
based on the person’s particular challenge or diagnosis. Psychiatric professionals are best qualified to recognise this and interact appropriately. ”
During the 11-month pilot, the LDO had 510
encounters with individuals seeking support . Thirty -
three per cent of them were known to MWI, and 18
per cent were current clients.

Integrated healthcare clinic
at the Lamb Foggo Urgent Care Centre
Hon. Kim N. Wilson: Mr. Chairman, in June of 2021,
BHB launched an integrated healthcare clinic at the
Lamb Foggo Urgent Care Centre. Run as a pilot, the
clinic brought together mental health outpatient services, patient -centred medical home appointment s,
asthma and diabetes appointments , and offered patients who needed these services the opportunity to
receive their care from th ese areas in the east end,
rather than travelling to King Edward or MWI.
Despite going through the delta and omicron
COVID -19 surges, the clinic has continued running
offering mostly in- person, but also some remote appointments via phone and W ebex. As of February,
there had been nearly 400 attendances at the clinic
566 7 March 202 2 Official Hansard Report

Bermuda House of Assembly which runs once a week in the daytime, when the
UCC is not being used for urgent care services.
Mr. Chairman, not only is this more convenient for patients in the east end, but the centre runs
from an available vacant space owned by BHB. Over
time, this type of multi -clinic service in the community
is easier for patients to access, hopefully improving
the management of chronic illnesses and reducing emergency and inpatient admissions.

Other mental health services in the community

Hon. Kim N. Wilson: Mr. Chairman, in October of
2021, BHB announced that it would be piloting the
delivery of mental health services from the Hamilton
Health Centre in partnership with the Department of
Health. A simil ar pilot was also underway in partnership with a GP’s community office. The goal is like the
integrated healthcare clinic, aiming to bring mental
health services closer to those who need it and in settings where people will feel more relaxed.

Community in tellectual disabilities team launched
Hon. Kim N. Wilson: Mr. Chairman, a community
intellectual disabilities team was launched in July of
2021 to support clients with intellectual disabilities
who are living at home with their families. A residential service in group homes is offered by the Intellectual
Disabilities Department, as is a day service. However, this multi- disciplinary team brings a number of professions together to support families and clients at home,
improving access to safe and equitable c are, increasing levels of independence and helping clients develop new skills so they can thrive in their community.

Systems and Technology

Hon. Kim N. Wilson: Mr. Chairman, t he major system
implementation at BHB was the launch of the electronic medical record implementation. This is a huge
undertaking for BHB, and while over 95 per cent of
non-federal acute care hospitals in the US have electronic medical records, this is BHB’s first organisation-wide, integrated system.
The selected vendor is Cerner and their EMR
product is called Millennium. It was selected in 2019
after a competitive RFP process that involved approximately 100 BHB staff, and was approved following a
full business case going to the Board.
The implementation timing was driven by the
retirement of an old clinical system that was no longer
supported by the vendor, and had been planned to
start in 2020 and go live in 2021. I first , Mr. Chairman,
announced this project in the budget debate in March of 2020, but it was postponed due to the emergence of COVID -19, by a year. The project launched last
April and is due to go live later in 2022. Mr. Chairman, this is a significant implementation programme. Over 350 BHB staff were involved in over 1,000 workshops and meetings in 2021 just for
the design and build process. Looking ahead, a further 1,000 staff will be involved in testing the system and training ahead of the go- live, expected by early
Fall.

Thank you very much.
Members of the public, we are in the Committee of Supply dealing with the Estimates of Revenue and Expenditure for the year 2022/23. You have been
listening to the Health debate led by the Minister of
Health Kim Wilson. This debate lasts five hours and
will conclude at 4:37 this afternoon.
Minister Wilson, if you could kindly take us to
lunch and then the Committee will return in Committee
at 2:00 pm.
Minister Wilson.
Hon. Kim N. Wilson: Thank you, Mr. Chairman.
Mr. Chairman, I move that we now recess to
lunch and return at 2:00 please.

Honourable Members, and the listening public, we are in Committee of Supply for further
consideration of the Estimates of Revenue and Expenditure for the year 2022/23.
At the moment, this is a five- hour debate on
the Ministry of Health covering Heads 21, 22, and currently 24. We have [Head] 91 still to follow. [We have]
the Honourable and Learned Minister for Health, Kim
Wilson, who is currently addressing Parliament.


Bermuda House of Assembly Thank you, Minister. When you are ready,
please continue.

HEAD 24 —HOSPITALS

Systems and Technology

[Continuation thereof]
Hon. Kim N. Wilson: Thank you, Mr. Chairman.
Prior to lunch I was in the midst of discussing
Head 24, the Hospitals, and I was drawing Honourable Members’ attention to the Systems and Technology initiatives of the hospital.
Mr. Chairman, there is a significant implementation programme concerning systems and technology. Over 350 BHB staff were involved in over 1,000
workshops and meetings in 2021 just for the design
and build process. And, Mr. Chairman, you w ill recall
that before lunch I was speaking in particular about
the Cerner project, the electronic medical records. Looking ahead, a further 1,000 staff will be involved in
testing the system and training ahead of the go- live,
expected by early fall.
Mr. C hairman, why have an electronic medical
records system, or EMR, now? The retiring clinical system does not have a replacement. Hospitals
around the world are moving to electronic medical records because they bring much compelling benefits
to the quality an d safety of patient care, offer innovation opportunities and support improved operational
efficiency. Patients will not have to repeat information
between departments. They can schedule multiple
appointments with one call, and there will be built in alerts that help clinicians avoid medication errors or
duplicating tests, or flag for sepsis or stroke which both require very fast treatments to save lives.
For BHB, it means several IT systems and
platforms can be replaced. Indeed, the cost of one integrated E MR across clinical and support services, if
you take out implementation costs, is about the same as the total cost of the different systems which all had
to be individually supported with maintenance and
upgrades .
Mr. Chairman, as was communicated in 2020
and 2021’s budget speeches and communicated via
release and the Public Access to Information contract
listing, the total cost of the entire EMR contract cost
over 10 years including implementation, consultation,
maintenance and upgrades is about $55 millio n paid
over 10 years. However, with the savings made on
other IT systems, the actual cost is closer to $30 million paid over 10 years, and if operational efficiencies
offered by the EMR over the longer term are considered, the project is expected to be cos t-neutral after
10 years.
The electronic medical record is not the only
system and technology improvement at BHB. A new
platform for patient safety reporting that provides eas-ier reporting and follow -up and risk management capabilities went live in October 2021, and a new policy
management system that supports policy updating
and compliance went live last month.
In conjunction with the increased reliance on
technology, cybersecurity training is now required by
all BHB staff using computers, and there was a special cybersecurity awareness month to improve
awareness and understanding of how to spot phishing
and hacking attacks. Multi -factor authorisation was
introduced for remote access in this year, and access
to email outside of BHB changed to improve securi ty.

Facility Improvements

Hon. Kim N. Wilson: Mr. Chairman, BHB installed its
new generators in 2021 for the KEMH General Wing
following the failure experienced in 2020 during the
BELCO blackout. The cost of the generators, as was
listed in the 2020 PATI listing, was in the order of $1
million, but they will ensure that services can safely transfer to generator power in the event of any future
disruptions. At MWI, a new electrical system was installed and new air handlers were installed in the
KEMH General Wing.

Community Activities

Hon. Kim N. Wilson: Mr. Chairman, BHB undertook a
number of community activities in 2021, including a
live Zoom panel with MWI and community experts
discussing addiction and recovery for recovery month
in September, a motorcade through Bermuda to rec-ognise International Day of Disabilities, the annual art
and photography exhibition for MWI clients took place
at the Bermuda Society of Arts, and a “Be Kind” promotion was run with a logo on Marketplace bags.
There was also activity around World Blood
Donor Day in June, with the theme ‘give blood and
keep the world beating. ’ Following a remote launch by
the Pan American Health Organization which included Bermuda, the BHB’s Bermuda Blood Donor Centre
held a virtual dance off to draw attention to the need
for blood donation with loc al youth dance group
DanceSations, the Royal Bermuda Regiment, H&H
Gombeys and the BHB’s Allied Health team who had
won an internal blood drive competition in 2021. There
were online interviews with local donors. The Hamilton
Princess donated gifts that went into a raffle for new and existing donors, and Freisenbruch Meyer was
announced as the winner of the Corporate Blood
Drive Competition 2021.

Looking Ahead
Electronic Medical Record

Hon. Kim N. Wilson: Mr. Chairman, BHB’s implementation of the new EMR is expected to go live late
in 2022. This year, BHB’s focus will be dominated by
568 7 March 202 2 Official Hansard Report

Bermuda House of Assembly the testing of workflows in the new system and training of over 1,000 staff. It is a major implementation
and BHB is shifting from many manual and paper -
based processes to streamlined electronic ones, and many fragmented systems are being replaced by the one EMR. It offers so many benefits to patient safety,
and opportunities to improve quality that the project is
one of a clinical transformation, not j ust installing an IT
system. I look forward to seeing the successful im-plementation and the benefits being realised by patients in Bermuda.

Laundry Upgrade
Hon. Kim N. Wilson: Mr. Chairman, BHB will start its
laundry upgrade project in the upcoming fiscal year, which will cost more than $4 million in total costs. The Laundry department supports the entire hospital service and is critical to the delivery of safe, high- quality
patient care. Like all departments, the demands on it
through the pandemic have only increased due to in-creased infection prevention processes. The ageing
washing machines had been experiencing increasing
maintenance and repairs issues and have had to be
supplemented by a commercial laundry operation to ensure services were not interrupted. While new
equipment has been purchased and used in the older
laundry, a full upgrade of the area is required to make best use of the equipment and to ensure the work area and flow is improved for staff.

Integrated Health

Hon. Kim N. Wilson: Mr. Chairman, BHB’s
healthcare integration programme is looking to improve healthcare access and outcomes by offering existing services in the community, collaborating with partners outside of BHB and involving patients and
partners in the planning of improvement s.

MWI Directorate Plan
Hon. Kim N. Wilson: Mr. Chairman, I was personally
very pleased to see that a plan for mental health, substance abuse and intellectual disability services was
being developed by staff and clients at the MidAtlantic Wellness Insti tute. It is very close to publication and the community can expect to see it published
in late spring.
I was given an overview of the plan, and I am
very excited that it is addressing some of the key is-sues being experienced by people who need MWI
service s, from shifting outpatient and residential services from the institutional environment to community
settings, being a part of a promotion that overcomes
stigma, to addressing the gap that currently exists on Island for youth with complex needs. At its heart is the
recovery model of care, which seeks to include pa-tients in their recovery journey as an equal partner with clinicians.
Initially introduced in the 2010 MWI Mental
Health Plan, at a time when the recovery model was
quite new internationally, this current Plan will be
building on what has been achieved so far and recognises that the recovery model is now the standard of
care recognised around the globe.

Cancer Pathway

Hon. Kim N. Wilson: Mr. Chairman, work on the cancer pathways of care at BHB st arted in 2021, and an
incredible amount of work has been undertaken that
has involved patients, as well as local and overseas
partners.
Focus has started on the breast cancer care
pathway. Out of this collaborative process, as we enter into 2022, we are going to see the appointment of
a cancer coordinator who will help support patients
through their emotional and clinical journey. There will
also be a rapid pathway for newly diagnosed breast
cancers to help improve the time between diagnosis
and treatment, as well as a rapid diagnosis clinic,
which will enable people with suspected cancers to
get all their required tests together, such as mammograms, ultrasounds and biopsies, rather than booking appointments and having tests separately.
This is not only more convenient, but can also
help reduce the time it takes for a diagnosis to be made. A similar process improvement is underway in
the prostate cancer pathway and will continue through
2022.

Palliative Care

Hon. Kim N. Wilson: Mr. Chairman, there is also
work in the palliative care service that will be working in collaboration with patients, families and partners to
improve care in Bermuda.
Mr. Chairman, this concludes Head 24, Hospitals. Mr. Chairman, moving on to the final Head, 91,
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 -169 to B -171 of the Budget Book.
Mr. Chairman, the mission of the Health Insurance Department (HID) is to provide equitable ac-cess to affordable benefits and collaborative programmes, leading to improved community health outcomes.
As the demand for affordable health insurance
in Bermuda continues to grow, the Health Insurance
Department provides a viable option that is accessible
to all Bermuda residents. If the last two years have


Bermuda House of Assembly shown us anything, it is that the availability of an affordable health package remains essential.
Mr. Chairman, for fiscal 2022/23, $2,669,000
has been allocated for this Head. The Head 91 budget
remains the partial source of funding behind the
Health Insurance Department (HID), which is responsible for developing and administering the Government’s social health insurance products offered to the
public, including the following:
• the Health Insurance Plan (HIP);
• the FutureCare Plan (FutureCare);
• the Mutual Reinsurance Fund (MRF); and
• the Government Subsidy Programmes (Sub-sidy), which pay towards the hospitalisation
costs of select populations.
Mr. Chairman, effective Nov ember 1, 2021,
HID’s policyholders saw premium increase of $30.00.
The HIP monthly premium increased from $429.24 to
$459.24, which is an increase of 6.9 per cent, while
the monthly premium for FutureCare increased from
$500.14 to $530.14, an increase of 6 per cent. Prior to
the said increases, the plans had seen no increase to
monthly premiums since 2015, due primarily to Government’s financial support and transfers from the
MRF.
HID was very pleased to introduce a new prescription drug benefit, which cov ers 100 per cent of
costs up to $1,000 per policy year for HIP policy hold-ers, and an increase of $1,000 to the existing FutureCare prescription drug benefit raising it from
$2,000 to $3, 000 per policy year, which also covers
100 per cent of costs up to the said amount. Since the
inception of HIP’s prescription benefit four months
ago, 1,432 policyholders have benefitted with almost $350,000 paid in claims, while the increase in FutureCare’s prescription drug benefit has benefitted 1,108 people thus far and resulted in an additional
$385,000 in claim payments since November.
The Health Insurance Department is also
pleased to be administering the Maternity Benefit Pro-gramme, which was implemented last November. The
goal of the programme is in keeping with th e Government’s mandate of ensuring equity and access to essential care, in this case, maternity -related care. The
programme pays maternity -related claims for up to
100 pregnant women who qualify, based on their uninsured status.
Mr. Chairman, eligible pol icyholders continued
to benefit from the Personal Home Care (PHC) benefit during fiscal 2021/22. The Health Insurance Department continued to provide the Personal Home Care
(PHC) benefit to eligible policyholders, resulting in homecare gaps being filled for our seniors, as well as
providing a means of income for family members who
act as caregivers for their loved ones. At this present
time, approximately 305 policyholders consistently
use the Personal Home Care benefit, with HID receiving an average of sev en requests for the benefit on a
weekly basis. HID’s estimated expense in Personal Home Care claims over fiscal year 2021/22, is $7.2
million, an approximate increase of 2.1 per cent from
the previous 2020/21 year.
Proper assessments and education by our
Nurse Case Management Team have effectively
managed cost containment for the Personal Home
Care benefit, while COVID -19 and natural departure
from the programme have also played some role. As
families navigate a new normal with COVID -19, HID is
seeing a sm all increase in care claims, which accounts for the estimated increase previously noted.
As a result of the pandemic, HID continues to
administer their in -home assessments via telephone
and video. The average wait time for assessment is seven business day s and the nurse case management team can complete as many as eight to nine assessments per day. This includes reassessments, which are administered at the request of the family,
responsible party or healthcare provider, when clinically indicated, or on an annual basis to ensure appropriateness.
Mr. Chairman, HID remains committed to the
Enhanced Care Programme (ECP), for the treatment
of chronic non- communicable diseases for the underinsured and uninsured within our community. The
programme continues to pr ovide access to primary
care, which enables participants to receive treatment
that they may not have had access to otherwise. Currently the programme has 99 active participants. From
inception, the ECP has provided participants with access to their primary care provider and prescription
medications required to manage their chronic disease without the burden of a high co- pay. The programme’s
clinical measures demonstrate that for this cohort the
overall disease trend is moving in a positive direction.
Mr. C hairman, it is evident that the ECP continues to provide access to healthcare services for those most in need.
Mr. Chairman, the final review of the 31 March
2017 Draft Financial Statements has recently been
completed by the OAG. The department continues to
work through the remaining fiscal years.
Mr. Chairman, I will now summarise the operating results of the various funds under HID’s administration, followed by a discussion of the performance
indicators for the department over the period.

Operating Results

Hon. Kim N. Wilson: HIF (Health Insurance Fund)
Operating Results: The HIF includes two products and policyholder groups, those being HIP and FutureCare.
The Fund projects to have a total estimated headcount at the end of fiscal year 202 1/22 of 8,540 which
is a -1 per cent decrease compared to fiscal year
2020/21.
• Projected, gross policyholder HIF premiums
earned for fiscal year 2021/22 are $49.4 mil570 7 March 202 2 Official Hansard Report

Bermuda House of Assembly lion, an increase of $4.2 million or 9.3 per cent
from 2020/21.
• Claims incurred in 2020/21 equalled $33.4
million with 2021/22 claims estimated to be at
$37.7 million.
• HIF has allocated approximately $3.95 million
in administrative expenses in fiscal 2021/22.

FutureCare Operating Results
Hon. Kim N. Wilson: The projected headcount for
Futur eCare is approximately 4,781 persons at
31 March 2022, a decrease of four [persons] or
0.1 per cent compared to 31 March 2021.
• Projected FutureCare premiums earned for
fiscal 2021/22 are $29.4 million, an increase of $1.9 million, or 7 per cent from 2020/21.
• Claims incurred for 2021/22 are estimated to
total $31.1 million as compared with $26.4
million in 2020/21.

HIP Operating Results
Hon. Kim N. Wilson: The projected headcount for
HIP is approximately 3,759 persons at 31 March
2022, which represents a decrease of 70 persons or
2 per cent compared to 31 March 2021.
• Projected HIP premiums earned for fiscal
2021/22 are $20 million, which represents an
increase of $2.3 million, or 12.9 per cent from
2020/21.
• Claims incurred for 2021/22 are estimated to
total $6.6 million as compared with $7 million
in 2020/21.
• Administrative expenses of approximately
$1.98 million will be incurred by HIP for the
fiscal year 2021/22.

MRF Operating Results

Hon. Kim N. Wilson: The MRF premium for 2021/22
remained the same as 2 020/21 at $331.97 per person
per month for the months of April through October 2021.
Effective November 1, 2021, the MRF premium rate was changed to $376.97, an increase of $45.00, or 13.6 per cent. This increase from the
2020/21 premium of $331.97 resulted from a reallocation of premium in the remodelling of the Standard
Health Benefit payment structure primarily to support the modernisation of the BHB Standard Health Benefit
reimbursement as discussed previously.
The total projected premiums to be received
by the MRF for the year ended 31 March 2022 total
$192 million, representing an increase of 4.4 per cent
compared to fiscal 2020/21. Administrative expenses
of $288,000 have been allocated to the MRF for the
2021/22 fiscal period.
Subsidy Operating Results
Hon. Kim N. Wilson: The total forecasted claims paid
for hospitalisation under the Youth, Aged and Indigent Subsidy Programmes are $116.6 million for the year ended 31 March 2022. These claims, which are processed and adjudicated by the Healt h Insurance Department, are paid from the Consolidated Fund in the
hospital budget and represent an increase of [$]11.1
million when compared with fiscal year 2020/21.

Performance Measures (Qualitative
Service Performance)

Hon. Kim N. Wilson: Mr. Chairman, we will now consider the d epartment’s Qualitative Service Performance found on page B -171 of the Budget Book.
HID reviewed and revised its performance indicators, with a focus on the following objectives:
• improving HID stakeholder level of engage-ment 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, I would like to thank HID’s
business partners: Sutherland Healthc are Solutions,
Argus Insurance, LifeWorks, Global Medical Man-agement Inc, and ProServe, who continue to provide
support to the d epartment. I would also like to thank
the team at the Health Insurance Department, as well
as the Health Insurance Committee, for their hard
work, commitment and perseverance, during what has
been another challenging year for Bermuda.
Mr. Chairman, this brings me to the end of my
presentation on Head 91, Health Insurance.
Mr. Chairman, just before I close, there are
just two quick matters that I wanted to raise. One was
with respect to the question that was asked at the beginning of this debate, Schedule 1, found at page C -
18. The SART [Sexual Assault Response Team] programme, the sum is $9,450. In my brief I indicated
$10,000 and the Budget Book says $9,000. The exact
amount was in between, $9,450.

I see, $9, 450 on line item 7088 at
page C -18 of the Budget Book. Thank you, Minister,
for that correction.
Hon. Kim N. Wilson: Thank you.
And one more thing, again before I wrap up, is
an issue from last week as it relates to the question of guarantees, again in the Budget Book, the BHB increase of $500 million guarantee. Las t week a question was raised regarding the reported Bermuda Government Guarantee for the Bermuda Hospitals Board
in relation to last year’s Budget Statement report at
$276.8 million versus the current 2022/23 Budget Statement reported guarantee figure of $ 787.7 million,
essentially an estimate of $500 million difference, Mr.
Chairman.
Previously the Bermuda Government financial
statements for the Consolidated Fund reported the principal value of Bermuda Government guarantees;
however the Bermuda Hospitals Board guarantee
amount has more recently been adjusted on the financial statements to record the full obligation amount
of the guarantee. Therefore, the prior year’s Budget
Statement recorded the BHB guarantee with a princi-pal amount of $276.8 million. How ever, this year it has
been adjusted to be consistent with the Bermuda Government’s 2021 Consolidated Fund Financial Statement and it is recorded in the Budget Statement
at the full obligation amount of $787.7 [million].

And can you just assist us with what
number needs to change on that page?

Hon. Kim N. Wilson: No number needs to be
changed on that page. It is correct. I am just explaining the justification from the question that arose previously by members of the media i nsofar as [to why
there] was a difference [between the current and] the
previous Budget Book.