March 9, 2020

Good morning, Mr.
Speaker , just one sad note.
I want to give condolences to first of all the
people of Shelly Bay, Crawl Hill for the passing of Mr.
Kent Gibbons of Redkiln Road. Mr. Kent Gibbons was a proud cricketer, proud supporter of Bailey’s Bay and also thei r blue -and-blue team. And he was a techn ician at the telephone company, BTC, for almost 30
years, probably more. Most importantly, he was a Bermudian who passed away suddenly over this
weekend.
Thank you, Mr. Speaker.

Thank you.
Does any ot her Member [wish to contribute] ?
We recognise the Minister of Education. Minister, you have the floor.
3492 9 March 2020 Official Hansard Report

Bermuda House of Assembly Hon. Diallo V. S. Rabain: Mr. Speaker, I would like to
add my condolences to the family of Kent. I worked
with Kent on the Eastern Counties for several years,
and I knew his passion and his commitment to ensur-ing that this competition, which is only two years
younger than the Cup Match competition, remained
alive and well with its various traditions. He was very
forceful in our meetings. He made sure that Bailey’s
Bay was always represented very well, along with the
other teams, Tucker’s Bay Club ( otherwise known as
Cleveland ), St. David’s and Flatts Victoria. And his
input into that competition will be sadly missed, Mr. Speaker.

There is one Bill to be introduced this
morning in the name of the Minister of Finance. But
the Deputy Premier is going to do this for him?
Hon. Walter H. Roban: Yes, Mr. Speaker.

FIRST READING

PAYROLL TAX AMENDMENT ACT 2020

Hon. Walter H. Roban: On behalf of the Minister of
Finance, I am introducing the following Bill, which according to section 36(3) of the Bermuda Constitution,
requires the Governor’s recommendation, so that it may be placed on the Order Paper for the next day of
meeting: Payroll Tax Amendment Act 2020.

Members, and particularly for our li stening audience, we are here today again to resume
in Committee of Supply for further consideration of the
Estim ates of Revenue and Expenditure for the year
2020/21.
And as you know, once we get into C ommi ttee the House will be in committee in the hands of the
[Panel of Chairs] led by the Deputy Speaker. And this
morning the first Chair up will be the Honourable MP
Commissiong. We just need the Minister of Finance or Deputy Premier to move us into C ommittee and the
House will be in the hands of MP Commissiong afterwards.

Hon. Walter H. Roban: Good morning again, Mr.
Speaker, to you and the listening public.
On behalf of the Minister of Finance, I move
that the House do now resume in C ommittee.

The aforementioned Heads are now
to be debated.
I call on the Minister now to proceed. You
have the floor, Madam .

HEAD 21 —MINISTRY OF HEALTH
HEADQUARTERS
Hon. Kim N. Wilson: Mr. Chairman, t he Ministry of
Health is found on pages B-169 to B -198 of the Est imates of Revenue and Expenditure. Mr. 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
on pages B -170 to B -176 of the Budget Book.

Mandate or Mission

Hon. Kim N. Wilson: Mr. Chairman, t he mandate of
the Ministry Headquarters is To make Bermuda
healthy .

Expenditure Overview

Hon. Kim N. Wilson: Mr. Chairman, t he Headquarters allocation constitutes under 6 per cent of the
budget allocated for the Ministry as a whole. A total of
$12,505,000 has been allocated for this Head for
2020/21, which represents an increase of $856,000,
or 7 per cent , over the original budget of 2019/20. This
change is due to the increase in grants for the admi nistration of the care homes and funding to support the overseas care of an inmate currently receiving treatment at St . Andrews Healthcare Medium Secure Forensic Unit in the United Kingdom , as well as another
inmate who wil l require similar treatment beginning in
the 2020/21 fiscal year.

Manpower

Hon. Kim N. Wilson: Mr. Chairman, the change in
manpower for this H ead is detailed in page B -176 of
the Budget Book, decreasing the employee numbers for the Ministry Headquarters from 47 to 46 established posts due to the transfer of the Permanent Secretary position to the portfolio of the Cabinet Office.
However, I must interject here, Mr. Chairman, to say the Ministry has taken great strides to fill its vacant
positions, which at its highest point last fiscal year was
89 vacancies and is currently 65. However, 65 vacant
positions out of 398 established positions represents
17 per cent of the Ministry’s workforce, and therefore
the impact on our ability to deliver services and pr otect the public is still significantly hampered.
Mr. Chairman, I cannot mention the Ministry’s
vacant position challenges without giving some historical content. I remind us all that this situation was i nherited from the previous Government, whose hiring
freezes and early retirement incentives crippled many
parts of public health provision. But I commend the
Ministry staff and the other partnering government
departments that are contributing to the work towards
filling the positions to assist in fixing this legacy problem.
The decline in vacancies is evidence that
teams have been working diligently to remedy these
deficits and hire the nurses, social workers, dentists,
dental hygienists, paraprofessionals and so on who
are desperately needed to provide front -line services
for vulnerable and dependent persons in our comm unity (largely , seniors and persons with disabilities).
However , there is still a lot of work to be done to undo
the damage that the shortages have placed on the
existing staff , who have been dedicated but burdened
with covering the workloads of vacant positions over
the years.
Mr. Chairman, the Ministry Headquarters
takes its interest and investment in its staff very ser iously. Measures have been put in place to mitigate
the devastation the noble professionals of the Ministry
have experienced during the periods of significant
staff shortage. For instance, the Ministry continues on
its path for acquiring the Investors in People certific ation and is aiming to achieve this international accred itation by 2021.
I will now speak on each of the sections and
business units under this Head.

General Administration and Corporate Services

Hon. Kim N. Wilson: The business unit 2101, “General”, comprises a small team of 10 persons and a
budget largely dedicated to grants for the community.
In total , over $5.7 million of the unit’s total budget of
$8.6 million is for grants. The balance is $2.9 million ,
which supports the strategic and operational components of the Ministry through the Accounts S ection
and our corporate services policy directorate. Add itionally , the overseas treatment funding for the i nmates I mentioned previously is allocated in business
unit 2101, General.

3494 9 March 2020 Official Hansard Report

Bermuda House of Assembly Output Measures

Hon. Kim N. Wilson: Mr. Chairman, the public se rvice reform has al lowed us to step back and assess
the output measures and ask questions such as , How
can we measure our performance and ensure we pr ovide the information to all stakeholders in the most productive and informative manner? This and similar
questions resulted in a mass review and change of
our performance measures , which are listed on page
B-173.
The Ministry has revamped its p erformance
measures to give better value for all stakeholders and
to ensure a core principle, accountability, is met. Si gnificant highl ights of the Ministry’s outcomes are better
demonstrated in the Ministry of Health Roadmap
2019. The r oadmap is an annual corporate plan which
provides an overview of the entire Ministry and is a useful document for all stakeholders to get a quick
and eas y readable glimpse of the Ministry’s performance. The Roadmap 2020 is also in production ;
however , the Roadmap 2019 is on our website at
www.gov.bm
under Health Library .
Mr. Chairman, under section 31000, General
Administr ation, as you know , in 2019 the Ministry engaged in an extensive public consultation on our pr oposed Bermuda Health Plan. The Bermuda Health
Plan is the Government’s proposal to reform the way
health funds are organi sed so that everyone can have
access to affordable, decent health coverage , and
health spending can be contained. The reforms will expand the core package of benefits, protect patient
choice of health care provider and maintain quality of
care.
Over 54 consultation meetings took place with
more than 600 participants over the four months of
consultation. Extensive dialogue was held, and the
meetings and feedback are available on our website. We are currently collating the feedback and will be
able to report back and determine next steps.
While t he opposition to a single -payer system
levelled by the Patients First group is important and
significant, for me the most valuable thing to come
from this open dialogue is a shared commitment to achieve universal health coverage. Bermuda’s adoption of this World Health Organization goal is vital for
the country to achieve equitable health care access,
and I am delighted that Patients First supports this
endeavour.
Mr. Chairman, following the Fiscal Respons ibility Panel’s 2019 r eport, the Government remains
committed to establishing, over a three- to-five-year
period, a single payer for Bermuda’s core health i nsurance package. The Fiscal Responsibility Panel is
an independent body established under the OBA
Government which assesses Bermuda’s fiscal and
econom ic state annually. This year’s report said of the
Government’s health reforms: “The Panel applauds
the Government’s initiative to address a very compl i-cated but important fiscal issue. It recognises the challenging task ahead for the Government in seeking to
reform a well -established health care financing system
that has conditioned the behaviour of employers, cit izens and health care providers.
“The objectives being sought appear eminen tly sensible, and broadly in line with the health financing reforms of other industrial countries faced with the
challenges of an ageing population. In particular, it is
very difficult to see how meaningful cost containment
can be secured without the proposed shift to a ‘single -
payer ’ model, which can use its monopoly purchasing
power to drive down prices.” (And, Mr. Chairman, this
can be found at the Fiscal Responsibility Panel Report 2019, page 23.) Further, Mr. Chairman, the Gover nment is encouraged by the American College of Ph ysicians’ [ACP] recent statement supporting a single -
payer system as a means to achieve universal health
coverage.
Mr. Chairman, I am thoroughly encouraged by
the Fiscal Responsibility Panel’s endorsement of the course of our health reforms. This independent assessment validates the Government’s pos ition that a
single- payer model will serve Bermuda’s interests
best. Likewise, I fully support the recommendations of
the American College of Physicians, whose analysis
of a health system similar to Bermuda’s is completely applicable locally.
Bermuda’s current multi -payer system is a
hindrance to cost containment and universal health
coverage. The $723 million Bermuda spends annually
on health care can and must be spent better to ensure
more health care dollars are spent on health care r ather than administ rative duplication and inefficiency.
In addition to this work, Mr . Chairman, the
Ministry is updating its Bermuda Health Strategy
2014 –2019, which was published by the previous administration and expired recently. This document pr ovided the vision for hea lth in Bermuda and outlined
strategic reform priorities for Bermuda’s health sy stem. Included in the strategy were 14 goals grounded in the [three] core principles for the health sector:
quality, equity and sustainability.
We have engaged KPMG’s global he alth care
expertise to assist us in upgrading the Strategy for
2020 –2025 in order to create a unified vision for
health with wide stakeholder input and engagement.
And w e expect this work to be completed in the summer, and I look forward to bringing it to this Honour able House in due course.
Mr. Chairman, regarding business unit 31015,
Grants Administration, p age C -18 lists the Health Ministry’s grants to a number of agencies , providing essential front -line services to aid public health and s ocial assistan ce. These are as follows:
• $2,502,000 for the LCCA to cover overseas
medical care for uninsured and underinsured
persons;


Bermuda House of Assembly • $125,000 for the Bermuda Nursing Council to
support the regulation of nurses and mi dwives;
• $1 million for the Bermuda Health Council;
• $15,000 for Age Concern;
• $1.05 million with respect to the following rest
homes:
o $800,000 for Lorraine Rest Home;
o $250,000 for Matilda Smith Rest
Home;
o $600 ,000 for Summerhaven; and
o $300 ,000 for Packwood Rest Home.
Further, we will provide the following grants:
 $10,000 for SART, which is the Sexual A ssault Resource Team;
 $13,000 for Tomorrow’s Voices; and
 $100 ,000 for public health scholarships for our
students .
The Dr . Barbara Ball Public Health Scholarship is undoubtedly a commitment that the Ministry
endorses 100 per cent. We are currently accepting
applications for the 2020/21 academic year and anti cipate awarding $100 ,000 in scholarships for the year.
Eligible and deserving students in key public health areas will receive funding to support their educational
journey which will in turn contribute to Bermuda’s
health system workforce. The priority remains the areas in which we are aware of manpower deficits in
public health, namely , nursing, social work, environmental health and allied health professions.
The Ministry of Health has supported nearly
40 students in the areas of medicine, nursing, social
work, physiotherapy, pharmacy, counselling, dentistry
and occupational therapy since 2015 and looks to
continue this obviously worthy endeavour.

Plans for the Upcoming Year

Hon. Kim N. Wilson: Mr. Chairman, the Ministry of
Health has been preoccupied since mid- January by
the emergence of a respiratory disease caused by the
novel coronavirus that originated in the Hubei Pro vince in China. And as I speak here today, the Ministry
team is aggressively, progressively and very passionately preparing for the escalating health threat, the
COVID -19.
The Ministry knows that there is great concern
throughout the community. We understand th ese concerns and are taking t his very seriously. We will continue to share the information with the public as soon
as it is humanly possible. We are working closely with
our many international affiliates, other Ministries, departments, the hospitals, the community providers and
other agencies to expeditiously investigate and monitor the activities. Depending on the extent to which the
COVID -19 threat evolves, the Ministry may be engrossed in work completely dedicated to managing
the situation during fiscal year 2020/ 21. I will speak further on the COVID -19 in other sections and Heads
in this brief , Mr. Chairman.

Office of the Chief Medical Officer

Hon. Kim N. Wilson: This is found, Mr. Chairman, on
pages B -170 to B -174 of the Estimates of Revenue
and Expenditure. Mr. Chairman, busines s unit 2102
under Head 21 is the Office of the Chief Medical O fficer (CMO), found on page B -170 of the Budget
Book. Its total budget for fiscal year 2020/21 is
$1,073,000, and the funds contain two cost centres:
31030 Healthcare Registration and Regulation, and 31040 Epidemiology and Surveillance Unit. The office
consists of eight full -time equivalents , and a part-time
consultant pharmacy inspector providing service
equivalent to 0.25 full -time equivalents .
The remit , Mr. Chairman, of the Office of the
CMO consists of four primary duties: registration and
regulation of health care professionals , pharmaceut ical drug control , epidemiology and surveillance, and
statutory public health responsibilities. Over the past
six years, the Office of the CMO has undergone signi ficant reorgani sation to optimi se efficiency and assure
appropriate delegation of statutory duties. Changes in
the office’s remit are still underway.
In previous years, the o ffice registered all
health care professionals except nurses and ps ycholo gists, as well as registering health care facilities
such as pharmacies, clinical laboratories and diagnos-tic imaging facilities. During [2019] , the registration
and regulation of some health care professionals and
facilities began to be transferred to the Bermuda
Health Council. And t his transfer is in the early stages
and will continue throughout 2020.
Currently, the Office of the CMO handles the
registration of medical practitioners, allied health pr ofessionals and pharmacists. It provides the admini strative support for the statutory professional bodies of
these professions , and the CMO is the executive officer of the Bermuda Medical Council. The Office of
the CMO vets professional credentials and qualific ations, and receives complaints against medical pract itioners. Pharmacy registration is also the responsibi lity of the office.
The Office of the CMO’s pharmaceutical
drugs control responsibilities include monitoring the
importation of prescription drugs, including controlled
(or banned) drugs to ensure these items are safe and
are received by the appropriate health care busines ses and individuals. The office must ensure that Ber-muda stays within its assigned quotas of controlled
drugs, and reports controlled drug importation to the
International Narcotic s Control Board (INCB), which is
situated in Vienna, Austria. The INCB monitors compliance to the United Nations’ international drug con-trol conventions.
Health protection and community health assessment are two essential public health functions
3496 9 March 2020 Official Hansard Report

Bermuda House of Assembly carried out by the Office of the CMO’s Epidemiology
and Surveillance Unit (ESU). The ESU monitors the
occurrence of diseases on the Island, both infectious
diseases (communicable diseases) and select chronic
noncommunicable diseases, to help prevent and co ntrol the se diseases. The ESU receives reports from
health care providers and laboratories and invest igates unusual disease occurrences. Contact tracing and case management help to prevent or mitigate
outbreaks of disease.
Periodic community health surveys are als o
conducted to monitor and document the health of Bermuda’s population. The STEPS to a Well Bermuda
survey, currently underway, is an example. Data from
community health surveys provide population health information which is essential to setting health sys tem
priorities and for planning.
Additional functions of the Office of the CMO
are to facilitate designated legislated functions, advise
government departments on health matters and support the regulatory work of statutory boards and coun-cils. The office serves as Bermuda’s public health f ocal point for communications from regional and inter-national authorities such as the Caribbean Public
Health Agency (CARPHA), the Pan American Health
Organization [PAHO] and the World Health Organiz ation [WHO].
Critical collaborations with these partners assist Bermuda by training public health professionals,
supporting and implementing strategic plans and
providing technical assistance to manage public
health emergencies.
Mr. Chairman, of the Office of CMO’s total
budg et, $629,000 is allocated to health care registr ation and regulation. This year the section registered
over 914 health care professionals, and processed
192 requests for prescription and commercial drug
requests. The Registration Section continued to meet
its performance targets by publishing accurate health
care professional registers and supporting the professional statutory boards in their registration and complaints -handling responsibilities.
For fiscal year 2020/21, a total of $444,000 is
budgeted for the work of the Epidemiology and Surveillance Unit. In 2019, the ESU managed over 667
reports of communicable diseases, investigated 152 individual case reports of disease and addressed
eight major disease outbreaks. Capacity -building in
public health whi ch was supported by CARPHA in
2018 has assisted the staff of the ESU, as well as
staff in the Department of Health, in meeting the challenge of preventing and controlling emerging diseases such as the novel coronavirus, and in managing outbreaks of vaccine- preventable diseases such as pertussis or whopping cough. Through the work of the
Public Health Emergency Response Team (PHERT), the Office of the CMO coordinates and collaborates
with a broad range of health stakeholders to prevent
and mitigate public health threats. Mr. Chairman, the Office of the Chief Medical
Officer’s entire workforce is nearly fully dedicated to the planning and preparing for the COVID -19, which is
rapidly spreading across the globe. It is a highly infec-tious disease and a rapidly escalating threat. Ther efore, it is a threat to Bermuda now and in the foreseeable future. There have been no cases of COVID -19
identified in Bermuda; however, the reality is that the
spread of the virus continues on track to become a
pandemic in the coming weeks, if not days.
Although COVID -19 is not currently in Berm uda, it has been documented in over 109,000 people in over 100 countries, including in our region. As of t oday, the countries for which there is a travel advisory
and a public health follow -up in Bermuda include China, Iran, North Italy, Hong Kong, Japan, Macau, Ma-laysia, South Korea, Singapore, Taiwan, Thailand and Vietnam. The Epidemiology and Surveillance Unit is
actively monitoring the global situation as this is rapi dly changing daily.
The Epidemiology and Surveillance Unit
works closely with public health partners including the
Caribbean Public Health Agency, the Pan- American
Health Organization and Public Health England [PHE]
to prepare for and respond to the COVID -19. The Ep idemiology a nd Surveillance Unit also remains abreast
of updates from the World Health Organization and
acts upon the relevant recommendations.
Mr. Chairman, I will take this time to remind us
all that we are in the phase of preparedness for a p otential pandemic and we must focus on preparing for
this situation. The World Health Organization says we must prepare to detect cases, prepare to treat cases,
prepare to follow contacts and prepare to put in place
adequate containment measures to control the
spread.
Mr. Chai rman, if I could I would stand here
today and use the entire five hours allocated to this
Ministry and appeal to all how such an historic threat can only be manged by the highest level of collabor ation and solidarity of every single sector and person in
this community. This community has proven to be r esilient against catastrophic hurricanes when we band
together as one. So I also ask that we rise to the occasion for this unexpected and unusual threat to health like we have never done so before.
Mr. Chair man, the development of the 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 disease in three entities —Bermuda Hospitals Board, the Bermuda D iabetes Association and the private endocrinology
practice.
In 2020, Mr. Chairman, the register will expand its data collection to include offices of a select
group of general practitioners and laboratories. This is one of several multi -sectorial collaborations coord inated through the Office of the Chief Medical Officer


Bermuda House of Assembly to fulfil the mission of monitoring, protecting and pr omoting the health of Bermuda.
Mr. Chairman, this ends my presentation on
business unit 2102, O ffice of the Chief Medical O fficer.

Ageing and Disability Services

Hon. Kim N. Wilson: Turning now, Mr. Chairman, to
Ageing and Disability Services (which can be found at
pages B -170 to B -176 of the Budget Book), Mr.
Chairman, I will now present the budget for business
unit 2103, Ageing and Disability Services (ADS), which can be found listed as the National Office for
Seniors and the Physically Challenged, found on page B-170 of the Budget Book.
The Ageing and Disability Services’ mission is
to protect seniors and persons with disabilities from
abuse, neglect and exploitation through compliance,
programme delivery and stakeholder collaboration.
Mr. Chairman, Ageing and Disability Services, or ADS, has a 2020/21 budget of $2,879,000, which is a
small decr ease of $4,000 when compared to the
2019/20 approved budget of $2,883,000.
There are two programmes provided within
the budget, which are the Ageing and Disability Services, which can be located at cost centre 31135; and the K. Margaret Carter Centre, whi ch can be located
at cost centre 31160.
Mr. Chairman, the K. Margaret Carter Centre,
or KMCC, provides direct support for persons with
intellectual disabilities in the community through day
programme services. KMCC has a budget of $1,860,000, which funds 19 staff and delivers direct
client services to 50 service users participating in six
different programmes. KMCC has endeavoured to
improve its community partnerships over the past
year, and those partnerships include the following accomplishments:
Client s have been involved in a work -based
programme in one of the nursing homes where select
clients are in engaged in targeted duties to improve
specific skills. Clients are involved in in -house contract
work with the Keep Bermuda Beautiful programme.
The Eco- School Programme supported by
BUEI [Bermuda Underwater Exploration Institute] is being revitalised. Local businesses and schools have
provided community service hours to the facility
through their Corporate Give Back Days. And the
Bermuda Sailors Home and Jubilee Sailing Trust have
provided two KMCC clients and one staff member with
a bursary to travel on board their tall ship, Tenacious .
The Training and Employment Division at
KMCC continues to do well. At present, 56 per cent of
the vocational clients w ork in various businesses
across the Island and take part in the in- house co ntract work. KMCC is constantly exploring feasible and
meaningful work placement opportunities for its cl ients. Mr. Chairman, the Office of Ageing and Dis ability Services (ADS) fo cuses on public education and
awareness, accessibility, compliance and case man-agement.

Case Management

Hon. Kim N. Wilson: Mr. Chairman, Case Management represents the largest staffing component for the
office. As of January 2019, the case manager supervisor position and three case manager positions were filled. For the first time, ADS has a full complement of
staff to assist seniors and persons with disabilities, yet
the client -to-staff ratios remain oversubscribed, based
on case management best practic e standards, which
supports a caseload of 25 clients to 1 case manager.
At present, the team’s ratios are 35:1, which
are embedded with welfare cases. Due to the growing
needs of these vulnerable populations, the Ministry
has requested an operational and staffing review of
Ageing and Disability Services by Management Consulting Services [MCS] to determine an equitable way forward for ADS.
As part of government reform, Ageing and
Disability Services have revamped its performance measures to improve product ivity as well as monitor
important components of the office’s programmes, systems and processes , such as , the following stati stics:
• the case management team currently su pports 186 clients ( which represents an increase of 11 per cent , compared to 168 cl ients in 2019/20) ;
• 80 per cent of ADS ’s case management cl ients are 70 years and older ; and
• with an ageing population on the rise, the si gnificant demographic shift is anticipated to i ncrease ADS's service load by 17 per cent in
the next five years and almost double by
2031 .
In 2020, the office continues to work on sol utions to address primary challenges in the area of
public welfare support due to the increased needs of
seniors and persons with disabilities when there is an absence of next of kin or family su pport. These cases
are time intensive, and their complexities are further
compounded when funding resources are unavailable
or insufficient to meet their needs.
For example, a welfare case involving a senior with no family support yielded approximately 25
hours in case management support over a one- month
period. This included home visits, transporting the cl ient to and from doctors’ appointments and arranging a cognitive assessment test.

Compliance

Hon. Kim N. Wilson: Mr. Chairman, the Senior Abuse
Regis ter Act 2008 is designed to raise awareness of
3498 9 March 2020 Official Hansard Report

Bermuda House of Assembly senior abuse, protect seniors from abuse, provide for
the mandatory reporting and investigations of alleged
abuse and establish a register of persons who have
been convicted of abusing a senior.
In 2019, there were 52 reported and 41 investigated cases of alleged senior abuse, which include physical, psychological and sexual abuse; financial
exploitation; and neglect. The remaining 11 cases
were due to recidivism or required case management
support. Based on ADS’s Presenting Issues Report
for both case management and senior abuse cases,
40 per cent had a presenting issue of financial concern or financial abuse. To this end, ADS works very
closely with the Bermuda Police Service in an effort to
seek prosecution for alleged offenders. However, this
is often impeded when the victim is unwilling to press
charges against their own family members, or when
there is an absence of support to substantiate the
claim of abuse.
The Ministry is currently seeking structural
and/or legislative changes to improve the protection
and support for all adults in need of such. This can be
achieved by adopting an adult protection model in the
coming years to provide legislative support to vulnerable adults. Furthermore, Mr. Chairman, the Ministry
manages the Personal Home Care Provider Registry,
which entails a vetting process of providers who in turn support disabled and ageing persons to remain
living in their own homes. A webpage entitled Looking
for a Caregiver was introduced to the Helping Services webpage to make searching for, hiring and
managing a caregiver easier for families. Additionally,
caregivers can now complete the registration process online.
Currently, there are 485 active self -employed
home care [providers] and 15 home care agencies
registered. Staff continue to assist the public in connecting with home care resources to support living at
home when feasible. The Ministry is reviewing and
developing best practice guidelines for the home care
sector to improve public safety, quality of care, and
workforce training and education.

Education and Awareness
Hon. Kim N. Wilson: Mr. Chairman, education and
awareness is an essential component to ADS’s man-date, but it is also a part of other functions of the office. Key achieve ments and work completed over the
last year include the following: The ADS accessibility officer completed over 58 inspections for compliance,
but also for consultation and advice to promote ac-cessible design to the community. The Disability Adv isory Counc il and the ADS celebrated the UN Day for
Disabilities on the 3
rd of December. The Disability A dvisory Council selected Bermudians who have made a
difference in their own lives and that of others, despite
being exceptionally abled. At the event, the Disabil ity
Advisory Council launched A Guide to Benefits Avai l-able to Persons with Disabilities in Bermuda, which is a comprehensive list of benefit entitlements for per-sons with disabilities and how to apply or enquire
about them. The booklet was produced by DAC and
can be found on the government website, Mr. Chai rman, at www.gov.bm
. Ageing and Disability Services
offered information on its programmes and services to
stakeholder groups such as the Bermuda Police Service, Bermuda Bankers Association and the MidAtlantic Wellness Institute. And in September 2019, ADS stocked up with promotional supplies in prepar ation of a launch of various awareness events.
Mr. Chairman, this concludes my remarks on
Ageing and Disability Services.

Bermu da Health Council

Hon. Kim N. Wilson: Lastly for Head 21, Mr. Chai rman, I would like to highlight the work of the Bermuda Health Council, which is a quango under the Ministry.
They receive operational funding in part from a Mini stry grant and are positioned to advise and make recommendations on health system matters to the Mini stry. Mr. Chairman, the Bermuda Health Council regulates, coordinates and enhances the delivery of health
services. The grant for Bermuda Health Council can be found on page C -18, cost centre 6895 under Mini stry of Health.
In 2020/21, the Health Council’s grant will be
$1 million dollars, and this is a marginal increase in
their funding level year over year as they have been
newly transferred over a significant number of regul atory r esponsibilities for the registration of health pr ofessionals, coordination of statutory bodies, oversight
of care homes and licensing of health facilities, which were previously conducted through the Ministry. The
Health Council’s total revenue is supplemented by a
transfer from the Mutual Reinsurance Fund and l icens ing fees paid by health insurers, for a total budget
of $2.4 million for 2020/21.
Mr. Chairman, in 2019/20 the work of the
Health Council centred on four strategic areas: quality
and standards, regulation, and finance and economics, with oversight by audit and governance. Some of the year’s achievements were as follows:

Quality and Standards

Hon. Kim N. Wilson: The Health Council has developed and implemented a health facility assessment
process. They have begun with a pilot of this asses sment with five local health care businesses. The r eports which have been generated from this asses sment provide recommendations to each facility on
ways to improve in areas of safety, governance and quality. T his has been a collaborative effort between
providers and the council to ensure that the indicators that are used would lead to progress in enhancing the
care available for our patients.


Bermuda House of Assembly In line with its mandate to identify goals and
make recommendations about health services, and
ensuring services are provided to the highest stan dards, the Health Council conducted health technology
reviews during this fiscal year and has also [provided] three formal opinions to the Registrar of Companies
on system capacit y for incorporation of health bus inesses. These processes involve comprehensive r eviews of proposed health services to ensure that they would address the care needs of Bermuda’s residents
and [that they] would be provided at an appropriate standard.

Regul ation

Hon. Kim N. Wilson: Mr. Chairman, the Health
Council continued its goal of improving health data
validity by progressing an initiative to transition the
health system from using International Classification
of Disease version 9 (ICD -9) medical coding to the
more current version, ICD -10. ICD -10 more accurately
describes the reason someone presents to the health
system and the cause of the injury or the health issue.
ICD-10 also provides much better information to help
providers and other decision- make rs understand how
much time and resources are needed to treat a medi-cal condition.
To support providers, the Health Council pr ovided multiple training sessions to review both the benefits and the process of converting coding to ICD -
10. The work with provi ders on ICD -10 is also a pr ecursor to the planning that the Health Council is i nvolved in for creating a strategy for a national elec-tronic health records system.
As the primary regulator of the health system,
the council was given the responsibility of f acilitating
the administrative functions for respective professional bodies and licensing functions in respect of select
health facilities. The Health Council is in the process
of transitioning what was previously a paper -based
process into an electronic process for over 2,200 non -
physician health professionals [for whom] it now has the responsibility of providing regulatory oversight. In addition, the Health Council has begun the process of
working with the statutory bodies to update standards
of practice policies and to support the management of
professional complaints.
In an effort to increase access to necessary
and cost -effective care for all residents, the Health
Council reviewed applications from community facil ities to provide services under the regulated health insurance package, or the Standard Health Benefit. This extended access to services for chronic disease
prevention and management. In addition to reviewing
the Standard Health Benefit, the council implemented
a chronic disease innovation fund, which has to date approved funding for chronic kidney disease management, dementia management, cancer prevention strategy and a programme to use telemedicine to
support chronic disease care.
The Health Council looks to continue working
with the public t o identify areas of need, such as better access to chronic disease medication for those
most vulnerable.
Mr. Chairman, between April and December
of 2019, the Health Council investigated 360 incidents of employer health insurance policies reported as i nactive. This was an increase of 55 per cent from the
previous year. As a result of the investigations and follow -up with employers during each month, 199 pol icies were reactivated, which affected coverage for
1,351 employees. Even though this year has seen a n
increase in reported inactive policies, it is still below
the historic averages of noncompliance.
The Health Council continues to work with
employers and with government on identifying risks and trends in the ability of the market to comply with
its leg islative obligations.

Financing and Economics
Hon. Kim N. Wilson: The Health Council is in the
process of publishing the 2019 National Health A ccounts Report, which details total health system expenditure during fiscal year 2018 of $736 million, r eflectin g an increase of 1.9 per cent and a per capita
expenditure of $11,526. During this same period, we
saw spending on overseas care at $93 million, which
was slightly above our 10- year average.
The Council conducts the annual actuarial
review of the standard premium rate, and published
the 2019 Actuarial Report, inclusive of premium recommendations for the mutual reinsurance fund and
the Standard Health Benefit. The allocation in prem ium included a reduction in the forecast of hospital ex-penditure and improved management of dialysis funding.
Mr. Chairman, in 2019/20, the Health Council
finalised its recommendations for updates to the medical and dental charges after consultation with stak eholders. The medical and dental charges are the regulated chargeable am ounts for non- hospital physicians
and dentists who provide services in the hospital. The
changes will address long- standing concerns surrounding standardisation and reimbursement model,
based on the complexity of services provided by nonhospital staff wit hin our local hospital facility.
The Council is also in the process of submi tting its recommendations for a prescription medication formulary and supply -chain management to fulfil its
mandate to fairly regulate the prices at which medic ations are sold to customers.

Audits and Governance

Hon. Kim N. Wilson: Mr. Chairman, to continue its
track record of timely financial transparency, the
3500 9 March 2020 Official Hansard Report
B ermuda House of Assembly Health Council, in close collaboration with the Auditor
General, tabled its audited financial statements and
2018/19 Annual Report in the fall of 2019.
Information Dissemination
Hon. Kim N. Wilson: Mr. Chairman, to enhance public education and encourage public awareness and involvement, the Health Council released key pieces of information about the health system on a weekly basis. In addition, the council held community discus-sions at least two times a week between August and December to better understand the current needs of
various health disciplines. The Health Council conti nues to strive to improve system understanding and
collaboration through its commitment to transparency and evidence- based decision- making.
The Future
Hon. Kim N. Wilson: Mr. Chairman, looking forward
to 2020/21, the Health Council will continue its i nvolvement in regulation of health professionals, reg ulation of health businesses, management of innovative
health programmes, recommendations for legislative
change, development of key health system reports, contribution to short - and long -term health system
strategies, oversight of health system data and analy tics, review of the Standard Health Benefit, dissemina-tion of health- related population- based surveys, co ntinued stakeholder engagement, timely communic ations, and management of local- and international -
partner relationships. These key items are important as the Health Council looks to support the larger goal of achieving a more equitable and sustainable health system.
The Health Council will also specifically co ntinue its work on long- term care facility standards as
the demographic of the population is placing more and more pressure on this part of the system, and provide expert advisement on health financing and system
reforms as the current fragmentation within the sy stem is constraining the ability of the system to receive
maximum results. In 2020/21, the Health Council will seek to become a paperless office and streamline its regulatory and thought -leadership processes to b ecome more efficient and a more cost -effective r esource to both government and health system stak eholders alike.
Lastly, Mr. Chairman, I would like to
acknowledge the appointment of Dr. Ricky Brathwaite as its Chief Executive, and the 2019/20 Bermuda Health Council board members whose expertise will
contribute to its ongoing achievements: The Chairperson, Dr. Alicia Stovell -Washington, is a highly r espected physician providing leadership for the Health Council. Mr. Granville Russell is the Deputy Chairman, providing nursing expertise. Dr. Annabel Fountain, providing the physicians’ voice for the Bermuda Med i-cal Doctors’ Association. Mr. Sandro Fubler, repr esenting allied health professionals. Dr. Darrien Ray, providing mental health perspectives. Dr. Claudette Fleming, advocating on behalf of the seniors’ popul ation. Mrs. Michelle Jackson, representing health i nsurers’ experti se. Mrs. Laure Marshall, providing i nformatics expertise. Mr. Peter Parker, providing insight
on financing. Mrs. Venetta Symonds, representing the
hospitals. And Ms. Cynthia Thomas, who brings legal expertise to the table. Again, that was the 2019/20 board, Mr. Chairman. And in addition, I would also like to acknowledge the ex officio members of the Board of the Health Council, the Health Council CEO, the
Permanent Secretary for Health, the Chief Medical
Officer, as well as the Financial Secretary.
And this concludes my remarks, Mr. Chairman, for Head 21, Headquarters.
HEAD 22 —THE DEPARTMENT OF HEALTH
Hon. Kim N. Wilson: Mr. Chairman, Head 22, the
Department of Health, can be found on pages B -177
to B-188 of the Budget Book. Mr. Chairman, again it
gives me great pleasure to present the budget for
Head 22, which is the Department of Health. The total
current expenditure, Mr. Chairman, is estimated to be $28,817,000 for 2020/21.
Vision and Mission
Hon. Kim N. Wilson: The Health Department’s vision
is Healt hy People in Healt hy Communities . The department’s mission is to promote and protect optimum health and well -being in Bermuda.
Programme 285, Department of Health Offi cers, is found on page B- 180. [The officers] work in 26
programmes to assure the health and well- being of
the general population.
Mr. Chairman, the 2020/21 budget estimates
for Health Promotion and Healthy Schools are listed at cost centres 32240 and 32265 on page B -178, and
the combined budget estimate is $457,000.
Mr. Chairman, the Health Department’s overarching strategic theme is to halt the rise in obesity and diabetes . To this end, the Health Promotion Office
develops and implements policies, programmes and products that will promote health and wellness in the
community, in collaboration with public health par tners. The Department of Health has initiated a “ whole
of society” (quote/unquote) approach to halting the
rise of obesity and diabetes locally.
Commit to Change: The Small Changes, Big
Results initiative promotes small daily changes that
can add up to big results. The initiative promotes
changes in four areas that will have an impact on a person’s overall health: choose to drink eight 8- ounce
glasses of water daily, eat at least three servings of vegetables daily, exercise for at least 30 minutes daily and balance mental well- being by reducing stress.

B ermuda House of Assembly The obesity crisis in Bermuda is driven in part
by an obesogenic environment, where the healthy
choice is not the easy choice. The Health Promotion
Office will roll out a social marketing campaign to dramatically raise the level of public concern in Ber-muda about the extent to which modern life is making people ill, also to [instigate] a wide and diverse
movement for change through which citizens, communities, faith leaders, concerned professionals, charities, businesses and others can join with Government to create change. Together (quote), “ Let’s make some
noise, Bermuda! ”
Mr. Chairman, the Speech from the Throne
2017 stated (quote), “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 educ ation to support the journey to a healthier public ser-vice.”
The Department of Health collaborated, Mr.
Chairman, with the Department of Human Resources,
GEHI [Government Employee Health Insurance] and
the Department of Communications to form the Government of Bermuda Employee Wellness Committee
to develop the Government of Bermuda Employee
Wellness Programme, which is branded as #choosewellness. In 2019, the committee rolled out Virgin
Pulse’s Global Challenge. Over 600 Government staff
partic ipated in the challenge over a three- month per iod, and there were significant improvements in the
areas of physical activity, nutrition, sleep, stress and
psych ological well- being. In 2020, there are plans to
roll out Global Chal lenge 2020 and other incentives
and initi atives to en courage and support public ser vants to lead healthier lifestyles.
Mr . Chairman, the Healthy Schools pr ogramme promotes health in schools through comm unity health partners and Department of Health school -
based programmes such as Child and School Health,
Nutrition Services, Oral Health, Community Rehabilit ation Services and Environmental Health. Healthy
Schools has been adopted by 28 of 31 public and pr ivate schools since 2007. The main challenge which
Healthy Schools continues to experience is that there are low levels of compliance to the Healthy Schools nutrition policy from cafeteria vendors. Some school-children can still buy high -calorie, fried, sugary and
salty foods at school. We remain steadfast in our ef-forts to continue progress and halt these unhealthy practices. Furthermore, many schoolchildren are able to purchase unhealthy foods at neighbouring markets and gas stations.
During this school year, Healthy Schools and
Nutrition Services is working with both government and community -based entities to develop a school
garden programme with the primary purpose of deve loping sustainable thinking in our children and teens so
that they learn that gardening can be a source of healthy food, especially as they enter adulthood. Mr. Chairman, the 2020/21 budget estimate
for Nutrition Services is listed at cost centre 32110 on page B -177 of the Budget Book, and the budget est imate is $193,000. Nutrition Services has been wor king towards healthy eating practices within the Health Department’s Obesity and Diabetes Framework, which was developed with community -wide consult ation and engag ement.
Community Education programmes include
the “Grow. Eat. Save.” workshops facilitated in par tnership with Instructor Chaplain Kevin Santucci, the Department of Parks, the Department of Environment, the Bermuda Agricultural Group, the Devonshire Se venth- day Adventist Church, Animal and Garden, and
Brighton Nursery. Two workshops with 54 graduates have continued with five weeks of theory and expand-ed to three months practical experience.
Sustainable Nutrition supports accessibility,
availability and af fordability of healthy foods to all.
Community and school gardens are being reviewed per the Crop Strategy 2016–2019 in partnership with BUEI, Department of Parks and Public Works in con-sultation with the Planning Department to develop ini-tiatives and strategies going forward.
Mr. Chairman, the nutritionists facilitated three
Complete Health Improvement Programmes (CHIP) lifestyle intervention programme as a part of gover nment employee wellness. Thirty -three graduates of
this 12- week programme participated in educational
sessions and experienced lifestyle skills that can mi nimise the consequences of illness or disease.
Mr. Chairman, Nutrition Services inspected
the government and nongovernment institutional facil ities for compliance with dietary requirements for Med-ical Nutrition Therapy diets and preparation of healthy and nutritious meals. The Westgate prison kitchen
facility was inspected to establish compliance from a
previous kitchen inspection report in 2017. This a llowed for reassessment of equipment and ongoing
operational processes still requiring improvements. The summer and winter prison menus were updated
accordingly. Twenty -one nursing home and rest home
facilities were inspected for compliance of the dietary
code of practice for re- registration .
Mr. Chairman, the 2020/21 budget estimate
for Sexual and Reproductive Health is listed at cost centre 32040 on page B- 177 and is allocated
$917,000. The Sexual and Reproductive Health Ser-vices Programme consists of two sub- programmes —
the Communicable Disease Programme and the Ma-ternal Health and Family Planning Clinic Programme. Under these programmes, services are available for the prevention and control of the spread of communicable diseases; education and health promotion about
sexually transmitted infections, including HIV and ot her communicable infections; and the provision of health education to promote sexual health.
Collaborative services, for example, the Bermuda Assessment and Referral Centre (BARC), and
3502 9 March 2020 Official Hansard Report

Bermuda House of Assembly Turning Point are provided for persons w ith 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 underinsured and uninsured members of our community, immunisations for pregnant women, family planning, and both women’s and
men’s health screenings.
Mr. Chairman, the HIV programme has been
successful in encouraging medication compliance. A
testament to this success is that there are very few persons admitted into the hospital for HIV/AIDS care.
Another highlight is that on the 25
th of September
2019, Bermuda was approved for maintenance of
elimination of mother -to-child transmission [EMTCT] of
HIV and syphilis as a public health problem by the World Health Organization (WHO). And, Mr. Chai rman, this validation has been awarded in part due to
antenatal clients being offered the recommended HIV
and syphilis testing, ensuring any necessary treatment
guidelines are followed, and the great work from our many invaluable partners. Recommendations from the
validation committee include the introduction of an
electronic data system, which will be actioned so that
Bermuda can continue to be recognised for the stellar
work that we have done on our Island.
The Maternal Health and Fam ily Planning
Clinic has experienced lengthy challenges, with hu-man resources being lower than our usual par levels.
This has resulted in our having to scale back in the
number of clients seen. However, in spite of these
challenges we have provided all of t he usual services
to the public of Bermuda and we are anticipating full
staffing in the near future.
Mr. Chairman, we want the 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. Clients are encouraged to
seek our services to strategize safer sex practices,
which include family planning advice, abstinence and counsel ling, and to know the status of your partners.
Mr. Chairman, the 2020/21 budget estimate
for the Clinical Laboratory is listed at cost centre
32090 on page B -177, and the budget estimate is
$270,000. Mr. Chairman, the Clinical Laboratory is
situated at th e Hamilton Health Centre. Testing of cli nical specimens is performed for child health, school
health clinics, oral health, and the sexual and repr oductive health programmes. The Clinical Laboratory also serves as the Public Health Clinical Laboratory for B ermuda, and provides specimen- handling and
international transport services to the Caribbean Public Health Agency [CARPHA] Laboratory, which is in
Trinidad, for advanced testing for diseases of public
health significance. Island- wide influenza surveillance
has been pursued by the clinical laboratory to ensure
appropriate vaccination coverage. The laboratory con-tinues effective molecular testing, the most sensitive
and specific testing for gonorrhoea and chlamydia
screening.

Child Care Regulation Programme

Hon. Kim N. Wilson: Significant steps have been
taken to increase oversight and support quality child
care in our day -care settings, day -care centres and
home day -care providers. An audit of all child care
files was completed and a new programme launched,
the Child Care Regulation Programme. A jurisdictional
review identified the need for specialised oversight by
persons with an early childhood background. And the
programme has now moved under the oversight of the
Director of Health.
The team now consists of persons with early
childhood or social work background and has trans-formed the interaction with the day -care settings,
providing increased visits and responses to com-plaints by the public. The child regulation officers have
also prepared a new inspecti on tool, which will be
used for the first time in 2020. This tool, Mr. Chai rman, will provide an opportunity to look at not just
health and safety, but also curriculum and develo pment activities for the children. In 2021, the tool will be
used to provide s tar ratings for the child- care settings.

Child Health

Hon. Kim N. Wilson: Mr. Chairman, the 2020/21
budget estimate for Child Health is listed at cost centre 32030 on page B -177 and is $2,533,000. Mr.
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 cur ative health services for infants, children, adolescents,
adults, seniors and the traveling public. This is c onducted through the various clinics, schools and com-munity settings.
Services consist of health and developmental
assessments, screenings, referrals, treatment of m inor ailments, health education, health promotion, a nticipatory guidance, adult and senior s 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 Expanded Programme on I mmunisation procures most vaccines through the Pan American Health Organization’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 sector.

Critical Success Factors
Hon. Kim N. Wilson : Mr. Chairman, the launch of the
Vaccine Hesitancy Strategy 2018 –2021 to address


Bermuda House of Assembly concerns about the falling immunisation coverage was
achieved. The strategy was a collaborative effort between the Department of Health and the private sector, including comm unity stakeholders and an overseas partner, namely, the Children’s Hospital of Phil adelphia. In order to obtain feedback regarding the public’s perception of vaccines, drop boxes were pr esent at most health promotion events held in 2019. A
pilot survey in the public and private sector was done
to collect information about client experiences and vaccination. This information will help health profes-sionals understand the barriers to vaccination.
A communications tool was developed to assist health professionals in discussing vaccine hes itancy with clients or patients. Training for health pr ofessionals in the public, private and institutional settings, and [with] allied partners was conducted on the
topic.
The vaccine hesitancy strategy is realising
favourab le results. Preliminary data for immunisation
coverage for two- year-olds was 90 per cent in 2019.
This is a significant increase from 76 per cent in the
prior years and may be explained by vaccines given to older children whose parents had delayed vaccines ,
improved reporting of immunisation data and/or i ncreased responsiveness to the messages for vaccina-tion.
Low vaccination coverage increases the
community’s vulnerability to re- emerging vaccine -
preventable diseases such as measles, diphtheria and
whoopi ng cough. The outbreak of mumps in 2019
demonstrates this vulnerability. The global target is
95 per cent coverage, so more work is required to attain this goal. In an effort to reach our consumers, a
mobile app, HealthyPeopleBda, was developed and is
currently in the testing phase. This app will act as an
informational resource for immunisation and child
health. Messages for health alerts can be sent to the
public. The use of technology will provide the Depar tment of Health with analytics for further work on health topics and public interests. A formal launch is
planned for April 2020. The app will also have links to
a Department of Health immunisation webpage which is currently in development.
The vaccine information system for monitoring
individual and population health data in real time is inadequate and a major challenge. A representative
from the Pan American Health Organization travelled
to Bermuda in February of 2019 to assess the r equirements for a web- based electronic immunisation
registry to strengthen accurate, timely and efficient
reporting of vaccines from public and private health facilities. A plan for implementation was established
inclusive of a five- year backlog of data. However, pr ogress has been challenged by insufficient IT support
and delays with customisation.
Mr. Chairman, in 2019 the School Health Pr ogramme operated below its established full -time
equivalency manpower, particularly with medical offi c-ers. This is reflected in the 8 per cent coverage for
five-year-old health assessment s. However, efforts
toward tackling childhood obesity remain a priority.
Data from the screenings suggest that 18 per cent of
Primary 1 students are overweight or obese. This r esult represents a consistent decline from previous years consecutively. The com munity health nurses
have had varied success with the lunchbox checks for
10-year-olds, and the programme is currently reassessing its strategy.
Parent engagement, Mr. Chairman, remains
an area of concern as reported by front -line staff. Adolescent heal th was a focus with a situational analysis
conducted by the Pan American Health Organization’s consultant in October 2019. A major challenge with
this exercise was an insufficient centralised repository
of health information from which a comprehensive asse ssment could be done efficiently. However, one
of the recommendations proposes an increase in
health services specific for the adolescent population
to address preventive health.
The annual Flu Express was conducted, offering influenza vaccine to the comm unity at sites around
the Island. In addition, the “ Take the Lead” initiative
was expanded to include our leaders (some of those
persons sitting here, Mr. Chairman) and public offi cers, essential workers to be vaccinated against infl uenza.
The Travel Heal th services continue to be in
demand for the community, with 1,100 consultations
conducted in 2019. Consultations provide education
on water, food and vector -borne illness prevention to
reduce the risk of Bermuda residents returning with
infectious diseases.
Mr. Chairman, the 2020/21 budget estimate
for Physiotherapy and Occupational Therapy is listed
at cost centres 32080 and 32120 on page B -177, and
the budget estimates are, respectively, $1,067,000
and $1,023,000.
Mr. Chairman, Occupational Therapist a nd
Physiotherapist [OT/PT] services are provided to maximise the functional potential of individuals with delays
in normal motor development or with physical mov ement challenges. The OT/PT team comprises nine occupational therapists, eight physiotherapists , one
coordinator and one team secretary who is shared
with the SLP [Speech Language Pathology] Pr ogramme. We currently have a vacant post in physi otherapy, which is being partly covered by a temporary relief post. Approximately 85 per cent of referrals sent
to community rehab were assessed within 20 working
days from receipt of referral. Collectively, it was est imated that 85 per cent of clients demonstrated pr ogress towards set goals following the first review per iod.
The OT/PT Seniors Team aims to increase
awareness of health prevention for seniors and to support clients to remain as independent as possible
in their own homes. Therapy’s Seniors Team con3504 9 March 2020 Official Hansard Report

Bermuda House of Assembly ducts home safety and falls risk assessments for all
seniors who are referred, with the intention of mi nimising the risk of falls at home. Client and caregiver trai ning were provided to maximise function and promote ageing in place.
Mr. Chairman, the OT/PT Paediatric Team
aimed to increase early recognition of developmental delays and to provide a more equitable service for
children and young people with sensory motor delays
throughout the year and not just during school term
time. School -age children, Mr. Chairman, with additional learning needs due to complex health conditions
and/or sensory motor delays require regular monitoring and intervention to retain their functional ability
and to access education. Last year the paediatric team continued to partner with WindReach to provide
treatment intervention to school -age children with
complex needs and/or sensory motor delays. These services proved beneficial in reducing the risk of r egression of motor skills prior to the start of school.
Mr. Chairman, the school -based paediatric
team successfully conducted motor screens at C edarBridge Academy for all student s entering Primary 1
public schools. During the screening event, parents
had the opportunity to ask therapists about their
child’s motor skills and learn about activities to stay
physically active and further develop motor skills.
Within the OT/PT Paediat ric Team, dedicated
specialist OTs and PTs provide early intervention for babies and young children between the ages of zero
and four years old who are at risk of developmental
delays and/or disability. Assessment clinics take place
on a biweekly basis to quickly identify and provide intervention for children at high risk of delays and to
decrease waitlist for services. Parent/multidisciplinary
training sessions were delivered throughout the year
in collaboration with the Child and Development Pr ogramme and within the community. The Early Intervention [EI] Team received 85 referrals this year and
discharged 69 clients. Interventions reduced the number of referrals sent from the Early Intervention team
into the school health team.
Mr. Chairman, the 2020/21 budget estimate
for Speech and Language Services is listed at cost
centre 32100 on page B -177, and the budget estimate
is $1,607,000. The Health Department’s Speech and
Language Programme provides speech- language and
feeding/swallowing assessment and interv ention services across the Island. The programme consists of 14 speech- language pathologists [SLPs] and one pr ogram coordinator.
Of these, three speech- language pathologists
provide early intervention services in collaboration
with the Education Department’s Child Development
Programme for children aged from birth to four to five
years of age. Eight speech- language pathologists [or
SLPs] are school -based, providing services across all
levels of the Bermuda Government Schools (from ag-es 4 to 18 years old). One SLP provides services to students with special needs who attend Dame Marj orie Bean Hope Academy (between the ages of 4 and 18 years), and one SLP provides school -based services to students who attend Bermuda’s private schools and home schools. (Two pos ts have been
vacant and under recruitment during this period, while
one additional post has been under secondment.)
Mr. Chairman, speech- language pathologists
work closely with parents and caregivers in private homes, schools and clinic settings across the Island to
raise awareness of speech and language delays and disorders, as well as to promote functional communication skills, as well as to prevent life- threatening
complications which may occur during eating and
drinking. SLP therapy services include th e provision of
prevention and promotion information, screenings and assessments, as well as intervention. Objectives are measured in terms of the following:
• responsiveness —the provision of timely assessments;
• delivery —the provision of treatment for those
identified as needing intervention; and
• client improvement —the effectiveness of
treatment as measured by reduction in the severity of the communication or swallowing challenges .
This year 61 new referrals were received wit hin the Early Intervention Program me, adding to the
waitlist for an initial assessment, and a total of 48
young clients from this waitlist were seen for an initial
assessment. While current programme time guidelines aim to provide an initial assessment for young children within three months of initial referral, the average wait time for an assessment is now running between nine and twelve months.
Thirty -three students were referred to the
school -based programme for students attending Bermuda’s Government schools, while 16 new referrals were received for students attending Bermuda’s pr ivate schools, for a total of 49 new referrals for school -
aged children. All of these students received an initial
assessment within this programme’s time guidelines
of 35 working days.
Once identified as needing services, clients
are provided with therapy intervention. A combined
498 clients were followed for intervention by Speech
and Language Services this year. Caseloads can vary
between 30 and 60 clients depending on workload demands. Clients are re- assessed on a routine basis
to assess their status and to measure progress. Of 161 clients who were seen for re- assessment in the
spring of 2019, a total of 75 of them, or 47 per cent,
had made measurable improvements.
The 2020/21 budget estimate for Community
Health and Community Health Administration is listed
at cost centres 32060 and 32010 on page B -177, and
the combined budget estimate is $2,672,000. Mr.
Chairman, community health nurses are responsible
for ensuring that the adult population, from age 18


Bermuda House of Assembly until end of life, have access to health services. This
vision aims to reduce unnecessary hospital admi ssions and allows persons to stay at home and in their
communities.
Community health nurses manage complex
care in the homes while providing and supporting self -
care, independence, health prevention, community
engagement, and enabling people to manage their
own health and adopt healthier health practices
through education and support.
Community Health Nursing received a total of
604 referrals for nursing s ervice, completed 8,813
home visits and provided health services in their Adult
Preventive and Wellness Clinics for 638 persons. In
addition, community health nurses provided a total of 22 health promotion and screening activities in the
community. Taking It to the Streets health initiative
screened a total of 263 within a three- month time
frame. Of those persons, 232 have been identified as
having two or more health risk factors and required
follow -up services. Another 164 are at risk for hypertension, 185 are at risk for obesity and 99 of them are
at risk for diabetes. These statistics indicate one in every two persons had two or more risk factors.
Based on the aforementioned statistics, it is
imperative for community health nurses to continue expanding t heir role in the Adult Healthcare Preventive Clinics and Taking Nursing to the Streets [initi ative] in an aim to reduce non- communicable diseases
and maintain chronic disease conditions by identifying
persons at risk and developing care plans to address
health, mental health and social care needs in our
community.
Mr. Chairman, during Flu Express a total of
1,749 persons were immunised. During their Cardi opulmonary Resuscitation (CPR) classes, the team
taught a total of 80 persons who are from the private
sector. Hotels and schools are now able to assist the
public in saving someone’s life. Community health
nurses assisted in managing the CedarBridge Shelter
during two of the Island’s hurricanes of 2019, which
hosted a total of 95 persons. There were no health
outbreaks or evidence of violence during this time.
The Community Administration Health has
oversight for six major programmes including Com-munity Health Nursing, Child Health, Sexual and R eproductive Health, Adult/Occupational Health, Rehabilitative Services and Nutrition Services, Clinical Laboratory and the two long- term care facilities for seniors. The administrative programme provides a
framework through collaborative efforts of the pr ogrammes for health prevention and some curative
health services for the community. The programme
has responsibility for maintenance of facilities and
equipment, procurement of supplies and staff performance to ensure clinics and related services operate effectively, efficiently and safely.
Mr. Chairman, the 2020/21 budget estimate
for the Adult Health, Occupational Health and Wel l-ness Programme is listed at cost centre 32130 on
page B -177, and the budget estimate is $487,000. Mr.
Chairman, the Adult Health Programme consists of
three sub- programmes: Correctional Heal th for medical services to inmates in correctional institutions; O ccupational Health for medical assessment of recruits to the uniformed services, and occupational health
services to government employees in hazardous and
high-risk occupations; and Forensic Services to the
Bermuda Police Service and medical supervision of detainees in police custody.

During 2018, a full 110 clinical sessions servicing 1,020 inmate medical consultations were conducted at Westgate facility. Also 86 per cent, or 176
new inmat es received an initial medical examination
within 72 hours of intake. A total of 56 recruitment
medicals were completed for the uniformed services, which include Police, Fire and Corrections. During
calendar year 2018, there were 43 Bermuda Police
Service forensic call -outs during working hours and 96
after hours that occurred, totalling 139 persons who
were serviced.
In 2020/21, the budget estimate for Oral
Health is listed at cost centres 32150, 32155 and
32160 on page B -178, and the combined budget estimate is $1,510,000. The Oral Health Section conti nues to provide comprehensive dental services to Bermuda’s children up to the age of 18 years; seniors 65
years and over; and priority groups including prisoners, co -ed and other institutions. We are also st arting
to see more adults between the ages of 18 and 65
who currently do not have health insurance or are u nable to pay for private treatment. The service is of
high quality and includes dental examinations, consultations, preventative and dental hygiene a ppointments, as well as a range of restorative clinical treatments including extractions 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.
Mr. Chairman, the school -based programmes
are an essential part of the Oral Health Section’s ser-vices, and they include a successful screen and seal programme, where children’s teeth are sealed at
school to prevent tooth decay. This currently has a
participat ion rate of 75 [per cent] to 85 per cent and is
offered at no cost to the parents. Oral health educ ation is provided at schools, where we have a 98 per
cent participation rate (and this occurs in our primary schools) and a school -based fluoride supplementation
programme for children aged six months up to 11 years of age, with a 78 per cent participation rate.
Mr. Chairman, preventive services are also
provided at the community level, with various oral health fairs and presentations in which persons bene-fited from free oral health screenings and professional
advice. Oral Health Month was a success under the
theme of Love your Teeth, where several health pr omotion activities and presentations were held during
3506 9 March 2020 Official Hansard Report

Bermuda House of Assembly the month of February to engage and educate the
public about the importance of good oral health and
the essential role it plays in maintaining optimal overall health. Special target groups such as the prisons
are being serviced on a regular basis and a range of clinical and preventative programmes provide d.
Mr. Chairman, the 2020/21 budget estimates
for Central Laboratory are listed at cost centres 32200, 32210 and 32220 and are listed at page B -
178. And the combined budget estimate for those three cost centres is $1,231,000.
Mr. Chairman, the Central G overnment L aboratory [CGL] provides a wide range of analytical
services. The forensic programme performs seizeddrug and toxicology analyses. A significant number of submissions to the laboratory were of cannabis and
cannabis products. Since November 2019 every su spected cannabis submission will have a quantitation performed to distinguish hemp from cannabis with
more than 1 per cent tetrahydrocannabinol (THC).
THC- containing products are increasing in the
form of edibles. The edibles which have been submi tted to the laboratory for analysis include gummy candies, lollipops, chocolate and THC -containing ecigarettes [e- joints]. All include concentrated extracts
of THC. Toxicology analysis and the urine programme have seen an increase in the number of submiss ions
of samples which have been positive for cannabis in
children, the youngest being a one- year-old infant.
The Water and Food Programme performs
analysis of potable and non- potable water samples,
dairy products and food. It is primarily a laboratory
support service to various government agencies such as Environmental Health, Public Works Department,
and the Bermuda Aquarium and Zoo. These analyses
assess the microbiological and chemical risks to human and animal health in environmental samples so
as to prevent transmission of food and waterborne
diseases.
Dairy products are tested monthly to determine if they meet legislated standards. In 2020/21, we
plan to increase routine food testing in collaboration
with Environmental Health so as to maintain our lo w
incidence of foodborne diseases. This programme
continues to meet all turnaround times for disseminating water, dairy and food testing results as set out in our performance measures. This programme also participates in international proficiency testing s tudies.
Our participation in these studies serves a dual purpose. Firstly, it allows us to ascertain how our analysts
perform with respect to international standards.
It should be noted that currently, the analysts
attain test scores that meet international standards,
and therefore the publication of these achievements
will be an added performance measure for budget
year 2020/21. Finally, our participation fulfils a prereq-uisite for acquiring accreditation status.
Mr. Chairman, the 2020/21 budget estimate
for Vector Control is listed at cost centre 32190 and is listed on page B -178 of the Budget Book with an est imate of $1,553,000. Vector Control is a hard- working
team, Mr. Chairman, which gets results and ensures
that threats of rodent -borne and mosquito- borne di seases do not manifest themselves in Bermuda. A lways trying to improve its services, Vector Control has piloted the use of novel rodenticide baits that include
rat birth control.
In response to a perceived increase in rodent
activity during 2020/21 the unit increased baiting acti vity within parks, public docks and hot spots; these are
now serviced on a weekly basis. Residents are r eminded that the best way to limit rodent numbers is to
deny rodent access to food sources such as garbage,
by using li dded- 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. A training workshop is also planned for A pril
2020. This will help to improve the training of staff. It will also be available to private contractors on Island
and should therefore improve vector control overall Island- wide.
Mr. Chairman, the 2020/21 budget estimates
for Environmental Health are listed at cost centres
32170, 32270, 32171, 32172, 32173, 32175, 32180
and 32285, all of which can be located on page B -
178. And the combined budget estimates for these
cost centres, Mr. Chairman, excluding Vector Control,
are $2,248,000. Mr. Chairman, the Environmental
Health Section continues to provide a monitoring, i nvestigative and regulatory function in such diverse
areas as food safety, occupational safety, nuisance
control, water quality and tobacco control.
In order to enhance the capacity of staff in
these areas, a very successful training course was
held in November 2019. A Tobacco Control meeting was held on Island in July 2019. This was attended by
representatives from Public Health England, other UK Overseas Territories, local businesses and charities.
Staff also participated in the organisation of training
courses on water quality in conjunction with the Bermuda College and related government agencies.
The Food Establishment grading system continues to increase awareness by the public of hyg iene
standards within food businesses. We encourage the
public, when deciding to dine out, to look at the grade
displayed on the establishment’s licence and on the
government website at
https://www.gov.bm/grades -
food- establishment -licences .
Mr. Chairman, the Port Health Section of E nvironmental Health carries out inspections of cruise
ships and other vessels visiting the Island. The unit
also monitors food products arriving on Island to e nsure they are safe for human consumption. This port
health function is central to Bermuda’s complying with
international health regulations. In July 2020 the new L. F. Wade International Airport will become oper ational, and a quarantine and isolation room is included


Bermuda House of Assembly in the new facility. This will further enhance Bermuda’s
compliance with international health requirements.
The office and function is being staffed with a manager with a dedicated small team to give the oversight
needed at all times, and cer tainly during crises such
as novel coronavirus.
The department will also work with Skyport
and other government stakeholders to ensure that the cargo shed is brought up to international standards for
processing and, where necessary, inspecting shi pments of food, medicines and human remains.
Mr. Chairman, the Department of Health operates two exemplary long -term care facilities, nam ely, the Sylvia Richardson Care Facility (SRCF) in St.
George’s and the Lefroy House Care Community (LHCC) in Sandy’s. Mr. Chairman, the 2020/21 budget
estimate for Sylvia Richardson Care Facility is listed at
cost centre 32015 at page B -177, and the budget estimate is $5,630,000. The 2020/21 budget estimate for
Lefroy Care Community is listed at cost centre 32000,
also found on page B -177, and the budget estimate is
$4,875,000.
Mr. Chairman, they provide care and promote
independence and optimal health to persons aged 65
years and over, who have significant nursing and care
needs requiring 24- hour facility -based care. The
LHCC i s a multi -level elder residential care community, which provides comprehensive medical nursing, environmental and recreational services to the res ident, respite care and day -care for elders in our community.
Our aim is to maintain and improve quality of
life for elders and their loved ones. Internal projects
are underway to provide and to improve the staff room, the recreational area for elders and storage areas to optimise the current space. Equipment upgrades are currently needed and underway for m echani cal lifts and laundry equipment so that elders can
be safely mobilised or transferred during activities of
daily living. Additional funding, Mr. Chairman, was
approved last —

Hon. Patricia J. Gordon -Pamplin: Excuse me, Mr.
Chairman, just a point of clarity .

The Chair recognises the Shadow
Minister.
Yes, Shadow Minister.

POINT OF CLARIFICATION
Hon. Patricia J. Gordon -Pamplin: Thank you.
The Minister is just indicating, I think she said
LHCC. I am just wondering which head. I know she
said Lefroy Care and Sylvia Richardson. I am just not
sure.
I just want to make sure that I am following
what she is bringing out.

Thank you for the clarification.

Hon. Kim N. Wilson: The LHCC is a multi -level elder
residential care community, which provides compr ehensive medical nursing, environmental and recreation services to the reside nt, respite care, as well as
day care, for elders in the care community. Our aim is
to maintain and improve quality of life for elders and
their loved ones.
Internal projects are underway to provide and
to improve the staff room, the recreational area for
elders, and storage areas to optimise the current
space. Equipment upgrades are currently needed and
underway for mechanical lifts and laundry equipment
so that elders can be safely mobilised or transferred
during activities of daily living.
Additional f unding was approved last year, Mr.
Chairman, for the re- opening of 10 nursing beds at the
Sylvia Richardson Care Facility. There are some r ecruitment challenges and staff attrition, but staffing
complements have been restored and again new res idents have begun to be admitted. Total bed capacity is 42. Currently, 35 long- term beds are occupied, and
two beds are used for short -term respite care to assist
families and persons living in the community. Demand very much exceeds capacity, and it is anticipated that the remaining five vacant long- term care beds will be
filled very soon.
In addition to full -time residential care and
short -term respite care, day -care services are also
offered from Monday to Friday. On average, seven
seniors living in the community at tend each day. Last
year, there were significant challenges with the air -
conditioning system, but these issues have now been resolved, and some upgrades were made to flooring
and furnishing.

Revenues
Hon. Kim N. Wilson: Mr. Chairman, revenues for the
Department of Health are projected to reach $3,688,000 for 2020/21.
These estimates can be found at page B -179
of the Budget Book. These rev enues come from the
sale of medications, vaccines and biologicals; fees for
clinical services; patient fees from the t wo long- term
care f acilities that I just spoke about; as well as fees
for licences and permits issued by the Environmental
Health Section of the depar tment.
This concludes Head 22, Mr. Chairman.

3508 9 March 2020 Official Hansard Report

Bermuda House of Assembly HEAD 24 —HOSPITALS

Hon. Kim N. Wilson: Mr. Chairman, Head 24, Hospitals, can be found in the Budget Book at pages B -189
to B-190. Mr. Chairman, the Bermuda Hospitals Board
delivers the only round- the-clock acute medical, ps ychiatric, palliative care, alongside diagnostic, surgical and outpatient services and resi dential long- term care
for seniors, amongst other services. These services
are provided from King Edward VII Memorial Hospital,
the Mid- Atlantic Wellness Institute [MWI] and the
Lamb Foggo Urgent Care Centre, with certain admi nistrative functions such as t he medical concierge, HR,
finance and IT in the Craig Appin Building in Hamilton.
Mr. Chairman, while attention is paid to BHB
consuming 45 per cent of the costs of Bermuda’s
health care budget, this is due to the number of critical services it provides. With over 350 inpatient beds,
based on 2018/19 statistics, BHB cares for approx imately 6,000 medical and surgical inpatients, 97 long -
term care residents and 102 hospice patients.
At MWI there were 231 mental health adult
inpatient stays. There were 33 ch ild and adolescent
inpatient admissions, which is nearly double the number of 18 in the previous year. And the number of patient days rose six -fold, Mr. Chairman, from 144 days
to 621 days. This is reflected in the longer length of
stay, which rose from 8 days to 19. There were 83 for
substance abuse patients who were admitted to the detox unit, which represents an increase of 77 from
the year before. Outside of the MWI campus there are
currently 66 intellectual disability and 29 mental health
service users in 27 BHB community group homes.
Mr. Chairman, MWI remains busy. In mental
health outpatient numbers, MWI staff saw over 1,700
individual visits, compared to 1,150 visits the previous
year. Follow -up appointments rose from 6,291 to
7,199; day patient vis its rose from 12,590 to 17,317;
and walk -in appointments rose from 12,388 to 14,937.
Home visits also rose, Mr. Chairman, to 8,010, up
from 7,437.
These numbers are astonishing, and we must
address them now. And BHB is the willing partner in
seeking solut ions to address them. Our hospitals are
susceptible to the same pressures as the Gover nment, businesses and individuals in Bermuda and cannot afford the spiralling health care costs. The i ncreasing demand mainly due to our ageing population,
chronic non- communicable diseases, comorbidity and
increases in mental health challenges limits the ability by both King Edward and the Mid- Atlantic Wellness
Institute to reduce the influx of people in need coming
through their doors.

BHB Financial Position

Hon. Kim N . Wilson: Mr. Chairman, the Bermuda
Hospitals Board is not on its own in the fight to reduce
the staggering numbers of service users and the hos-pitals’ cost, as it is a Bermuda problem and we all
must contribute to solving it. This includes the deve lopment of solutions outside of the hospitals such as
the avoidance of admissions and to care for post -
acute patients when they are discharged.
BHB is playing a significant role in this regard
in cost reduction to the health care system by manag-ing expenses whil st operating a global budget. Effective the 1
st of June 2019, the portion of funding prev iously paid by insurers for BHB claims that came under
the standard health benefit was replaced with a fixed payment from Bermuda’s mutual reinsurance fund.
The total funding from Government was capped at
$322 million. Mr. Chairman, this amount was lower
than BHB’s expenses in fiscal year 2018/19, so sa vings of $14.1 million, or 4 per cent, were required for
BHB to break even in 2019/20, which is required by the BHB’s l egislation.
International evidence suggests the maximum
level of ongoing savings possible by a health care or-ganisation without impacting clinical services is around 2.0 [per cent] to 2.5 per cent. However,
through much hard work and a number of improv ement projects, BHB had made $13.1 million of these
savings by January 2020 and expects to achieve a
break -even position at the end of this fiscal year. After
the third quarter this year, BHB had a loss of $0.2 mi llion, based on current revenue for the year of $256.2
million and total expenses of $256.4 million. This illustrates that BHB is successfully controlling expenditure
and increases in revenues to counteract the impact of
the restricted revenue.
Mr. Chairman, a slight overrun in salaries and
budgets for the quarter of 0.3 per cent is being r eviewed by BHB. The main causes are use of casual
workers and overtime, which are required to manage
surges in activity. BHB is monitoring the use of cas uals and overtime, especially through the busy winter
months. Operating expenses were also above budget.
This has been caused by increases in the costs of
medical supplies (5.6 per cent over budget), office and
consulting increases (17.3 per cent over budget) rela ting to strategic projects and clinical improvements;
utilities were 6.3 per cent over budget; and food was
8.7 per cent over budget.
Mr. Chairman, despite this, BHB is performing
better than its budgeted estimate of a net loss from
operations of $5 million at this point in the fiscal year.
This is due to t he hard work by staff and managers,
who have taken responsibility for their budgets and
improvements within their departments, resulting in
greater operational efficiencies.
Bermuda, Mr. Chairman, like many countries,
is attempting to deliver high- quality health outcomes
against a backdrop of rising utilisation and year -onyear increases in per capita costs. While the financials
are a concern to us all as we work to make health
care affordable, within the health care context an eff icient service by necessi ty has to be a high- quality


Bermuda House of Assembly one. When delays and errors are minimised and care
is consistent, people are seen quickly, diagnosed and
treated; outcomes are optimised; and they are able to
return home with quality of life. Quality improvements
are therefore not just measurements for clinicians, but essential for cost containment and improved care.

Accreditation

Hon. Kim N. Wilson: With respect to accreditation,
Mr. Chairman, BHB achieved a decision of Accredited
with Exemplary Standing, Accreditation Canada’s
highest level of accreditation in 2019. The decision follows four years of quality and safety improvements,
culminating in a week -long onsite visit by independent
surveyors in May of 2019. They measured BHB
against 3,837 standards and required organisat ional
practices and visits to King Edward VII Memorial Hos-pital, Mid -Atlantic Wellness Institute, Lamb Foggo U rgent Care Centre and three of BHB’s group homes,
observing staff, reviewing documentation and policies, and interviewing staff, patients, volunte ers and community partners.
More than 1,000 health and social service
organisations and 7,000 sites around the world have
been accredited by Accreditation Canada, with a goal
of safer high- quality health care. The standards BHB
is measured against are the same as those used to
accredit Canadian hospitals.
Accreditation Canada noted the following as
positives: how BHB has developed and used its
2016 –2021 Strategic Plan and how the extensive Cli nical Services Plan serves as the anchor for BHB’s
strategic goals. They cited BHB’s dedication to quality
and safety improvement and training at all levels. Also
noted was BHB’s increasing engagement of patients
and families in policy and process development. And
a key achievement was the establishment of a Patient
and Family Advisory Council, comprising community
members who provide advice on how we can impl ement or change processes to improve the patient experience.
Mr. Chairman, Bermuda hospitals are r equired by law to be accredited by an approved accrediting body , and we should recognise that BHB has
surpassed requirements with the exemplary level r esults. BHB has been accredited since the 1970s. This
year marks the 13
th onsite survey by Accreditation
Canada. And, Mr. Chairman, the next survey will be
held in May 2023. The full accreditation report, dec ision letter and survey comparison table are available on the BHB website.

BHB COMMUNITY ACTIVITY

Community Education and Testing

Hon. Kim N. Wilson: Mr. Chairman, this year BHB
offered free screening for chronic illnesses in Novem-ber, and offered stroke awareness training and free screening for stroke risks at health fairs and on the
streets of Hamilton. BHB is also spearheading a stroke awareness campaign in the community to help
identify stroke symptoms early.

Hands -on CPR Training

Hon. Kim N. Wilson: Mr. Chairman, BHB’s Nursing
Staff Development Department offered hands -on CPR
training again this year to the community. A total of
146 people attended the training, which educates people on how to deal with someone who goes into
cardiac arrest, using just the hand pumping rather
than hands and mouth. The goal is to increase the
number of people who can help someone in the event
of a cardiac emergency in the community.

Mental Health Awareness

Hon. Kim N. Wilson: Mr. Chairman, MWI took a
community -partnership approach to this year’s Mental
Health Awareness Week, working with the Alpha Nu
Omega, the Bermuda Football Association and Mental
Health Foundation around the theme of suicide pr evention. Previously, activiti es have focused on an
awareness week, but this fiscal year a Mental Health
Awareness Committee met to broaden activities and
the time frame. The annual MindFrame PhotoVoice
Exhibition at the Bermuda Society of Arts kicked off
events. Numerous interviews were held through Oct ober and November, along with a scavenger hunt,
church service, education opportunities, and in D ecember a movie night at the Bermuda Underwater
Exploration Institute. Activities are being planned
quarterly going forward, so look out for more opport unities to learn more about mental health.

Teen Life Skills Programme

Hon. Kim N. Wilson: Mr. Chairman, once again MWI
offered its teen life skills training programme for six
teens. Supported by many local organisations who
provide work exper ience placements, and with financial support from the Bermuda Hospitals Charitable
Trust, the Teen Life Skills Programme ran for four
weeks over the summer, Mondays to Thursdays, with
workshops in the morning aimed at helping teens cu ltivate and hone their social and life skills, and work
placements where they can gain experience and put
into practice what they learn.

Corporate Blood Drive Competition

Hon. Kim N. Wilson: Mr. Chairman, BHB, in partnership with the Ministry of Health, runs an annual corporate blood donor drive competition in order to increase
the numbers of people donating blood in Bermuda. This competition generated nearly 30 per cent, one3510 9 March 2020 Official Hansard Report

Bermuda House of Assembly third, 30.6 per cent, of all blood donations in 2018/19.
The competition had the highest number of com petitors thus far. Ending in June on World Blood Donor
Day, Bacardi was the winner. And this is their third
successive win in this competition.

BHB STRATEGIC ACTIVITIES

Hon. Kim N. Wilson: Mr. Chairman, following the establishment of a five- year strategi c plan in 2016, there
have been annually agreed projects and initiatives,
and BHB worked with over 450 stakeholders within
and outside the hospitals to create a clinical services
plan outlining a pathway for developing and evolving
services, which was publ ished in 2018. All of these
documents are available on the BHB website. A fina ncial recovery plan was also established to stabilise BHB’s finances and meet the fiscal responsibility r equirements of the BHB Act.
The strategic process (and supporting doc uments) has guided successful BHB projects this year.
A key focus for the last two years has been on ensuring that BHB runs as efficiently as possible, to deliver
timely and effective care to patients and to optimise
outcomes at the lowest cost possible. BHB appointed
KPMG at the end of September 2018 to work with
frontline BHB staff, providing people with specialist skills and training which the hospital does not have in
house in order to assist in a number of projects that
improve care at a lower cost. In August 2019, a 10month review on progress and achievements found
that every dollar spent with KPMG had a net return of
$3.2. Here is an overview of some of the key projects, Mr. Chairman:

Improvements in the Operating Room [OR]

Hon. Kim N. Wilson: Mr. Chairman, new standar dised processes and booking policies with daily, weekly
and monthly meetings have helped streamline eff iciency. Cost savings of $790,000 have been delivered
in the current fiscal year, primarily through more eff icient use of staff to matc h a new OR schedule.

Improvements in Outpatient Services and
Diagnostic Imaging

Hon. Kim N. Wilson: Mr. Chairman, BHB's Clinical
Services Plan noted that in 2016/17 a full 36 per cent
of all Bermuda residents visited BHB for an outpatient
service. That r epresents over 20,000 people. Internal
process and communication improvements were
made to this busy service, along with finding ways to
reduce the number of people who do not turn up for
their appointments. Such patients cause delays for
other patients who could have had that slot and also increase costs of providing the service. A new patient
standby booking criteria was trialled, and a new p atient reminder process to avoid cancellations and gain early enough warning for other patients to be r escheduled.
The result, Mr. Chairman, without any add itional hours being added, was 5,300 more patient
scans across X -ray, ultrasound, mammography, CT,
MRI, cardiac diagnostics, as well as bone densitom etry comparing 2019 to 2018. In outpatient clinic areas,
a 21 per cent productivity improvement was achieved
between October 2018 and March 2019, Mr. Chai rman.

Improvements to Patient Flow

Hon. Kim N. Wilson: Work was undertaken to consider quality improvement initiatives which would help
patients move through their j ourney at BHB in the
most timely and efficient way possible, to reduce
length of stay and improve discharge planning. A daily
multi- disciplinary bullet round process now takes
place on each of the acute care wards which involves the whole health care team to review the patients'
care plans and how they are each progressing along that plan.
The goal is to identify bottlenecks and delays
more rapidly and plan discharges safely as soon as the patient is medically ready. This patient -centric
work style also hi ghlights system issues, where delays
are common, so that they can be addressed. Between May and January of the fiscal year, 5 per cent more
patients received inpatient care compared with the
same period in 2018/19, and there was an 8 per cent
reduction in Emergency Department boarding over the
same time period. The Emergency Department also
worked on process improvements, whilst hospitalists
on the wards focused on discharging patients safely in
the morning, helping to open up bed space for emergency patients. A total of 23 per cent of patients were
discharged before midday in this fiscal year versus
15 per cent in the year 2018/19.
Mr. Chairman, the successful projects that I
just mentioned have enabled BHB to care for more
patients at a lower cost and hav e been instrumental in
helping BHB navigate the financial constraints in the
2019/20 fiscal year.

Estates Management and Facilities

Hon. Kim N. Wilson: Mr. Chairman, the acute care
wing provided a multi -purpose- built solution for acute
medical services, but outpatient and long- term care
services at KEMH, as well as all mental health, substance abuse and intellectual disability services at
MWI are being delivered from increasingly old and
expensive- to-maintain facilities. BHB’s board has approved the devel opment of an outline business case
in the upcoming fiscal year to identify how the rest of
the BHB campuses should be developed in order to meet Bermuda’s health care needs. The outline bus iness case will require consultant technical support


Bermuda House of Assembly and staff input to consider BHB’s service needs and
how BHB campuses can best be redeveloped to meet
them.

BHB PEOPLE

Hon. Kim N. Wilson: Mr. Chairman, BHB has worked
with BPSU and BIU partners in this fiscal year to
make a stand against harassment, bullying and inciv ility [HBI]. BHB mandated that all 1,800 staff members be trained in how to deal with HBI in the workplace. So all 1,800 staff members, Mr. Chairman, were
trained in how to deal with harassment, bullying and
incivility in the workplace. And they had the option of
in-person training or a recorded video. The HBI pr ogramme offers a confidential BHB helpline to flag i ssues. And alongside employee relations staff, there are 16 BHB staff members who have been trained as
volunteer HBI advisors to provide informal support,
coaching and referrals to other resources as needed.

Intellectual Disability
Hon. Kim N. Wilson: Mr. Chairman, a $1.2 million
additional grant to [BHB] will pay for the development
of a BHB community intellectual disability team to
support indiv iduals who live in the community but are
not resident in BHB’s group homes. The demand, Mr.
Chairman, for expert assessment and support from
people who live in the community is growing. Because
there has been insufficient community support to meet
the people’s needs, currently their only option is admission to a group home or long- term unit. Improved
community support will help people to stay in their
homes with their families.
This gap was recognised in BHB’s 2018 Clinical Services Plan, which recommended that BHB’s
multi- disciplinary team’s role should be expanded b eyond the group homes to support more people within
the community. The funds will pay for additional r esources, including clinical psychology, social work,
occupational therapy, physiotherapy, speech and language therapy, nursing, dietitians, and behaviour and
activities assistants.

Supporting the New Mental Health Act

Hon. Kim N. Wilson: Mr. Chairman, an additional
$350,000 for MWI will support an anticipated rise in
the number of community t reatment orders, based on
the evidence of similar laws in the United Kingdom. Community treatment orders are provided to people after an inpatient psychiatric admission under the
Mental Health Act. It means that they will have supervised treatment after they leave hospital, with certain
conditions in place. If the conditions are breached, the individual can be brought back to the hospital. Each
new patient placed on a community treatment order
under the Mental Health Act requires reviews of treatment, and t hese will require a second opinion by
an approved doctor. The funds will pay for the i ncreased supervision, training and for the approved
doctor to regularly visit Bermuda to provide the r equired second opinions.

BHB AND THE CORO NAVIRUS
(COVID -19) PREPAR ATION

Hon. Kim N. Wilson: BHB has escalation plans in
place which identify options for emergency, intensive
care unit and acute care wards to cope with an influx
of patients in the event of a pandemic. The availability
of beds can change on a daily basis. However, BHB
has taken actions to increase the capacity of availabi lity by making adjustments such as discharging stable
patients, postponing elective surgeries and using ad-ditional beds in other areas. There are negativepressure rooms in emergency and on each floor of the
acute care wing. Negative- pressure rooms stop the air
flowing out of the patient rooms, keeping the rest of
the hospital safe. Mr. Chairman, there is also an entire floor, inclusive of 30 beds, with an independent air
filtration system; should that need arise, it can be
used for potential cases.
It will be critical for people who can be cared
for at home to stay there so that hospital services can
focus on those most in need. Most importantly, no one should turn up at the hospital or ot her health care pr oviders without calling ahead first to inform the personnel of the hospital or the health care facility of their
symptoms and to receive advice on next steps.
Mr. Chairman, this concludes my presentation
for Head 24, Hospitals.

HEAD 55 —DEPARTMENT OF
FINANCIAL ASSIS TANCE

Hon. Kim N. Wilson: Mr. Chairman, the Department
of Financial Assistance is Head 55 and can be located
in the Budget Book at pages B -191 to B -194. Again,
Mr. Chairman, Head 55 represents the Department of
Financial Assis tance.

Mandate or Mission

Hon. Kim N. Wilson: Mr. Chairman, when compared
to the prior year, changes have been made to the
mission statement, department objectives and performance measures, as reported in the 2020/21 Budget
Book. These changes became necessary as part of the Government public service reform and to ensure
alignment with the Government’s vison. The new mi ssion of the Department of Financial Assistance is, To
assist vulnerable Bermudians to maintain a minimum
standard of living during chall enging economic times .
Yes?

3512 9 March 2020 Official Hansard Report

Bermuda House of Assembly ANNOUNCEMENT BY THE CHAIRMAN

HOUSE VISITOR

I would just like to welcome into the
Chamber the former Deputy Speaker from the Parish
of Sandys. Mr. Walter Lister has joined us this mor ning. Welcome.
Continue on, Minister. Thank you for that.
[Committee of Supply, Ministry of Health, debate co ntinuing]
Hon. Kim N. Wilson: Thank you, Mr. Chairman.
Mr. Chairman, as I said, the new mission of
the Department of Financial Assistance is, To assist
vulnerable Bermudia ns to maintain a minimum standard of living during challenging economic times .

Expenditure Overview

Hon. Kim N. Wilson: The total 2020/21 expenditure
is estimated to be $50,944,000. This represents a decrease of $540,000, or 1 per cent, from the prior y ear.
This budget constitutes 21 per cent of the budget all ocated for the Ministry as a whole. This allocation of
funds will continue to maintain grants, support finan-cial assistance programmes and the child day -care
programme during the fiscal period.

Capital Expenditure

Hon. Kim N. Wilson: The total capital expenditure is
estimated to be $30,000, as shown on page C -13.
This expenditure comprises an upgrade to the d epartment’s CCTV security system at $13,000; maint enance of the air cleaning system at $11, 000; and r eplacement of obsolete and non- compatible monitors at
$6,000. The total capital estimate for 2020/21 is a
100 per cent increase from the prior year, as there
were no capital estimates for 2019/20.

Manpower

Hon. Kim N. Wilson: The FTE count for 2020/21 r emains the same as prior years of 34, as can be seen
at page B -193. The caseload of the department averages 178 clients per financial [assistance] worker;
however, a review of the operational processes and
the organisational structure of the depar tment was
completed by Management Consulting Services in
2019, and recommendations for optimal design or
framework to meet current and projected client d emand will be implemented in 2020/21.
The size of portfolios may continue to grow
from year to year; h owever, in this regard, in order to
avoid burnout, the department is seeking to upgrade
current technology systems and its uses as much as
possible to allow for more streamlined processes. The upgrades should also promote improved statistical
data reportin g. Current workloads remain unsustain able, and antiquated systems continue to hinder pr ogress.
The 2020/21 budget estimates are listed as
two business units shown at page B -192. They are
65050 Grants and Administration, and 65080 General Administration.
Cost centre 65050, Grants and Administration
is estimated at [$47,545,000]. These funds maintain
grants, the financial assistance programmes and child day-care programmes. There is a decrease from the
year prior of $776,000 [sic] , or 2 per cent, to ensure
requested budget amounts are in line with projected expenditures for 2020/21.

Hon. Patricia J. Gordon -Pamplin: Sorry. Yes, just a
point of clarification if I may.

POINT OF CLARIFICATION
Hon. Patricia J. Gordon -Pamplin: The Minister just
indicated $776,0 00. The book says $767,000. I just
want to make sure that we are dealing with the right number here.
[Inaudible interjections]
Hon. Patricia J. Gordon -Pamplin: Yes. Yes, that is
correct. You said seven- seventy -six. I do not know
whether it is 776 or 767.
Hon. Kim N. Wilson: Yes, Mr. Chairman, that was an
error.
Hon. Patricia J. Gordon -Pamplin: Okay. Thank you.
Hon. Kim N. Wilson: It is 767.

Hon. Patricia J. Gordon -Pamplin: Thank you.

Hon. Kim N. Wilson: The brief says that as well. I
mixed up the numbers.

Hon. Patricia J. Gordon -Pamplin: Okay.
Hon. Kim N. Wilson: Cost centre 65050, Grants and
Administration is estimated at $47,545,000. These
funds maintain grants, the financial assistance pr ogrammes and child day -care programmes. There is a
decreas e from the year prior of $767,000, or 2 per
cent, to ensure requested budget amounts are in line
with projected expenditures for 2020/21.
Mr. Chairman, there are two types of grants
awarded from this estimate. The first involves the i ssuance of funding to support community -based pr ogrammes such as Vision Bermuda, Meals on Wheels
and the Salvation Army Shelters, and this is all shown
at page C -19. The total support to these helping orBermuda House of Assembly ganisations amounts to $613,000. The remaining
amount of $46,932,000 serves as the total budget,
divided between the assisted programmes for eligible
individuals of $44,848,000 and the child day -care pr ogramme of $2,084,000.
Mr. Chairman, the Investigative Officers continue to pursue persons or vendors who have outstanding debt s owing to the department. There are 79
active cases on their docket. Individuals pay small
sums of money towards their debt, which means the
amounts owing are carried over from period to period.
A total of $493,000 was owing at the begi nning of the fiscal year. The total amount recovered by
the time of this writing is $81,000. Four cases have
been referred to the Department of Public Prosec utions in an attempt to recover approximately $70,000
of debt. These cases are as a result of fraudulent activity or abuse to the system.
Mr. Chairman, the total estimate for cost centre 65080, General Administration for 2020/21 is $3,399,000, as shown on page B -192. This represents
an increase of $227,000 from the prior year. This
change is due to a combination of the 2 per cent uplift
in BPSU salaries together with salary increments from
the prior budget year, of $138,000; an increase in l ocal training by $16,000 to ensure staff retains certific ation in 2020/21 and are kept abreast of current trends
and practices in fi nancial/social assistance; an i ncrease in travel local by $15,000, which will facilitate the payment of gasoline, repairs and maintenance of
a vehicle purchased by the department in 2019/20 to
transport investigative officers, social workers and
financial assistance workers on client site visits; and
finally, an increase in local consultant services of
$57,000 to assist with legal and other financial assi stance reform matters.

Major Policy Changes

Hon. Kim N. Wilson: Mr. Chairman, in preparation for
the implementation of a new structure, financial assi stance teams were reorganised and case files were
evenly distributed among workers to promote an equ itable working environment. As I mentioned previously,
Mr. Chairman, each worker now has approximately
178 f iles compared to 200 stated in prior reports. They
each have the same number of clients in each category. And those categories are as follows:
• pensioners, 82;
• disability clients, 63 ;
• earnings -low, 24 ; and
• able-bodied, 9.
Every effort will be taken to ensur e that the
distribution of work remains equitable. Despite the
reduction of files per worker, the workload remains
challenging and unsustainable, although there is relief
for the workers knowing that the burden is equally
shared amongst them. At the writi ng of this report, the average
monthly total number of clients equals 2,082. A su bstantive management accountant joined the team in
August 2019. This was a much- needed resource as
recommended in the 2018 Internal Audit Report. As a
result of this recruitment, there has been a marked
improvement with data reporting, compliance with F inancial Instructions, reduction of waste and clean audit results. Internal policy -writing to align with legisl ation continues to be a work in progress, although completion is pl anned for quarter two of fiscal
2020/21.

Plans for the Upcoming Year

Hon. Kim N. Wilson: Financial Assistance staff will
participate in an extensive two- day customer service
training in an attempt to improve client experience.
The first cohort is schedul ed for April 16
th and 17th,
and the second is scheduled for April 20th and 21st.
Following successful completion of this training, staff
will attain an internationally recognised International
Leadership Management (ILM) certificate.
It is the intention of the department to examine and identify a robust technical solution to address
audit exit points that underpins deficiencies with the
financial assistance system software. The current sy stem limits the capacity to perform compliance checks and does not pr ovide effective reporting capabilities.
However, a system is only effective if the users possess the required knowledge and know -how. Ther efore, resourcing, roles and responsibilities of staff will
be streamlined in accordance with a new framework
to ensur e skill sets are adequate and policies and
procedures will be reviewed and updated.
The department plans to work closely with the
Department of Workforce Development to launch f inancial planning and budgeting programmes to assist
clients once they gain th eir financial independence. In
accordance with section 6A of the Financial Assi stance Regulations 2004, there is a maximum period of
five years for payment of an award to (quote) “ablebodied recipients.” (end quote) And at the writing of
this report, appr oximately 15 persons will be affected.
The department has already started to communicate
with these individuals and is connecting them to other
workforce initiatives such as the Earn as You Learn
programme, which is provided jointly with the Berm uda Touris m Authority.
Mr. Chairman, there has been a lot of conversation in recent months in respect to the cost of gr ocery items in the stores. To that end, the department
is seeking to work with other vendors who are willing
to provide bulk staple items at lower -than- retail costs
to ensure that allowances for groceries can be maxi mised.
Mr. Chairman, this ends the presentation for
Head 55, the Department of Financial Assistance.

3514 9 March 2020 Official Hansard Report

Bermuda House of Assembly The Chairman: Minister, we are near the bottom of
the hour. As you have one more Head, would you like
to start that one on the other side of lunch?

Hon. Kim N. Wilson: That is fine, Mr. Chairman.

Good afternoon, Honourable Members. We will now continue in Committee of Supply for
further consideration of the Estimates of Revenue and
Expenditure for the year 2020/21.
Heads 21, 22, 24, 55 and 91 are now to be
debated and I call on the Minister in charge to pr oceed.
Minister, you have the floor.

HEAD 91 —HEALTH INSURANCE
Hon. Kim N. Wilson: Thank you, Mr. Chairman.
Prior to breaking for lunch, I was about to
commence discussion of Head 91, the Health Insur-ance Department, and that can be located in the
Budget Book under pages B -195 to B -198.
Mr. Chairman, [the mission of] the Health I nsurance Department (HID) is to provide accessible health benefits.
The primary role of HID is to provide access
to affordable health insurance to all residents of Bermuda. Affordable health insurance is particularly d emanding in Bermuda as we continue to face the challenges of increasing health costs, poorly managed
chronic illnesses and a rapidly ageing population t ogether with a low birth rate. Persons continue to find
themselves having to choose between the purchase of health coverage, whether it be health insurance or
subsequent co- pays, versus the purchase of daily li ving necessities. I cannot express enough the need for
a more value- based health system to manage these
demands and if we can concentrate on population
health outcomes and health financing reform, we can
achieve this.
Mr. Chairman, taking these actions with an i ntentional approach will assist in reducing the financial
burdens of the health system, as well as improving
overall population health through the delivery of opt imal health services to all residents.
Mr. Chairman, for fiscal 2020/21 [there has
been] $3,755,000 allocated for this Head, which is a decrease t o the approved 2019/20 budget of
$175,000, or a 4 per cent decrease.
The Head 91 budget is the partial source of
funding behind the Health Insurance Department
(HID), which is responsible for developing and admi nistering the Government’s social health insurance products offered to the public, including:
• The Health Insurance Plan (HIP);
• The FutureCare Plan (FutureCare);
• The Mutual Reinsurance Fund (MRF); and
• The Government Subsidy Programmes (Subsidy), which pay towards the hospitalisation
costs of select populations.
Mr. Chairman, HID’s policyholders have seen
no increase to monthly premiums since 2015 as a r esult of the Government’s financial support and trans-fers from the MRF. Although there were no benefit
changes in fiscal year 2019/20, the source of funding
of the Standard Health Benefit for the Health Insurance Fund ensured that Bermuda’s population is now
facilitated through the Mutual Reinsurance Fund. This new model changed the fee for service method of
funding for Bermuda Hospitals Board’s delivered
Standard Health Benefit to a block grant payment
model without impacting the public’s ability to access
medical care. This change also centralises the collection of health service metrics inclusive of disease and medical encounter types.
Mr. Chairman, during fiscal 2019/20, the
Health Insurance Department continued to provide the
Personal Home Care (PHC) benefit to eligible polic yholders. This benefit has proven to fill home care gaps
in the community and certainly supports the ageing in
place concept. Ap proximately 349 policyholders regularly use the Personal Home Care benefit, with HID
receiving an average of four requests for the benefit
on a weekly basis. This benefit contributes a pro- rata
monthly maximum amount toward the cost of in- home
caregivers. It is estimated that HID will pay out more
than $7.5 million dollars on Personal Home Care
claims over fiscal year 2019/20, an approximate i ncrease of 25 per cent versus the 2018/19 fiscal period.
The benefit not only provides policyholders a home care set ting, it also provides income for those perBermuda House of Assembly sons, such as family members and the like, who care
for the policyholders.
As expected, this benefit has exponentially
trended upward as has operational impact and expenses. In 2019/20, HID implemented processes t o
moderate rising claims expenses by way of reassessments whilst financial means testing shall be o perationalised for eligible policyholders in quarter one
of fiscal year 2020/21.
Mr. Chairman, the Enhanced Care Pr ogramme (ECP), is a programme HID is comm itted to
for the treatment of chronic non- communicable di seases for the underinsured and uninsured. The pr ogramme provides access to primary care which ena-bles participants to receive treatment they may not have had access to prior to becoming part of the programme. Currently the programme has 124 active participants and the contracts with the three participating providers are due to expire 31 March 2020. The
clinical measures continue to demonstrate the overall
disease trend is moving in a positive directi on with
health improvements and stabilisation being shown.
The outcomes vary with co -morbidities and other factors; however, results show participants had signif icantly less emergency room visits and hospitalisations and an increase in access to health car e services and
medication.
Mr. Chairman, the participants’ and providers’
feedback continues to be positive. Collaboration and
frequent re- evaluation between stakeholders have
allowed for a reduction in administration burden over
the fiscal year. In summar y the Enhanced Care Pr ogramme continues to provide access to health care
services for those most in need whilst ensuring a patient centred focus.
Mr. Chairman, HID is constantly looking to
improve the delivery of their services. The 2019/20
financial year is the second fiscal year of the Health
Insurance Fund and the FutureCare Fund consolida-tion. The FurtureCare Plan and HIP are now admini stered in one fund, the Health Insurance Fund. The
transition to the one fund was without major incident;
the service to the participants was uninterrupted, and
the consolidation offers inherent cross -subsidisation
leading to the desired aggregate loss ratio, in addition to providing reduced accounting, administration, and auditing efforts.
Mr. Chairman, as we know, numbers can tell
you a story and can provide a picture of how oper ations are going. Following on from the fiscal year ending 31 March 2015, in which Qualified Opinions were
received for all three funds, an Unqualified Opinion
was received from the Office of the Auditor General
(OAG) for the Health Insurance Fund and FutureCare
Fund under the department’s management for the
fiscal year ending 31 March 2016. As the Mutual R einsurance Fund received a Qualified Opinion from the
Office of the Auditor General for the same period, the department continues to bolster its controls reliance
and a risk mitigation environment.
Mr. Chairman, I will now summarise the operating results of the various funds under HID’s admi nistration, followed by a discussion of the Performance
Indicators for the department over the period.

PART I
HIF (Health Insurance Fund) Operating Results

Hon. Kim N. Wilson: The HIF includes two products
and policyholder groups, namely, HIP and F utureCare. The fund projects to have a total estimate headcount at the end of fiscal year 2019/20 of 7,655
which is a 5 per cent increase compared to fiscal year
2018/19.
• Projected, gross policyholder HIP premiums
earned for fiscal year 2019/20 are $42.9 mi llion, which represents an increase of $1 mi llion and $157,000, or 4 per cent from
2018/19.
• Claims incurred in 2018/19 equalled $63 mi llion with 2019/20 claims estimated to be si gnificantly less at $36.5 million (and this is due
to the Standard Health Benefit now being funded through the MRF.
• HIF has allocated approximately $2.5 million in administrative expenses for this fiscal year 2019/20.

FutureCare Operating Results

Hon. Kim N. Wilson: The projected headcount for
FutureCare is approximately 4,379 persons as of 31
March 2020, which represents an increase of 226
persons, or 5 per cent compared to 31 March 2019.
• Projected FutureCare premiums earned for
fiscal 2019/20 are $26 million, which repr esents an increase of $1 million, or 4 per cent
from 2018/19.
• Claims incurred for 2019/20 are estimated to
total $27.2 m illion as compared with $36 mi llion in 2018/19.
• Administrative expenses of approximately $1.25 million will be incurred by FutureCare
for the fiscal year 2019/20.

HIP Operating Results

Hon. Kim N. Wilson: The projected headcount for
HIP is approximately 3,276 persons as of 31 March
2020, which represents an increase of 140 persons,
or 4 per cent compared to 31 March 2019.
• Projected HIP premiums earned for fiscal
2019/20 are $16.9 million, an increase of
$548,000, or 3 per cent from 2018/19.
• Claims incurre d for 2019/20 are estimated to
total $9.2 million as compared with $27 million in 2018/19.
3516 9 March 2020 Official Hansard Report

Bermuda House of Assembly • Administrative [expenses] of approximately
$1.25 million will be incurred by HIP for the
fiscal year 2019/20.

Mutual Reinsurance Fund Operating Results

Hon. Kim N. Wilson: The Mutual Reinsurance Fund
[MRF] premium for 2019/20 increased to $331.97 per
person per month from $101.97 per person per month
during fiscal 2018/19. This 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 I discussed previously, Mr. Chai rman. The total projected premiums to be received by the MRF for the year ended 31 March 2020 total
$157.1 millio n, which represents an increase of
99.5 per cent compared to fiscal 2018/19. This signif icant increase, Mr. Chairman, is due to the BHB
Standard Health Benefit model change. Administrative
expenses of $864,000 have been allocated to the MRF for the 2019/20 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 $105.8 million for the year
ended 31 March 2020. These claims are paid from the
Consolidated Fund and represent no increase compared with fiscal year 2018/19.

PART 2
Performance Measures (Qualitative Service
Performance)

Hon. Kim N. Wilson: Mr. Chairman, we will now consider the department’s Qualitative Service Performance found on pages B -197 and B -198 of the Bud get Book.
HID reviewed and revised its performance i ndicators, in alignment with the Government Public Service Reform, and focused on the following objec-tives:
• improv ing HID stakeholder level of engagement and ease of doing bus iness;
• reducing paper use and using more digital
systems;
• operationalise Personal Home Care means
testing;
• achieving an unqualified opinion on the finan-cial statements; and
• improving reliability and efficiencies in the use
of digital applications.
The new performance measures are derived
from the objectives and provides all stakeholders with
information on the activity and progress being made in
attaining policy and organisational goals. Mr. Chairman, thanks must be given to HID’s
various business partners : Sutherland Healthcare S olutions; Argus Insurance; ProServe; and Global Med ical Management Inc. for their valuable support which
is greatly appreciated. And finally, I would like to thank
the Health Insurance Department and the Health I nsurance Committee for their diligence and commi tment.
Mr. Chairman, this ends my presentation on
Head 91, Health Insurance.

Closing Remarks

Hon. Kim N. Wilson: Mr. Chairman, in closing, as you
can see, the mandate of the Ministry of Health is wide
ranging and expansive. D espite the challenges with
resources, growing health needs, and the unexpected
and unusual events such as the coronavirus, we are
grateful to benefit from the expertise, dedication, passion and of a broad range of health and business pr ofessionals whose commitment [is] to public health,
and who remain committed, Mr. Chairman, to public health.
I am sincerely appreciative and indebted to
our staff and to our health partners who make it hap-pen on a daily basis by not only doing their job, but
going well beyon d what is required to plug gaps and
catch people who have fallen through the net, to care
for their health and social needs. When I hear of staff
using their days off or their rest days to check in on
client’s welfare I cannot possibly, Mr. Chairman, explain the feeling it gives me to have such impeccably
dedicated staff. And I applaud each and every one of
them and the whole community should join me, Mr.
Chairman, because, without them, Bermuda would
look very, very different.
This concludes my budget brief for the Mini stry of Health.
Thank you.

You may continue.
Hon. Patricia J. Gordon -Pamplin: —get all my questions in appropriately.
Okay, than k you, Mr. Chairman.
Mr. Chairman, I am going to start where the
Minister finished, and that is with offering a vote of
thanks, certainly on behalf of our team, to those within the Health Ministry across all departments because
there is significant work t hat is being done on behalf of
our sick population and on behalf of our wellness
population. So, we want to make sure that the work that is being done, both in terms of rehabilitative services as well as preventative services, is acknow ledged. And we certa inly appreciate that.
I just also wish to refer to the Minister’s ope ning comments this morning in terms of the numbers of
staffing overall in the Ministry, the employee numbers. The Minister indicated . . . and this will be found on
page B -169 of the Budget Book in terms of the overall
Ministry. The employee numbers are estimated at 383
people for the coming year in the Ministry. And it is
probably just on par with the original estimate for
2019/20, albeit the actual . . . the revised for 2019/20
did not quite meet the anticipated.
And the Minister, in her opening comments,
indicated that the history behind these numbers was
predicated upon the decisions which were taken by a
previous administration in terms of both early retir ements and position freezes.
And I just want to make one comment on this,
and I will just put it to bed, hopefully, once and for all.
[And that is] to say that the previous administration did
not come into Government with the idea of being a
mean ogre to cut back ser vices that were being pr ovided through this depar tment and that to significantly
impact the numbers of employees that are shown in
this Budget Book.
The reason behind it . . . and I believe the
public is well aware, and they have probably heard it ad infinitum —and I am getting sick and tired of saying
it—that at some point in time we are going to get
some responsibility being taken by the administration
that their former administration was not stellar and
that the decisions that were taken at the point in time
of 2012 and going forward to 2017 were to try to keep
the country from falling off the brink of disaster —
financial disaster.
So, I think once that is said if we, at some
point in time, at least get a modicum of responsibility
being accepted by the Government, that t hose dec isions that were made were caused by their poor handling of the economy, then I think that we can all at least start from a point of view of honesty and not be
disingenuous to the people of this country. That is in respect of the numbers of staffing that are shown on
page B -169.

Honourable Member, you got that off
your chest, so —
Hon. Patricia J. Gordon -Pamplin: I have gotten that
off my chest, and it is quite appropriate for the budget
debate because it is reflected in the numbers. And the
Minister referred to them in her brief. And I think it
would be remiss of me to not make those comments.
Now, Mr. Chairman, I would just like to go to
the Ministry of Health, and I have a couple questions
in respect of the numbers that we have. No w, you will
note, Mr. Chairman, when we are looking at the . . .
okay, I will deal with Grants and Administration after
the fact. I am going to do that last.
But I wanted to look at the National Office of
Seniors and Physically Challenged.

And you are referring to page?
Hon. Patricia J. Gordon -Pamplin: This is on page B -
170 and this is on programme 2103 and under cost centre 31135.
Now, you will note, Mr. Chairman, that if we
go back to the trends that we are seeing in this d epartment, and that is from the 2018/19 actual came to
$742,000 on Ageing and Disability Services. And then
revised, or the original, for 2019/20 was $1,023,000
which would have been an increase of about
$250,000 . . . $280,000 over what the actual came out
to be for 2018/19 and that was the original 2019/20.
The 2019/20 has been revised downward to $829,000
which is $194,000 difference from the original est imate. But in 2020/21 we have increased it up again to
be on par with what they had for 2019/20. So, we had
$1.023 [million] in 2019/20 and we have $1.020 [mi llion], which is just about the same amount for
2020/21.
And I am just wondering if the Minister could
explain either what was not done in 2019/20 that took the $1.023 [million] down to $829,000 that gives us
comfort that it will go up to $1.020 [million] and that
that is an appropriate number for the 2020/21.
Similarly, with the Margaret Carter Centre we
had an original budget of $1.860 [million] in 2019/20
that has been revised downward to $1.597 [million],
which is a $300,000 decrease, give or take. And then
it is going back up, this 2020/21, the Minister said in her comment $1.860 [million], but the book says $1.859 [million] for 2020/21 [cost centre] 31160 for
Margaret Carter. And I am just wondering what was
not done in 2019/20 that $1.860 [million] planned only
came out at . . . or the new revised is intended to be
$1.597 [million] and then it is going to go up, again, to $1.859 [million]? Are these numbers appropriate, do they make sense?
3518 9 March 2020 Official Hansard Report

Bermuda House of Assembly I want to also look at the . . . on page B -171,
under the Revenue Summary, when it comes to the
Registration of Doctors, 8151, and there were 50 [sic]
doctors estimated in 2019/20, a revised estimate of 50, and for 2020/21 there is 47[sic] . While three people is not necess arily a significant number, I am just
wondering if there is anything to read into whether doctors are either retiring or leaving the country , and
whether we are going to find ourselves being deficient
with medical services, with the registration of doctors ,
such that our health system may be compromised if
there are insufficient services.

Member, those are dollar signs I
see—

Hon. Patricia J. Gordon -Pamplin: Yes, these are
dollar signs. This is the . . . this is . . . oh, I am sorry.
Sorry, sorry, sorry. I am sorry. You are perfectly right. I
am sorry. I was looking at numbers. I was looking at
hard numbers. Those are dollar signs, my apologies.
So, we are going to get less money for doctors’ registrations and does that mean that . . . well,
clearly, if we are going to get less money, it means we
are registering [fewer] doctors. And if we are going to
register [fewer] doctors, if we are anticipating only
$47,000 from revenue as opposed to $50,000 from revenue of registration, it means that we are going to
get $3,000 less in registration, what is the [reason] behind that decrease? Do we have doctors who have
retired, who will not be renewing their registration? Or
do we have doctors who are leaving the Island who
are not renewing their registration? Therefore, the money . . . I apologise, I was looking at —

This is alright.

Hon. Patricia J. Gordon -Pamplin: —those numbers,
you know, where the money is not going to come in as
it was intended. And that really accounts for all of the
differences in respect of the revenue source for the
Ministry, so that really is the only question that comes
out of that.
If I go to Grants and Administration and General Administration, and that is back to page B -170
under General, 31000 and 31015, the Minister ind icated, I believe, under [cost centre] 31000, General
Administration, that part of that money that was expended between [the] 2019/20 of $1.804 [million] and
the revision to that number of $1.976 [million] had
something to do with the meetings which were held in
relation to the new proposals for the health care sy stem. And the Minister indicated that there were 59
meetings with a total of 600 participants and that
those meetings were . . . but there were 59 meetings
held, and I think it came under that General Admi nistration budget vote. What I am just curious about is that those 600 people to which the Minister referred
represent less than 1 per cent of the population. And 59 meetings, which would . . . if you had
600 people and there were 59 meetings, that would probably average an aggregate . . . probably you
would get 10 people per meeting. And I know some were far higher in numbers in terms of the attendance and some were far lower, so I am just wondering
whether the Minister is satisfied that the meetings that
have been held have been sufficiently informative
such that the population can feel comfortable with the
renewed intent of the Health Ministry and what it is
intending to do in respect of the health system.
I want to go over to Perform ance Measures
under page B -173 and, in respect of business unit
31000, General Administration, and the last item on that Performance Measure is to “improve public perception of the Ministry of Health from 49 per cent.”
Now, one would assume that if we cann ot even get
half of the population saying that the Ministry is doing
a good job, given the fact that if you look at . . . if you
go back to look at the way over to the back of the Budget Book, Mr. Chairman, pages C -38 and C -38
indicate the estimated expend iture in millions by each
Ministry. It is a pie chart. And on that pie chart you notice that the Health Ministry takes up . . . it is the
largest Ministry, $243.3 million. And for $243.3 million,
and we are getting less than a 50 per cent satisfaction
level . . . something is not quite right. And we have to
figure out what we need to do to get that right be-cause that is an awful poor return for an awful lot of
money.
And I just wonder if the Minister can give us
some indication as to, while the intent is to improve
public perception of the Ministry of Health from 49 per
cent, to increase it, I am just curious what measures,
specifically, are being taken in order to engender a
sense of, not just comfort, but embracing from the
population so that we can get to a higher level than a
49 per cent acceptance of the Ministry.
I will go down one further, under business unit
31015 Grants and Administration, and the second point on that item has been a discontinued measure
where grantees submitted up- to-date financials and
annual reports by September following the fiscal year
end. And this has been a discontinued measure, Mr.
Chairman.

Mm-hmm.

Hon. Patricia J. Gordon -Pamplin: This must [create]
cause for concern, and I am wondering what we can
do. And I think this is a perennial problem, so I am not
saying the present Government is responsible, it is a
perennial problem. But what can we do to ensure that
there is accountability by grantees? Because this is
public money. They need to be able to make sure t hat
their financials are up to date in an appropriate timeframe.
We noticed when we spoke of the hospital
that their accounts were five years behind. And in


Bermuda House of Assembly those five years of delinquency in terms of the accounts, there has still been a major shift in ho w the
hospital is going to be funded. I will speak to that a
little bit further, but just because this performance
measure covers health care, as far as I see it, then I think that I just want to ask the question and I want to
ask it here, whether we are not being irresponsible to
be giving public money and not ensuring that there is
effective accountability for the recipients of those public funds.
I am going to move now to . . . the Minister
indicated with respect to some of the oversight of the department, in terms of ensuring . . . I think, let me
make sure I have got the right one. I guess it is under
Surveillance and Epidemiology. I am not 100 per cent sure. I just need to make sure, just give me a second.

Mm-hmm.

Hon. Patricia J. Gord on-Pamplin: I think under page
B-170, under the Office of the Chief Medical Officer,
31040, I think the Minister indicated that there was . . .
Just give me one second, Mr. Chairman. That there
was, in fact, surveillance, if I can call it that, which is
conducted by members within the Health Ministry
Headquarters that would ensure that, both in terms of
. . . the Minister mentioned what will happen and what
is being planned as far as the COVID -19 is concerned. But also, I believe, that this is the department under health care, under 2102, Office of Chief Medical
Officer, which is responsible for overseeing the effectiveness and the cleanliness and the propriety of the
happenings at the Hospital in terms of Epidemiology and Surveillance.
Now, I have been made aware, Mr. Chairman,
that there is a matter at the hospital which effectively
is showing that there are some hoods and vents that
are required to be erected in the laboratories because
the air quality there is creating negative impacts on
some of the employees. So, if we have got a depar tment in the Ministry at Headquarters level that is r esponsible for overseeing that . . . and my understan ding is that there was actually an investigation that took a significant amount of time to look at that issue with
respect to the hoods and vents at one of the laborat ories at the hospital. I am just wondering how the staff
there can be comforted that the results coming from
that oversight have been positive, such that their
health is not going to continue to be impacted by the
negativity that has been caused, which resulted in a
year and a half investigation and no effective dec isions being made to either move staff or implement
the recommendations of putting in hoods and vents
that would make sure that the employees ar e safe in
their environment.
Okay, I am a little bit concerned about the . . .
on page B -174 under Ageing and Disability Services,
unit 31135, about the number of residential care home
complaints received and the number of residential home complaint inves tigations. If this is not the most
inane or innocuous or ridiculous or nonsensical measure of performance, I do not know what could
possibly be. We have no control over how many complaints are received.
So, if the performance measure is something
like to try to reduce residential care home complaints
or to try to ensure that inspections of residential care
homes results in fewer complaints, then I can understand that. That is something to look forward to. But to say that you are looking forward to getting 30 residen-tial care home complaints makes no sense. You might
get 50, you might get none. And hopefully we get
none, because that has got to be the aim. And then, in
terms of rectifying and doing something about that,
the number of complaint investigations ought to be
100 per cent of those which are received. That needs
to be the target. Not to say that we are going to do 30
because you might only get 10, you might get 100.
And if 30 is your goal, then you are already either undershooting or well overshooting the target and that
makes no sense.
I think that we have looked at these performance measures from time immemorial and we have
always tried to update them so that the performance
measures have some sensibility in their application.
So, it is not just a q uestion of trying to fill a page with
words, but rather to try to ensure that there is som ething in the words which makes some sense. And
these do not. So I just wondered if the Minister could,
in looking at Ageing and Disability Services, do som ething about these particular performance measures
because they are just nonsensical.
There was a discontinued measure in that
same area, on 31135, on the number of accessibility
assessments conducted. But there is a new measure
of a number of accessibility assessments and consultations conducted. So that is a new measure. So, it
actually added consultations in with that. And I am just wondering if the Minister can give us a little bit of . . .
add just a little bit of flavour in terms of what kinds of
consultation m ake this measure different from the
measure that has been discontinued.
I realise that “consultation” is a word that has
been added in, but are we talking about onsite consultation? Are we talking about in- office consultations?
Are we talking about planni ng to go onsite? What
kinds of consultation are we discussing here to make sure that our patients and our clients in the Ageing
and Disability Services are being well and properly
served?
Page B -175 again, still following on under
31135 in respect of Agein g and Disability Services,
the number of senior abuse complaints submitted to the Registrar by types of abuse. This is a new performance measure but, again, the measure itself needs
to have some degree of sensibility behind it and the efficacy of being abl e to provide what we are saying
that they want to be able to do.
3520 9 March 2020 Official Hansard Report

Bermuda House of Assembly So, if you are saying that you want to submit
to the Registrar 20, 30, 40, 45 abuse complaints . . .
ideally, we are looking that there should be no abuse
complaints. So, we might be looking at, rather than a
number, we might be looking at a percentage of cases
that are reported that need to be moved onto the next
level to be able to look at it. So, to have a number . . .
you know, I hope that there are . . . especially when
you look at a lot of . . . we know that the Minister indicated in her brief that there were significant numbers
of both financial . . . sorry, my machine was talking
back to me on my screen as to what I was saying —