March 11, 2019

Good morning.

GOVERNMENT FEES
AMENDMENT REGULATIONS 2019

Hon. Curtis L. Dickinson: Mr. Speaker, with the
Governor’s recommendation and in accordance with
section 36(3) of the Bermuda Constitution, I have the
honour to attach and submit for the consideration of
the Honourable House of Assembly the following: Government Fees Amendment Regulations 2019, made by the Minister responsible for Finance under
section 2 of the Government Fees Act 1965.

Yes.
Members, although the Order Paper does not
indicate it, and we have these quick turnovers with
[our] sitting every other day for Budget [ Debate] , the
Premier does ha ve a Statement that he would like to
give this morning, and it is being circulated to you at
this moment.
Premier.

Hon. E. David Burt: Good morning, Mr. Speaker.

Good morning.

PROFESSIONAL SERVICES/CONSULTANTS
AND ADVISORS —A REVISED CONSTR UCT
Hon. E. David Burt: Mr. Speaker, the use of subject
matter experts , or political advisers , in support of a
government’s policy aims and objectives is an established and accepted use of professional services
in
Bermuda and elsewhere. From the days of Raj Nada-rajah, some consultants have attracted controversy
while others have hardly been known, although their
contribution to the development of Bermuda can be seen in many facets of our everyday lives.
Mr. Speaker, the increasing demands of modern governance and public administration have taxed
the traditional ministry headquarters within Bermuda’s
public service. In Bermuda, permanent secretaries
combine their principal role of lead policy advisor to
ministers with office management, accounting and budgetary responsibility, speechwriting, the drafting of Cabinet memoranda and briefs, managing union rel ationships, PATI oversight, and many day -to-day tasks
associated with ministers’ needs.
Mr. Speaker, the SAGE Commission examined the operations of ministry headquarters and the
930 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly role of p ermanent secretaries. In their 2013 r eport ,
they recommended, citing the 2011 Civil Service R eview, the creation of a ministerial private office. To
quote from the SAGE report , Mr. Speaker , “A Minist erial Private Office should be created to relieve Perm anent Secretaries of the day -to-day tasks associated
with Ministers’ needs. ”
To again quote the 2011 Civil Service Review ,
“We believe that a Private Office would relieve the
Permanent Secretary of the day -to-day managing of
Ministers (tasks such as detailed briefing, speech wri ting, intelligent prioritization of the Minister’s diary, ‘gate- keeping ’, managing the Minister’s rel ationship
with the Legislature, progress -chasing of submissions
from within the Ministry, etc.).”
Mr. Speaker, t he 2011 r eview said, “We b elieve that . . . such a role close to a Minister would be
a good one for young C ivil Servants who are judged to
have the potential for rapid advancement.”
Mr. Speaker, let me pause on that point to
remind Honourable Members of the recent announcement I made on the Cabinet Office internship
programmes set to be run during this summer. From
the young people we will attract for this period, I expect that we will identify such high- fliers who will co ntinue to add to the capacity of the p ublic service.
Mr. Speaker, the r eview continues , “We b elieve that such a system would free the Permanent
Secretary to develop a closer ‘ grip’ on improving the
performance of the Ministry and its constituent D epartments ; the development of policy options . . . and
driving better delivery and accountability through the
system .”
Mr. Speaker, after almost two years in go vernment , I think I c an speak for all Ministers in saying
that permanent secretaries are increasingly busy and
challenged to meet the demands of the post without the support required. Therefore, I have indicated my
full support for the SAGE Commission’s recommendation on private ministerial offices and have encour-aged Ministers , who field a significant number of r equests from the public, to start the process of building
this capacity within ministries by hiring an advisor , as
permitted by the Ministerial Code of Conduct.
Honour able Members should note that s ection
9.1 of the Code dictates that such engagements are subject to budgetary approval and the prior written
approval of the Premier. Further, Mr. Speaker, I can
advise this Honourable House that , terms similar to
the
Premier and Opposition Leader Personal Staffs
Act 1983 , I shall shortly invite the Cabinet to approve
amendments to releva nt legislation to formali se mini sterial private offices.
Mr. Speaker, Honourable Members will note
that the Ministerial Code of Conduct also contem-plates the engagement of expert consultants, who
through their professional expertise can be taken on in support of the policy remit of a Minister. It is not a poor
reflection on the p ublic service that successive go v-ernments have required professional services to advance their programmes. Highly technical areas, the
use of cutting- edge technology , and the prov ision of
expert advice all demand special skill and expertise.
I wish to further advise Honourable Members
that I have invited the Policy and Strategy Section
within the Cabinet Office to conduct a jurisdictional
review and to advise on a means by which t o grade
consultant engagements in order to ensure pay equity
and a compensation package that is more standar dised and in keeping with the level of expertise for
which the particular consultant has been engaged.
This will set a standardised scale for compensation of
which all parties will be aware and to which they subscribe when working in support of the Government of
Bermuda.
Mr. Speaker, the pursuit of political goals has
made the term “ consultant ” a bad word in many cases. Providing a legislative under pinning and a more
transparent system of grading and compensation for
consultant work , both political and expert , will go a
long way towards changing that perception and , most
importantly, promoting greater efficiency in the deli very of services and the im plementation of policy on
behalf of the people of Bermuda.
Thank you, Mr. Speaker.

The Sergeant -at-Arms has the answer

distributed to the Member. Okay.

QUESTION: CONSULTANTS /ADVISORS
PAID FOR BY GOVERNMENT

Hon. Michael H. Dunkley: Will the Honour able Premier please inf orm this Honourable
House which Government Ministers have had
advisers since 18th July 2017 as per section
9.1 of the 2015 Ministerial Code of Conduct


Bermuda House of Assembly and accordingly, name the advisors paid for
by the government ?

Hon. Michael H. Dunkley: Will the Honour able Premier please inform this Honourable House which Government Ministers have had
consultants since 18
th July 2017 as per se ction 9.1 of the 2015 Ministerial Code of Conduct and accordingly, name the consultants paid for by the government ?

Good morning.

QUESTION 1: CONSULTANTS/ADVISORS PAID
FOR BY GOVERNMENT

Hon. L. Craig Cannonier: Good morning, colleagues.
Yes, I am just curious. The Premier says that
he is looking to start the process of building this c apacity with in ministries by hiring advisors as permitted
by the Ministerial Code.
I was just curious as to an idea. Does he have
an idea of the numbers of Ministers who are seeking
this assistance? Also, how many Ministers already
have started the process and have assistants in
place?

Thank you.
Premier.
Hon. E. David Burt: Mr. Speaker, I do believe that the
written question may provide the answer to that. I believe that there are four Ministers who have that in
place, the Ministry of Education—
Hon. L. Craig Cannonier: Is it part of the written answer?
Hon. E. David Burt: I think so, yes.
[They are] t he Minister of Education, the Deputy Premier, the Minister of Public Works, as well as
myself.

Continue.
Honourable Member ,
SUPPLEMENTARY

Hon. L. Craig Cannonier: Yes. In relation to that,
then, I am just seeing now some of the answers, just
getting them. My apologies. I did not have it in front of
me.
But do we have an idea then, based on these
answers as well, what we ar e anticipating that these
salaries might be for the consultants? If we are going to do it across the board, have we decided that it is going to be within a range, per se?

Hon. E. David Burt: Thank you very much, Mr.
Speaker.
Mr. Speaker, these items are due to specific
approval of myself for all ministerial consultants. I
have graded them at PS36 , and there is no one higher
than PS36 for ministerial consultants who are advising
ministers in a personal capacity. For others who are in
the provision of speci fic expert advice, those ones are
rated differently. However, for personal staff, they are
graded at PS36 .

Does any Member wish to speak to
that?
We recognise the Premier.

Hon. E. David Burt: Mr. Speaker, thank you very
much.
Mr. Speaker, I rise this morning on a very sad
note. And I would ask that this Honourable House
send a letter of condolences to a Bermuda resident by the name of Mr. Paul Njoroge, Mr. Speaker, Mr.
Njoroge on the tragic loss of his wife, his mother -inlaw, and three children who were aboard the Ethiop ian Airlines flight ET 302, which crashed just shortly
after take- off from the Ethiopian capital of Addis Ababa to Nairobi in Kenya.
Last evening, on behalf of the Government,
the Minister of Finance and the Minister of National
Security visited the home of Mr. Njoroge and offered
condolences. As a father and a husband, I cannot i magine how he must feel during this time. In times of
tragedy, we want the expatriate community to know
that we support them. S pecifically, to the African D iaspora, thank you for cloaking this family with support.
932 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly He is in our thoughts as he travels back home to Kenya. And we will continue to support him upon his r eturn. And I would assume, Mr. Speaker, that all Honourable Members would wish to be associated with
those remarks.

Would any further Member wish to
speak?
We recognise the Honourable Member from
constituency 10.
Honourable Member, you have the floor.

Hon. Michael H. Dunkley: Thank you, Mr. Speaker.
Mr. Speaker, yes, I am sure all Members want
to be associated. And I would like to turn, Mr. Speak-er, just to a brighter note, because it is important that
we recognise Bermudians when they strive and do well. I would like to congratulate Camiko Smith and
Daniel Augustus for their great showing in the Grey
Goose World Par 3 Championship that was held over
the weekend. Camiko came in third, Mr. Speaker. I
understand that he was duelling down to the wire at
the l ast with some professional golfers who have
played on the world stage for many years. The tournament was won by Barry Lane. But Camiko is a
young Bermudian, and I think we are all aware of his
endeavour to become a professional golfer on the
PGA tour. He h as certainly made some great strides.
And I would like to send congratulations to Camiko.
And also, to Daniel Augustus, who came in
fifth at one over par. Most will know that Daniel has
been playing on some tour events, some satellite tour
events in the U S for many years and showing great
progress. I highlight that to not only recognise the
great work that young professional golfers are doing,
but just to show how tough it is to make the headway.
And we do have a lot of talent in this Island.
We need to r ecognise people. We need to
support them where we can in a very competitive field
because we tend to accept that in any sport Bermudians can rise to the top. But it takes effort, it takes
commitment, it takes cash to make it happen. And it
takes the suppor t of community, friends , and family
and the sacrifice to make it happen.
So, we recognise them and congratulate
them. But let us continue to rally with them so we can
have more Bermudians flying the flag on the world
stage.
Thank you, Mr. Speaker.

The S peaker: Thank you.
Does any other Member wish to speak?
We recognise the Honourable Member from
St. George’s. Honourable Member.

I would like to take this moment t o
congratulate the Bermuda Industrial Union. They held
their annual International Women’s Day Tea on Saturday. And the theme for this year, I think you heard
me say it already, was #balanceforbetter
. And I just
want to commend them for the fact that they have been doing this now for nine years, each year on the Saturday preceding the date of the International
Women’s Day. And we highlight the challenges that
we as women face. And in this instance, the guest
speaker was none other than the Premier’s wife, Kri stin Burt. She highlighted the challenges that she has
as a mother, as she had her assistant, her young daughter there, who was able to help her deliver her
speech on Saturday.
Also, I would like to give thanks to Sister
LaVerne Furbert, because she tirelessly organises this event year after year. And also, to young Dakota
Tucker, who sang two beautiful songs at the tea. So,
as we as women continue to strive for our equality
and our gender parity, there are events like these that
help to highlight that we still have a long way to go.
Thank you, Mr. Speaker.

Thank you, Mr. Speaker, and
good morning, all.
Mr. Speaker, in line with the Honourable
Member , from constituency 10 I think it is, who congratulated Bermudian athl etes, I would like to have
congratulations sent to the Bermuda Rugby Team,
who just recently participated in the Rugby America’s
North area championships, by thumping, if I could use
that word, the Jamaican team that came here. I think it was something lik e 43 to 12, 13, something like that .
So, it shows that we do have some talent spread around the Island, Mr. Speaker, and I would like congratulations to be sent.
On a sadder note, Mr. Speaker, I would ask if
a letter of condolences could be sent to the family of
the late Earlston Winfield Bascome. Mr. Bascome was
an old friend of mine. W e supported the Young Men’s
Social Club, Bluebirds, together on our days out. He
will be missed. He was a character around the B ack o’
Town area. But at the same time, I am sure he will be
missed by his family.
Thank you, Mr. Speaker.

I also would like to recognise the
BPSU [Bermuda Public Services Union], who also
celebrated International Women’s Day on Friday. They had a breakfast in the morning, as well as a talk
show, the Tea Talk Show, where they highlighted
many great women in our community, including Ms. Tina Evans, the daughter of the late Dame Lois Browne -Evans. And also, Superintendent Na’imah
Astwood gave some very valuable insight into what it meant being a woman in our police force. So, they all
shared very valid information, essential information to
our community , and our network of women in our
community, as well as information for the progression
of women and advancement of women in our comm unity.
So, I would just like to also congratulate the
BPSU for the brilliant activities that they set out for the
day. I would like to associate MP Renee Ming, as well
as many of the other women MPs in the House.
Thank you.

Good morning.

Hon. Hubert (Kim) E. Swan: Mr. Speaker, I would
like a suitable acknowledgement and letter sent to two
ladies who have made Bermuda part of their home
annually. Their names are Joy Bonhurst, a golf pr ofessional from Maryland; and Baily [Johnson ]
Scheurer, a business executive from the Washington, DC, area.
These ladies, staying at Pompano Beach now
for 22 years, have staged a Ladies Pro- Am [Golf
Classic ] event successfully. And yesterday, they had
one of the rounds at Port Royal with over 70 ladies participating.
I am proud to say, Mr. Speaker, that this tournament is a follow -on of the event that I staged for
over 10 years. And these ladies first came to Berm uda— well, Joy Bonhurst certainly did—[for] the former
Bermuda Easter Lily Pro- Am for Ladies that I founded
way back in the mid- 1980s. But they have stuck to it.
And with the suppor t of Pompano and Goslings, they continue to host this event. And I am hoping to get,
particularly, the Minister of Sport, who is a lady, to
meet them because I think there will be some natural
synergies that will be at play in that regard, especially
durin g this time of celebration of the contributions of
women globally.
And I associate the Chairman of the Port
Royal Golf Course with that. And I would like to be associated with the congratulations made to my fellow
golf professionals, one of whom has already won the
tournament that they were congratulated on earlier today, previously.

Before we move off of condolences
and congratulations, let me just take this moment to
recognise the young students who are in the Gallery
this morning.
We have the students of P4 class from Nort hlands, under the guidance of their teachers, Ms. Hill,
Ms. Matthew , and Ms. Hollis there. It is good to have
you here this morning, visiting with us.
And I hope that you will find this a learning
exercise, young people, in how government operates
here in trying to act in the best interests of all of our
citizens.
So, welcome to Parliament.

[Desk thumping]

MATTERS OF PRIVILEGE

There are none.

INTRODUCTION OF BILLS

GOVERNMENT BILLS

934 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly The Speaker: There are two Government Bills that
are being introduced this morning. The Junior Minister
of Finance, are you going to do them on behalf of the
Minister?

FIRST READINGS

EXEMPTED PARTNERSHIPS
AMENDMENT ACT 2019

Hon. Wayne L. Furbert: Thank you, Mr. Speaker.
On behalf of the Minister of Finance, the Ho nourable Curtis Dickinson, I am introducing the follo wing Bill, which, according to section 36(3) of the Bermuda Constitution, requires the Governor’s recommendation, s o that it may be placed on the Order P aper for the next day of meeting: the Exempted Par tnerships Amendment Act 2019.

Again, for our listening public, we are
here to continue the Budget Debate on the Estimates
of Revenue and Expenditure for the year 2019/20.
Today, the Ministry that is being debated is the Mini stry of Health.
And, in fact, they have the entir e day. So, the
whole eight hours today is for the Ministry of Health.
I call on the Junior Minister of Finance to
move us.

Hon. Wayne L. Furbert: Thank you, Mr. Speaker.
I move that the House do now resume in
Committee of Supply to consider the Estimates of
Revenue and Expenditure for 2019/20.

Good morning, Honourable Members.
We are now in Committee of Supply for further consideration of the Estimates of Revenue and Expend iture for the year [ 2019/20] .
The following heads will be debated: Heads
21, 22, 24, 55 and 91.
I call on the Minister in charge to proceed.
Minister, you have the floor.

MINISTRY OF HEALTH

Hon. Ki m N. Wilson: Thank you, Madam Chairman.
I move the following heads: Head 21, Ministry
of Health Headquarters; Head 22, Department of
Health; Head 24, Hospitals; Head 55, Financial Assi stance; and Head 91, Health Insurance, be now taken
under consideration.

HEAD 21 —MINISTRY OF HEALTH
HEADQUARTERS
Hon. Kim N. Wilson: Madam Chairman, it gives me
great pleasure to present the budget for the Ministry of
Health overall, which includes Head 21, the Ministry of
Health Headquarters, found at pages B -167 through
B-172 of the Budget Book.
Madam Chairman, the mandate of the Mini stry Headquarters is to serve as the policy directorate
for Bermuda’s health system.
Madam Chairman, with respect to the expenditure overview, the headquarters allocation co nstitutes under 5 per cent of the budget allocation for
the Ministry as a whole. A total of $11,649,000 has
been allocated for this head for the 2019/20, which
represents an increase of $161,000, or 1 per cent ,
over the original budget of 2018/19. Madam Chairman, this ch ange is due to increases in salaries due to
the transfer of posts from the Department of Health
and the Health Insurance Department to the Office of the Chief Medical Officer, to support health care regulation, epidemiology, surveillance and disease outbreaks. The change will be reflected in the corr esponding reductions in Heads 22 and 91.

Manpower
Hon. Kim N. Wilson: Madam Chairman, the change
in manpower for this head is detailed in the Budget
Book at [page] B-169, increasing the employee numbers for the Ministry Headquarters from 45 to 47 established posts, representing three sections.


Bermuda House of Assembly However, I have to pause here briefly, Madam
Chairman, to remind us all that across the Ministry of
Health, we continue to have a total of 89 vacant pos itions out of 398 established posts. This is 22 per cent
of the Ministry’s total workforce, and it has a severe impact on our ability to deliver services and protect
the public.
Madam Chairman, I have to stress that this
situation was inherited from the previous Government, whose hiring freezes and early retirement incentives
crippled many parts of public health provision. From closing dental clinics to 10 bed closures at a rest
home facility, hiring freezes on health care systems
and services cause harm to real people in the short
term and damage the community in the long term.
While we 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 community (who are [mostly] seniors and
persons with disabilities), it is impossible to reverse 89 vacancies fast enough. The staff shortages left exis ting teams over -stretched to cover as much as they
could and, subsequently, were burnt out.
It is a travesty, Madam Chairman, to see
health care professionals —amongst the most noble of
professions —treated in this way. Recruitment cannot
catch up fast enough to outpace resignations and early retire ments due to burnout. But we continue to
make strides, Madam Chairman, and have put
measures in place to restore morale across the Mini stry. In particular, we have signed up for Investors in
People certification, and we are actively working to
ensure that this international accreditation is obtained
by 2021.
I will now speak on each of the sections and
business units under this head, Madam Chairman.
The business unit 2101, General, comprises a
small team of 11 persons and a budget largely ded icated to gr ants for the community. In total, Madam
Chairman, over $5 million of the unit’s total budget of
$7.7 million dollars is for grants. The balance serves to run the operational and strategic engines of the
Ministry through the Accounts Section and our corporate services policy directorate.

Output Measures

Hon. Kim N. Wilson: The output measures, Madam
Chairman, for the business units are listed at page B -
170. Some highlights of the Ministry’s performance
measures are better demonstrated in the Ministry of
Health Roadmap 2019, which serves as the Ministry’s
annual corporate plan and provides a helpful overview
of the Ministry as a whole. The Roadmap 2019 has been published on our website at www.gov.bm
under
the Health Librar y. Specific measures I want to highlight are as
follows: Under 31000, General Administration, health insurance rates will be tabled during this session, but
with a proposed effective date later than the 1
st of
April 2019, thus missing the target date. Thi s is due to
the decision to leverage hospital funding in order to put the health system on a more sustainable path.
Honourable Members will be aware that the
Ministry has worked with the Bermuda Hospitals Board [BHB] and the Bermuda Health Council on a
transformative innovation that will transition the hosp itals to a streamlined payment mechanism. This will
create dramatic efficiencies, incentivise a focus on
appropriate care and efficient use of resources, and
prevent a forecasted $20 million in additional health
care costs. The savings are being used to minimise standard premium rate increases, as well as to invest
in evidence- based programmes for more prevention
and primary care.
Currently, the Bermuda Hospitals Board c overs its annual cost through four m ain funding
sources: (1) fees charged to the Island’s public and
private insurers for health services rendered (this is claims against the Standard Health Premium); (2) a
government subsidy grant towards the cost of caring
for children, seniors, and the indigent; (3) a gover nment grant for the Mid- Atlantic Wellness Institute
[MWI]; and (4) a transfer from the Mutual Reinsurance
Fund [MRF]. The hospital is also able to bill nonresidents for any health care delivered and can bill
residents for select services that are not standard
health benefits.
The objective of these various revenue
sources is to ensure that BHB has enough funding to
operate the hospital and MWI, and to be able to ge nerate sufficient surplus to re- invest in necessary buil ding maintenance a nd infrastructure, such as technol ogy upgrades.
However, fragmented approaches like these
are increasingly viewed by health and finance experts
as expensive, outdated and, in the long run, unsustainable in the face of an ageing population and gro wing heal th care needs. International evidence has
clearly shown that these types of volume- based feefor-service payment models result in higher spending.
Alternative payment models, such as capitated pa yments, bundled payments, and value- based grants,
have been proven to be more cost -effective and to
result in better health outcomes.
Madam Chairman, the 2018 transition of
BHB’s fees to a rational methodology, using an internationally accepted standard based on the relative
value of procedures, has been extremely valuable to
properly assess the volume and complexity of care
delivered by our hospitals. This makes it possible to
properly budget, based on actual cost of services r ather than by using the antiquated process of rubber -
stamping arbitrarily derived fees. I t has also placed us
in a better position to transition Bermuda’s health sy s936 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly tem away from the antiquated coding framework that
the rest of the world has abandoned, and adopt ICD -
10, at long last. In short, the planned transformation of
hospital funding is aligned with the conversion of fees
to relative values.
Madam Chairman, regarding business unit
31015, Grants Administration, that can be found at
page C -17, which lists the Health Ministry’s grants to a
number of agencies providing essential front -line se rvices to aid public health and social assistance. These
are as follows:
• $2,862,000 for the LCCA to cover overseas
medical care for un insured and underinsured
persons;
• $125,000 for the Bermuda Nursing Council to support the regulation of nurses;
• $800,000 f or the Bermuda Health Council,
which I will speak about moment arily;
• $38,000 for Age Concern;
• $753,000 for the following rest homes:
Lorraine Rest Home ($502,000), and Matilda
Smith Rest Home ($250,000); and in addition
• $300,000 for Summerhaven;
• $300,000 for Packwood Rest Home; and
• $42,000 for Admiralty House;
• $10,000 for SART ( Sexual Assault Resource
Team );
• $13,000 for Tomorrow’s Voices; and
• $100,000 for public health scholarships.
Madam Chairman, our commitment to the Dr.
Barbara Ball Public Health Schol arship is unwavering.
We are currently accepting applications for the
2019/20 academic year and anticipate awarding $100,000 in scholarships once again to deserving
students in key public health areas. We continue to
prioritise areas in which we are aware of manpower
deficits in public health, such as nursing, social work,
allied health professions, and environmental health.
Since 2015, the Ministry of Health has su pported nearly 30 students in the areas of medicine,
nursing, social work, physiotherapy, pharmacy, counselling, dentistry, and occupational therapy. This is a
worthy investment in Bermuda’s health workforce.
Madam Chairman, business unit 31020, Corporate Services, serves to support my office and leads major policy initiatives and PATI implement ation.
Significant policy and legislative changes
achieved in the last year include amendments to up-grade the Psychological Practitioners Act, the Allied Health Professions Act, and now the Midwifery and
Nursing Act, the Day Care Regulations, legislation
impacting operations of the Chief Medical Officer, and
the Mental Health Act. In addition, we have developed
and implemented the Care Homes Code of Practice,
which is raising standards across the Island’s rest homes; and we overhauled the child day care re gulatory regime to protect the well -being and safety of our
children. Madam Chairman, these are excellent
achievements that Honourable Members in this House supported unanimously and helped move Bermuda
forward in protecting the public.
With respect to th e Public Access to Information (PATI) Act responsibilities, the Ministry of Health continues to be disproportionately burdened.
Again, while we fully support the spirit and intent of
PATI and go to more lengths than most to provide
accountability and trans parency to the public through
our website, Health eBites , Issue Briefs , as well as
Vital Signs newsletters, PATI implementation is costly
and draws resources away from material public health
needs.
This year, my Ministry has handled 17 PATI
requests to date, including seven internal and seven
ICO reviews, some of which have been open for over a year. These absorb a tremendous amount of staff
time and resource that is out of proportion to any possible benefit to the public. By way of an example,
Madam Chair man, just one PATI request that was
studied to assess its impact required an excess of 337
man- hours and cost the government well over
$20,000. Madam Chairman, this cannot possibly have
been the intent of PATI. I would have much preferred
to have given that $20,000 to a rest home or to a
homeless programme. But instead, this public money
was spent on satisfying the curiosity of one requester. And it is a regrettable usage of the public’s money.

Major Policy Changes

Hon. Kim N. Wilson: Madam Chairman, amongst the
most significant policy changes in the current year has
been the introduction of the sugar tax, jointly with the
Ministry of Finance. This initiative was in our platform
and the 2017 Throne Speech, and was developed quickly to send the strongest message to the comm unity that Government is serious about tackling obesity
and chronic diseases.
The sugar tax was introduced with the intent
of shifting public choices towards healthier beha viours. Lowering our sugar consumption is necessary
to combat our obesity, diabetes, and kidney -related
disease rates, which are driving up health care costs
untenably. Under the new tax, both consumers and
businesses benefit from avoiding sugar -based products. We welcome and encourage entrepreneurship in
tapping into th e public’s increasing demand for healt hier alternatives with reduced or no sugar. A market exists for this, and more and more products can be seen on many retailers’ shelves, reflecting the changing mood and tastes of the population.
As of the 1
st of Apri l this year, the rate goes up
to 75 per cent, and it will also be applied to chocolate
and cocoa preparations containing added sugar and
to sugary breakfast cereals. This is in alignment with the original consultation feedback, which called for
application to a wider set of items. In addition, Madam


Bermuda House of Assembly Chairman, changes to the tariff code will be made to
ensure drinks that do not contain sugar are not su bject to tax.
In addition, Madam Chairman, the Ministry
advanced its 2018 Throne Speech initiative on healt h
financing reform. Consultation was conducted with an
[appointed] Stakeholder Consultation Group, including
insurers, health professionals, charities and patient
representatives. Excellent feedback was gathered,
which is being considered to enable a final determination on a way forward. I expect that we will be able to
advance this further before the summer. Updates are
provided regularly through our newsletters and on our
website.

Plans for the Upcoming Year
Hon. Kim N. Wilson: Madam Chairman, under thi s
business unit, we will be bringing some legislation changes in the upcoming year, including updates to
health professional statutes to upgrade and standar dise all health professionals’ regulation, modernise the
Medical Practitioners Act, and upgrade the Dental
Practitioners Act. We are also preparing consultation
to reform the handling of health professional complaints to develop a more effective, streamlined trib unal structure that will ensure that complaints against
health professionals are handled fast er and more
consistently.
In addition, Madam Chairman, as I indicated
previously, a lot of movement has been taking place
under the auspices of the Bermuda Health Strategy to
put our health care system on a sustainable path for-ward. We have an ambitious agenda and are relentlessly focused on improving access for all, increasing
affordability and better patient outcomes. These are
the priorities for our health system and require us to
have the courage for transformational reform. We
need to do things very d ifferently if we want to get di fferent results. The time for change, Madam Chairman, is now.

Office of the Chief Medical Officer

Hon. Kim N. Wilson: The Office of the Chief Medical
Officer can be found, Madam Chairman, at pages B -
167 to 172 of the Estimates of Revenue and Expend itures. Moving now to business unit 2102 (under Head
21), which pertains to the Office of the Chief Medical
Officer [CMO], its total budget for fiscal year 2019/20
is $1,074,000, which funds two cost centres, namely,
31030, the Hea lthcare Registration and Regulation;
and 31040, Epidemiology and Surveillance Unit. The
office consists of eight full -time employees and a co nsultant pharmacy inspector providing service equiv alent to 0.25 of a full -time employee.
The responsibilities of the Office of the CMO
fall under four broad categories. First, the office regi sters health care professionals and health care facil i-ties, such as pharmacies, clinical laboratories, and diagnostic imaging facilities. It monitors credentials,
qualifications and standards of practice, and receives
and addresses complaints against health care profes-sionals.
Second, the office’s pharmaceutical drugs
control responsibilities include monitoring the import ation and export of controlled (banned) drugs and r elated products to ensure that these items are safe and
are delivered to the appropriate persons. The office
issues personal and commercial importation licences for controlled drugs and ensures that the Island is upholding the controlled drug quotas agreed by the I nternational Narcotics Control Board [INCB] in Vienna,
Austria. The INCB monitors the implementation of the
United Nation’s international drug control conventions.
Third, the Office of the CMO provides health
protection and community health assessment fun ctions through the work of the Epidemiology and Surveillance Unit [ESU]. The Epidemiology and Survei llance Unit monitors the occurrence of diseases on the
Island, both infectious disease (communicable di seases) and some chronic non- communicable diseases, to help prevent and control these diseases. The
unit receives reports from health care providers and facilities, and investigates possible outbreaks. Its staff
advises health care professionals and the public on managing infectious diseases which have the pote ntial to spread throughout the community.
The ESU also conducts intermittent community health surveys to monitor and document the health of the population, and it shares assessment infor-mation with the public, with government departments,
and with col laborating institutions in order that appr opriate public health actions can be taken to prevent and control diseases.
Finally, the Office of the CMO performs var ious statutory functions and services required by Bermuda law, such as granting permission for burials,
relief of customs duty, advising government on health
matters, and serving on and supporting the work of
statutory boards and councils. The office serves as
the national public health focal point for communic ations coming from and going to international agencies such as the World Health Organization and the INCB. Many of these communications relate to funded trai ning opportunities for health sector workers.
Madam Chairman, of the Office of CMO total
budget, $630,000 is allocated to Healthcare Reg istration and Regulation. This year, the section registered 870 health care professionals and processed 248 statutory requests from the public. Of these, 129 were
commercial drug requests.
Also in this fiscal year, the office launched the
inaugural online reregistration of medical practitioners,
allied health professionals and pharmacists. The need
for automation of these processes was long- awaited
and not without challenges. We are satisfied that the
tedious manual procedures are being replaced by
938 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly more ef ficient and thorough electronic procedures. An
online process for initial registration of all health pr ofessionals will be implemented in the coming year.
The Registrations 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 the coming year,
the office expects to complete the policy development
required to update the Medical Practitioners Act 1950,
and to update the Standards of Practice for Medical Practitioners.
Regulatory responsibilities were weighty in the
past year due to the steady flow of complaints which were handled within the Professional Conduct Com-mittees. These procedures require costly legal support. As a result, legislative reform efforts continue to
be a priority, with the hope of developing complaints -
handling procedures that are better suited to the r esources available.
Legislative reforms in 2018 transferred some
of the regulatory functions from the Office of the CMO
to the Bermuda Health Council. Specifically, the regi stration of health care facilities is an initial step. Regulatory support for professional boards will also be
transferred to the Health Council over t he coming fi scal year, starting with allied health, dental professionals, and optometrists and opticians. This will allow
greater focus of resources on the regulation of medical practitioners and on essential health protection
and community assessment func tions within the Office
of the CMO.
A sum of $444,000, Madam Chairman, has
been budgeted for the work of the Epidemiology and
Surveillance Unit for the year 2019/20. In 2018, the
ESU managed over 600 reports of communicable di seases, investigated 156 indi vidual case reports, and
addressed eight major disease outbreaks. I have to stress, Madam Chairman, that this is a mammoth task
that was undertaken by three staff members. I cannot
underestimate the difference that three people make
in keeping Bermuda safe from communicable diseases and their outbreaks.
In addition, the ESU focused on improving the
capacity of staff in the office and in the Department of
Health to respond rapidly and effectively to public health emergencies such as disease outbreaks. The
ESU successfully implemented the Caribbean Field
Epidemiology and Laboratory Training Programme, an
intensive practical epidemiology training from Cari bbean Public Health Agency. We are delighted to con-firm that five Ministry of Health employees are ex-pected to graduate successfully from the programme
in the coming two weeks.
Work continued in 2018 on the development
of the chronic disease register and on the multi -
sectorial collaborations to address the threat of anti -
microbial resistance [AMR]. Both endeavours are considered critical public health work and will continue indefinitely, by necessity.
Also, in 2019, Bermuda’s second community -
wide chronic disease risk factor survey, STEPS 2019,
will be implemented. Data from the first STEPS [to a Well Bermuda] survey of 2014 informed policy deve lopment and planning. It will indicate progress, or lack
thereof, made in addressing chronic disease risk factors such as obesity, sedentary lifestyle, tobacco and
alcohol use, and poor diet. As always, the purpose of
obtaining such public health information is so that effective strategies and actions involving the whole of
society can occur to protect and promote the popul ation’s health.
Madam Chairman, this ends my presentation
for business unit 2102, the Office of the Chief Medical
Officer.

Ageing and Disability Services

Hon. Kim N. Wilson: Ageing and Disability Services,
Madam Chairman, can be found at pages B -167 to B -
172 of the Budget Book. Line item 2103, Ageing and
Disability Services [ADS], can be found listed as the
National Office for Seniors and the Physically Cha llenged.
Madam Chairman, ADS’s mission is to improve the quality of life for seniors and persons with physical and intellectual disabilities . This is achieved
by regulating care homes, coordinating and ensuring
the delivery of programmes, and by collaborating with
a network of stakeholders.
Madam Chairman, Ageing and Disability Services has a budget of $2,883,000, which is the same as the previous year’s budget, though $788,000 higher than the revi sed estimate.
ADS operates two programmes, Madam
Chairman. One is the Ageing and Disability Services,
which is cost centre 31135, and the second is the K. Margaret Carter Centre, which is cost centre 31160.
Madam 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
[$1.86] million to fund 19 staff delivering direct client services to 51 service users participating in six dif ferent programmes. In 2018, all vacant posts, with the
exception of one, were filled at KMCC, making it a
total of 18 permanent staff. However, the staff -to-client
ratio remains too high, causing untenable shortages when permanent staff is out sick or on l eave. Accor dingly, the Management Consulting Services [MCS]
has begun an operational and staffing review to i mprove the efficiency and service quality of KMCC.
A key KMCC programme to highlight is the
community -based employment programme. The
Training an d Employment Division engages clients in
meaningful work, based on their skill level and their area of interest. At present, Madam Chairman,


Bermuda House of Assembly [92] per cent of a select group of clients work in var ious businesses across the Island, while 93 per cent
participate in in- house contract work and receive st ipends from local businesses for the completion of
short -term projects.
In addition, over the last year, KMCC has
partnered with MWI’s programme for persons with
intellectual disabilities to increase opportuniti es to cl ients and their families for enhanced client development. Part of this collaboration is the use of client -
centred passports geared to the client’s personal care
and enhanced development needs.
Madam Chairman, outside of KMCC, the O ffice of Ageing and Disability Services focuses on public education and awareness, accessibility, compl iance, and case management.
Speaking of case management, Madam
Chairman, that represents the largest staffing component for the office. And as of January of 2019, the o utstanding and essential posts of case manager supervisor and three case managers were filled. However, due to two staff members being on maternity leave,
the office will remain understaffed until April of 2019.
Despite the staffing shortages, ADS continues
to manage both general and complex cases for sen-iors and persons with disabilities in our community. In
2018/19, the team managed 168 general cases and 24 complex cases. Complex cases are heavily time
intensive and difficult to manage, most often due to
the clients’ and/or the government’s limited and fragmented support system. In 2019, the office is working
on solutions to address some of the primary challenges in this area, including consideration of public r eceivership options and required support funding.
A major step in 2018 to strengthen case management services was the purchase of a case management software programme. Ageing and Disability
Services spent $50,768 on this software and training
to improve data collection and tracking. The software
will certainly help facilitate and ensure more standar dised delivery of ADS supports and future system planning.
Compliance. As part of their remit, ADS oversees the Senior Abuse Register Act 2008, the Res idential Care Homes and Nursing Homes Act 1999,
the personal home care benefit provider registration
process, and accessibility building inspections and
permit reviews in partnership with the Department of
Planning.
In 2018, there were 32 reported and invest igated cases of alleged senior abuse, which inclu de
physical, psychological and sexual abuse, financial
exploitation and neglect. ADS and its partners remain
challenged with investigating cases of abuse, especially for an end result of prosecution, due to the complexity of the family, health, care and support circum-stances that surround these cases, but also due to our
legislative structure. The Ministry is looking for struc-tural and/or legislation this year to improve the protection and support for all adults in need of such.
For care home compliance monitoring, in
2018, ADS received 15 care home complaints and
conducted 15 investigations. At present, with the as-sistance of a contracted inspection officer, ADS has a
24-hour response rate to care home complaints.
In 2018, twenty licensed care homes recei ved
a comprehensive inspection, using a significantly up-graded inspection tool and process based on the new
Code of Practice for Care Homes. The code was pu blished as result of the 2017 amendments to the Act
and explicitly outlines standards of care, including a
Bill of Rights. Care homes have been given a year to
address deficiencies against the new code, as of D ecember 2019 re- licensing process will include compl iance grades and associated relicensing fees to i ncrease accountability, transparency and, ult imately,
the quality of services.
With an ageing population, the demand for
long-term care services will grow, including home
care, and ADS is seeing this demand through their registration of personal home care providers paid
through HIP and FutureCare be nefits. Currently, the
register has over 500 self -employed home care pr oviders and 14 home care agencies in 2018, compared
with 185 home care providers and 10 home care
agencies in 2017.
The Ministry is currently reviewing and u pgrading the registration process and developing
standards for this sector to improve public protection,
due process, and quality of care.
Madam Chairman, Education and Awareness
are essential components to ADS’s mandate. Key achievements and work completed over the last year
include the following:
• An Education Officer was seconded in to pr ovide education and professional development
programmes to care home staff to facilitate
compliance with new Code of Practice;
• The ADS accessibility officer completed over
56 inspections for compl iance, but also for
consultation and advice to promote accessible
design to the community;
• The Disability Advisory Committee and the
ADS celebrated the U nited Nations Day for
Disabilities on the 3
rd of December in partnership with KMCC, MWI , and the Depart ment of
Workforce Development , through an outreach
and awareness event focusing on employing
persons with disabilities; and
• ADS engaged senior groups across the I sland
regarding offered services and senior abuse. This included stakeholder relationship- building
and collaboration to provide education and
awareness with the Bermuda Police Service,
the Department of Community and Cultural
Affairs, and Mid- Atlantic Wellness (MWI) Inst itute, to name a few.
940 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly Madam Chairman, the work of the ADS team
is mammoth, and it serves as a proxy for adult social
services. However, it cannot fulfil this role with its current structure, resources and legislation. Despite this,
however, the staff perform herculean tasks every si ngle day, assisting vulnerable seniors and persons with
disabilities where there is no one else to help.

Bermuda Health Council

Hon. Kim N. Wilson: Madam Chairman, the Bermuda
Health Council is at Head 21. I want to highlight the
work of the Health Council, which is a quango under
the Ministry and whose operations are funded in large
part through a government grant, to advise and make
recommendations on health system matters to the
Ministry.
Madam Chairman, the Bermuda Health
Council’s general purpose is to regulate, coordinate
and enhance the delivery o f health services . The grant
for the Bermuda Health Council can be found on page
C-17, representing cost centre 6895, under the Mini stry of Health. In 2019/20, the Health Council’s grant will be $800,000, which is a return to the grant level
given in 2017/ 18 and 2016/17. The Health Council’s
total revenue is supplemented by a transfer from the
Mutual Reinsurance Fund [MRF], and licensing fees paid by health insurers, for a total budget of $1.7 mi llion for 2019/20.
Madam Chairman, in 2018/19, the work of the
Health Council centred on four strategic areas: quality
and standards, regulation, finance and economics,
and audit and governance, as well as its mandate to disseminate information to the public. Some of the
year’s achievements were as follows:
The Health Council facilitated active use of
the unique patient identifiers with 14 public and private
health service providers, encompassing approximately
1,400 patients. This is a progressive step toward more
accurate patient reporting, improved continuation of
care, and reduction in health costs associated with
unnecessary testing and treatment.
In an effort to enhance the quality of health
services provided, the Health Council collaborated
with two statutory boards to develop a standards of
practice assessment tool, which provides guidance on measuring compliance with and effectiveness of pr ofessional standards of practice.
In line with its mandate to identify goals and
make recommendations about health services, and
ensuring services are provided to the high est stan dards, the Health Council conducted nine health tec hnology reviews between April and December of 2018.
This process involved review of proposed health services to ensure that they would address the care
needs of Bermuda’s residents and would be pro vided
at an appropriate standard.
Madam Chairman, the Health Council mai ntained its goal of improving data validity in 2018/19 to enhance health system analysis and planning. The
Health Council collaborated with private and public
insurers to identify opportunities to improve accuracy
in the data that the insurers receive and improve their
internal processes for claims adjudication.
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, also referred to as the standard
health benefit.
Madam Chairman, between April and December of 2018, the Health Council investigated 231 employer health insurance policies reported as inactive,
and conducted nine inspections, representing 1,231
employees.
After investigation and responding to 81 complaints and queries, 40 per cent (or 92) of the policies were reactivated and 37 per cent (or 454) of the employees regained health insurance coverage.

Financing and Economics

Hon. Kim N. Wilson: Madam Chairman, the Health
Council published the 2018 National Health Accounts
Report, which details total health system expenditure
of $723 million, which reflects an incr ease of 2.26 per
cent and a per capita expenditure of $11,336.
The council conducts the annual actuarial r eview of the standard premium rate and published the
2018 Actuarial Report inclusive of premium reco mmendations for the MRF and standard health benef it.
Madam Chairman, in 2018/19, the Health
Council also began to consult about proposed changes to the structure and application of the medical and
dental charges, which are the regulated chargeable
amounts for non- hospital physicians and dentists who
provide services in the hospital.
The proposed changes are intended to address long- standing concerns around appropriate r eimbursement for complex medical and dental proc edures.

Audit and Governance

Hon. Kim N. Wilson: Madam Chairman, to continue
its track record of timely financial transparency, the
Health Council, in close collaboration with the Auditor
General, tabled its audited financial statements and
2017/18 Audit Report in June 2018.
The Health Council held a Strategic Planning
session where the board and secretariat discussed the strategic vision of achieving a quality, equitable
and sustainable health system by addressing local
and overseas care costs, out -of-pocket payments,
data accuracy, accessible essential care for all, sup-port for a reduction in chronic kidney disease, and enhanced collaboration and care integration.



Bermuda House of Assembly Information Dissemination

Hon. Kim N. Wilson: Madam Chairman, to enhance
public education and encourage public awareness
and involvement, the Health Council released key pieces of information about the health system and any
proposed or upcoming changes. In 2018/19, this i ncluded two issue briefs, four information briefs, and one procedure summary. This was also supported
through an improvement in its transparency around
interact ions with different stakeholder groups.

Looking Forward to the Future

Hon. Kim N. Wilson: Madam Chairman, in 2019/20
. . . excuse me.

[Pause]

Minister, I will just take a minute to
just remind the listening audience that we are in
Commi ttee of Supply for further consideration of the
Estimates of Revenue and Expenditure for the year [2019/20]. And we are currently doing the Ministry of
Health, under Head 21.
Hon. Kim N. Wilson: The Health Council will continue
its involvement in health s ystem and financing reform
to ensure affordable and accessible health coverage
for all and achieving a more value- based health sy stem. The Health Council will also continue its work on
the development of an essential medicines list and
associated regulatio ns, as a step forward toward
achieving its mandated function to regulate the price
at which drugs are sold.
In June 2019, the Health Council’s regulatory
oversight will increase in accordance with the Chief
Medical Officer (Transfer of Functions and Validation)
Act 2018 to include diagnostic imaging facilities, clinical laboratories and hospitals.
In 2019/20, the Health Council will enhance its
enforcement of the claims regulations in an effort to further improve the reliability of health system data in aid of health system planning and to better understand health costs.
And finally, Madam Chairman, I would like to
acknowledge the 2019/20 Bermuda Health Council
board members, whose expertise will contribute to its
ongoing achievements. The members are as follows:
• Dr. Alicia Stovell- Washington, Chairperson;
• Mr. Granville Russell, Deputy Chairman;
• Dr. Annabel Fountain;
• Mr. Sandro Fubler ;
• Dr. Darrien Ray ;
• Dr. Claudette Fleming;
• Mrs. Michelle Jackson;
• Mrs. Laure Marshall ;
• Mr. Peter Parker ;
• Mrs. Venetta Symonds ; and • Ms. Cynthia Thomas.
In addition, I would also like to acknowledge
the ex officio members of the Board of the Health
Council, the Permanent Secretary for Health, the
Chief Medical Officer, and the Financial Secretary.
Madam Chairman, this concludes my remarks
on Head 21, Ministry of Health Headquarters.

HEAD 22 —DEPARTMENT OF HEALTH

Hon. Kim N. Wilson: Head 22, the Department of
Health, can be found in the Budget Book at pages B -
173 to B -183. Madam Chairman, the Department of
Health’s vision is Healt hy People in Healthy Communities. The department promotes and protects the
physical, psychological and social well -being of the
community, to enable Bermuda’s residents to realise their optimum quality of life. On page B -176, we see
that 285 Department of Health officers work in 25 pr ogrammes to ensure the health and well -being of the
general population. The total current expenditure is estimated to be $28,817,000 for 2019/20 and repr esents a decrease of $95,000, so that, overall, the
budget is very slightl y reduced from the 2018/19 orig inal budget.
The Health Department’s overarching strat egic theme is to halt the rise of obesity and diabetes.
To this end, the Health Promotion Office develops and
implements policies, programmes and products that
will promo te health and wellness in the community, in
collaboration with public health partners. The Depar tment of Health has initiated a whole- of-society a pproach to halting the rise of obesity and diabetes l ocally.
Madam Chairman, the Speech from the
Throne 2017 stated, “The Government will lead the
way in wellness by encouraging its employees to
make healthy choices, and will contribute to their well -
being by offering programmes, incentives, and educ ation to support the journey to a healthier public ser-vice.”
The Department of Health is collaborating with
the Department of Human Resources, GEHI, and I nformation and Digital Technologies to form the Gov-ernment of Bermuda [GOB] Employee Wellness
Committee to develop the Government of Bermuda’s
Employee Wellness Programme, which is branded as
#choosewellness
. The committee will be rolling out
various initiatives in the near future to encourage and support public servants to lead healthier lifestyles.
Madam Chairman, the Healthy Schoo ls 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. Healt hy
Schools has been adopted by 28 of 31 public and pr ivate schools, since 2014.
942 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly The Premier’s Youth Fitness Programme
[PYFP] is administered through Healthy Schools.
Whilst the programme, implemented by the Premier’s
Council on Fitness, Sports, and Nutrit ion, has its roots
in all public school levels, the primary aim is to i ncrease the level of physical activity and healthier eat-ing in children and teens, and their families.
Madam Chairman, the 2019/20 budget est imates for Health Promotion and Healthy Schools are listed as cost centres 32240 and 32265, on page B -
174, and the combined 2019/20 budget estimate is
$458,000.
Madam Chairman, Nutrition Services has
been working towards healthy eating practices within the Health Department’s Obesity and Diabetes Framework, which was developed with community -
wide consultation and engagement.
Sustainable Nutrition supports accessibility,
availability and affordability of healthy foods to all.
Programmes include the Grow. Eat. Save. workshops,
which have been facili tated in partnership with Instructor Chaplain Kevin Santucci, the Department of Parks,
the Department of Environment, the Bermuda Agricultural Group, the Devonshire Seventh- day Adventist
Church, Animal and Garden and Brighton Nursery.
Two workshops, with 54 graduates, have continued,
with five weeks of theory and expanded to three months practical experience.
Community Gardens are being promoted in
partnership with the Department of Parks, Green
Rock, and Keep Bermuda Beautiful, in consultation
with the Pl anning Department, to develop guidelines
for the establishment of parish community gardens.
Nutritionists are collaborative partners with the
Health Visitors, establishing that the exclusive breas tfeeding rates, at age six months, in Bermuda is 16 per
cent. This is an increase from a very low 1 per cent
rate measured in 2001. This highlights the barriers to breastfeeding in our community, such as the need for
policies supporting breastfeeding in workplaces. Co ntinuing policy work includes drafting the Department of
Health’s Breastfeeding Policy, collaborating with
KEMH Maternity Ward for a Baby -Friendly Hospital
Initiative, and partnering with WHO/PAHO in the draf ting of the Health Department’s Infant and Young Child Food Policy.
Community education includes collaboration
with the Ministry of Education, the Argus Group,
Healthy Schools, the Department of Health, and the
Bermuda Dieticians Association in facilitating the
School Lunch Challenge, in which 12 schools receive
awards for participating, and 23 overall students wi nners from P1 to M1.
Madam Chairman, the 2019/20 budget est imate for Nutrition Services is listed as cost centre 32110 on page B -173 and is $189,140.
Madam Chairman, the mission for the Maternal Health and Family Planning Clinic is to pr ovide
women of Bermuda with high quality, accessible and affordable reproductive health services , to promote
Planned Parenthood amongst women of reproductive age, and to offer antenatal and postnatal care for
women who are under insured or uninsured.
The D epartment of Health provides the Communicable Disease Clinic —

POINT OF INFORMATION

Hon. Patricia J. Gordon -Pamplin: I am sorry , just a
quick point of order.
I lost the Minister with the head to which she
is just referring. She is going through it very quickly.
And I am trying to copy down and make notes. So, if
she would just refer, when it comes to the department
heads or the business units, if she could just make
sure and slow down a little bit so I can make sure. Then I will not have to come back and ask for it.

Basically, she wanted you to slow
down a little.

Hon. Kim N . Wilson: Cost centre 32040 at page B -
173, for Sexual and Reproductive Health.
Hon. Patricia J. Gordon -Pamplin: Thank you.

Hon. Kim N. Wilson: You are welcome.
The Department of Health provides the Communicable Disease Clinic and services to prevent and
control the spread of communicable diseases; ed ucates the community about sexually transmitted infections, HIV and other communicable infections; and
provides education to promote sexual health.
Last year, Bermuda was formally validated by
the Pan Americ an Health Organization as having eli minated mother -to-child transmission of HIV and syph ilis. This is a distinguished accomplishment met by few
countries, globally.
The management of the two programmes has
merged into the Sexual and Reproductive Health Pr ogramme.
Madam Chairman, I am now turning to the
Clinical Laboratory, which can be found at cost centre 32090, on page B -173. The Clinical Laboratory is si tBermuda House of Assembly uated at the Hamilton Health Centre. Testing of clinical specimens is performed for child health, sc hool
health clinics, oral health, and the sexual and repr oductive health programmes. The Clinical Laboratory
also serves as the Public Health Clinical Laboratory for Bermuda, and provides specimen handling and
international transport services to the Caribb ean Public Health Agency [CARPHA] Laboratory in Trinidad
for advanced testing for diseases of public health si gnificance. In 2019/20, the Clinical Laboratory will be expanding its testing capacity to support diagnosis in the Adult Preventive Health services.
That again is cost centre 32090, which r eceived a budget of $276,204.
The Child Health Programme, which is listed
as cost centre 23030 on page B -173, will receive the
sum of $2,523,000, which is up from the previous year of $1,876,307, simply because of the transfer of the
Health Visitor’s post from another business unit that I
will speak about in a moment.
Madam Chairman, the Child and Health Pr ogramme consists of four sub- programmes —child
health; school health, including asthma education;
travel heal th; and immunisation. The programme pr ovides preventive and curative health services for i nfants, children, adolescents, adults, seniors, and the traveling public. This is conducted through the various clinics, schools and community settings. Services i nclude health and developmental assessments,
scree nings, referrals, treatment of minor ailments,
health education, health promotion, anticipatory gui dance, adults’ and seniors’ immunisations, and travel consultation for travel to high- risk areas.
Bermuda’s E xpanded Programme on Immu nization [EPI] plans for the needs of vaccines in the
Child and Adult Schedules. [The] Expanded Pr ogramme on Immunization procures most vaccines through the Pan American Health Organization, e nsuring safe, effective, cost effective and quality vaccines. Universal access for many of the vaccines is
provided through the public and private sectors.
Vaccine hesitancy is a primary challenge,
Madam Chairman. Immunisation coverage was 72 per
cent at two years of age in 2017, which is significantly below the global target of 95 per cent coverage. Pr eliminary data for 2018 is 76 per cent. Low vaccination
coverage increases our vulnerability as a community
to re- emerging vaccine- preventable diseases, such as
measles, diphtheria and whooping c ough. The concerns are evident in the low immunisation coverage
and confirmed through a poll survey conducted as a
part of Vaccination Week of the Americas in April 2018.
To that end, Madam Chairman, the Depar tment of Health has created a working group to address public and health provider concerns. The wor king group includes Health Department staff, private
sector physicians, and community stakeholders. The
focus of the working group is education for health pr o-fessionals and the public on the issues. The use of
technology for messaging is being explored.
In 2018, the Child Health Programme operated below its established manpower levels. This is r eflected in the 32 per cent coverage for five- year-old
[health] assessments. However, efforts toward tac kling c hildhood obesity have been prioritised, and the
data suggest a stationary 22 per cent of all five- yearolds are overweight or obese.
The community health nurses continue to
monitor lunches for all 10- year-olds and educate on
healthy nutrition. Health information is also sent home,
Madam Chairman, to parents.
Madam Chairman, turning to Occupational
Therapist and Physiotherapist [OT/PT] Services,
which is located in the Budget Book at cost centre
32080 and 32120, on page B -173. The budget for
2019/20 is $1,035,000 and $1,022,000, respectively.
Madam Chairman, occupational therapist and physi otherapist services are provided to maximise the func-tional potential of individuals with delays in normal
motor development or with physical movement chal-lenges. The OT /PT team comprises nine occupational
therapists, eight physiotherapists, one coordinator,
and one team secretary who is shared with the pr ogramme.
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 conducts home safety and falls risk assessments for all
seniors who are referred, with the intention of minimi sing the risk of falls at home. Client and caregiver trai ning are pr ovided to maximise function and promote
“ageing in place .”
The Seniors -based Team continued to be i nvolved with interdisciplinary rest home inspections to
ensure that all licensed facilities were in compliance
with rest home standards. Additionally, educa tional
talks for residential care facilities were conducted to
decrease risk of falls and increase awareness of
equipment used to improve independence.
The OT/PT Paediatric Team aimed to i ncrease 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 the school term time.
School -age children with additional learning needs
due to complex health conditions and/or sensory m otor delays req uire regular monitoring and intervention
to retain their functional ability and to access educ ation.
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 benef icial in reducing the risk of regression of motor skills prior to the start of the year.
944 11 March 2019 Officia l Hansard Report

Bermuda House of Assembly Madam Chairman, the school -based Paediatric Team successfully conducted motor screens for all
students 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 help children stay physically active
and further develop motor skills.
Madam Chairman, I would like to t urn now to
the Speech and Language Programme, which can be found at page B -173, cost centre 32100. For the
2019/20 estimate, this programme will receive
$1,592,000. Madam Chairman, the Health Depar tment’s Speech and Language Programme provides
community -based speech therapy services in homes,
schools, and clinic settings across the Island. The
ability to communicate effectively is one of the foundations for a healthy community. Speech language pathologists work to promote functional communic ation skills, as well as to prevent life- threatening complications that may occur during eating and drinking.
The Health Department’s Speech and La nguage Services provide community -based therapy
services to infants and children who may be exper iencing communication or swa llowing challenges.
Therapy services include the provision of prevention
and promotion information, screenings and asses sments, as well as intervention. This year, 83 children
were referred to the early intervention programme,
with 50 of these having been seen for a screening or
assessment. In total, 48 students have been referred
to the school -based programme, all of whom have
received a full assessment. A combined 334 clients
were followed for regular intervention by both pr ogrammes.
Madam Chairman, turni ng now to the Co mmunity Health Nurses, which can be found at page B -
172 [sic], cost centres 32060 and 32010. Their combined budget —

[Inaudible interjections]

Hon. Kim N. Wilson: Yes, thank you. Page B -173. (I
am glad you are listening.)
And their combined budget estimate is
$2,644,000. Again, that is page B -173. I beg your pardon. Cost centres 32060 and 32010, page B -173.
Those are the Community Health, Madam Chairman,
and the Community Health Administration.
Madam Chairman, community health nurses
are r esponsible for ensuring that the adult population,
from age 18 until end of life, has access to health services. Madam Chairman, the analysis of the results of the “ Taking It to the Streets ” screening initiative
showed a high prevalence of behavioural risk factors,
such as physical inactivity, tobacco and alcohol use; high prevalence of self -reported non- communicable
disease diagnoses, such as diabetes, which repr esents 16.4 per cent, and hypertension, which repr esented 38,4 per cent; whilst only approximat ely 50 per cent of those diagnosed reported current treatment.
Biomedical assessment revealed that almost two out
of three were overweight or obese, and four out of five
had elevated or high blood pressure.
Madam Chairman, the Bermuda Health Strategy 2014– 2019’s Health Sector Goal 13 speaks to
this, and I quote, “Increase the access to interventions
to prevent and manage non- communicable diseases
and their risk factors, in order to reduce the burden of
chronic non- communicable diseases to Bermuda.” As
such, the community health nurses will further expand
their roles to provide services through the adult pr eventive health care services. Adult preventive health
care services are medical care that focuses on di sease prevention and health maintenance, including
early diagnosis of disease; discovery and identification
of people at risk of development of specific problems; counselling and other necessary referrals; and interventions to avert a health problem.
The Adult Health Programme consists of three
sub-program mes, namely, Correctional Health for
medical services to inmates in correctional institutions;
Occupational Health for medical assessment of r ecruits to the uniformed services, and Occupational
Health services to government employees in hazar dous and high- risk occupations; and Forensic Services
to the Bermuda Police Service [BPS] and medical s upervision of detainees in police custody.
During 2018, 110 clinical sessions servicing
1,020 inmate medical consultations were conducted at Westgate facility. Also, 8 6 per cent, or 176 new i nmates received an initial medical examination within
72 hours of intake. Fifty -six recruitment medicals were
completed for the uniformed services, which include police, fire, and corrections. During calendar year
2018, a total of 43 BPS forensic call -outs during wor king hours and 96 after hours, a total of 139, were ser-viced.
Madam Chairman, the Oral Health Section,
which I would like to continue with, can be found at cost centres 32150, 32155 and 32160, at page B -174.
And their combined 2019/20 budget estimate is
$1,497,000. Again, that is with respect to oral health.
The Oral Health Section provides comprehensive dental services to Bermuda’s children up to the age of 18 years old, as well as seniors 65 years and
older, priority groups, and others including the priso ners at the co- ed and other institutions. These services
include prevention, consultation and dental hygiene services, as well as other restorative clinical services.
Some of these services are free of charge. The ser-vices have now expanded to include full -time dental
service at the St. George’s clinic, and plans are on the
way to provide clinical services to Somerset in the
near future.
Preventive services are provided at the
schools. The preventive dental staff visit each clas sroom in the pre- school and primary school settings to
provide oral hygiene instructions, fluoride supplemenBermuda House of Assembly tation in the form of drops and tablets, and the screen
and seal programmes at the schools, which have
been very effective in protecting the children’s teeth
and reducing the incidence of tooth decay.
Madam Chairman, the Central Government
Laboratory, which can be located in the Budget Book
at page B -174, cost centres 32200, 32210 and 32220,
has a combined 2019/20 budget estimate of
$1,220,000. Again, that is with respect to the Central
Laboratory. And that provides a wide range of analyt ical services.
The forensic programme performs seized
drug and toxicology analysis. The seized drug anal ysis section has seen a change in the type of submi ssions to the laboratory, particularly those involving
[tetrahydrocannabinol] THC -containing products. The
product types submitted are no longer the traditional
cannabis plant or resin, but are coming in the form of
the ever -increasing and popular edibles. T he edibles
that have been submitted to the laboratory for analysis
include gummy candies, lollipops, chocolate and THC -
containing e- cigarettes [e- joints]. All include concentrated extracts of THC.
As a direct consequence, toxicology analysis
has increased in the clinical area for patients who pr esent themselves to the Emergency Department at KEMH with symptoms of apparent paranoia and ps ychosis.
The Water and Food Programme continues to
perform analysis of potable and recreational water
samples, dairy prod ucts and food, working closely
with the Environmental Health Section. There were
3,832 water samples tested in the prior budget period, and samples for this budget period are showing a further increase. As well as the analysis of dairy products
to meet legislated standards, food samples are now
being collected routinely from licensed food prepar ation and retail establishments, and tested for bacterial
quality and the presence of disease- causing microorganisms.
Vector Control, Madam Chairman, which is
going to be located in the Budget Book at page B -174,
at cost centre 32190, has a 2019/20 budget estimate
at $1,637,000. Vector Control is a hard- working team
that gets results and ensures that threats of rodent -
borne and mosquito- borne diseases like Dengue (I am
looking at the former Minister. I said I was going to get
that right!), Chikungunya and Zika do not manifest
themselves in Bermuda.
Always trying to improve its services, Vector
Control has piloted the use of novel rodenticide baits
that include rat bir th control. Residents are reminded
that the best way to limit rodent numbers is to deny
rodent access to food sources, such as garbage, by
using lidded, metal trash containers and not putting
trash out on non- pickup collection days.
The New Day Care Standards, Madam
Chairman, were released in November of 2017 and updated in 2018. All stakeholders involved in child care, from the government agencies to parents and
child care providers, are now clear on what is expected from them. A renewal of the oversight s ystem
for Bermuda’s —

Member from [constituency] 23, do
you have a question?
Hon. Patricia J. Gordon -Pamplin: Thank you, Ma dam Chairman.
Yes. We were just talking about Vector Control. And now I am hearing about child care. So, I am
just wondering if the Minister can go back and highlight what head she is speaking about, because obv iously we have moved on to something different.