February 26, 2024

We do have questions this morning.
There were written questions submitted to the Minister
of National Security. Those questions we re from MP
Dunkley, and they are for oral response.
Minister, do you have your answers?
MP Dunkley, would you like to put your questions? And we will start the clock now.
Hon. Michael H. Dunkley: Thank you, Mr. Speaker.
Good morning to you, colleagues and the listening au-dience.

Good morning.

QUESTION 1: MANPOWER OF BERMUDA POLICE
SERVICE, HM CUSTOMS, DEPARTMENT OF
CORRECTIONS AND BERMUDA FIRE & RESCUE
SERVICE AS OF 31 JANUARY 2024
Hon. Michael H. Dunkley: Mr. Speaker, to the Honourable Minister: Will the Honourable Minister please provide for this Honourable House the current man-power levels as of January 31, 2024, for the Bermuda
Police Service, HM Customs, the Department of Corrections and the Bermuda Fire & Rescue Service?

Supplementary? No? Okay.
Would you like to put your second question?

QUESTION 2: APPROVED MANPOWER OF
BERMUDA POLICE SERVICE, HM
CUSTOMS, DEPARTMENT OF CORRECTIONS
AND BERMUDA FIRE & RESCUE SERVICE
FOR FINANCIAL YEAR 2023/24
Hon. Michael H. Dunkley: Thank you, Mr. Speaker.
Second question: Will the Honourable Minister
please provide for this Honourable House the approved
and funded manpower levels as per the approved
budget for this current financial year, April 1, 2023 –
March 31, 2024, for the Bermuda Police Service, HM
Customs, the Department of Corrections and the Bermuda Fire & Rescue Service?

Supplementary? No supplementaries.
Would you like to put your third question?

QUESTION 3: OFFICERS HIRED IN
BERMUDA POLICE SERVICE, HM
CUSTOMS, DEPARTMENT OF CORRECTIONS
AND BERMUDA FIRE & RESCUE SERVICE
APRIL 2023 TO JANUARY 2024
Hon. Michael H. Dunkley: Thank you, Mr. Speaker.
Third question: Will the Honourable Minister
please confirm for this Honourable House how many
officers have been hired from April 1, 2023, to January
31, 2024, in the Bermuda Police Service, HM Customs,
the Department of Corrections and the Bermuda Fire &
Rescue Service?

Let me reset the clock.
Deputy Premier, you have the floor.
Hon. Walter H. Roban: Yes, Mr. Speaker.
I would just like to offer congratulations to the
Leopards Club International Bermuda. This past week-end they had a gala, which was part of a full week of
activities. I will associate the whole House with my con-gratulatory remarks, Mr. Speaker.

[Inaudible interjections]

Hon. Walter H. Roban: It is on.

Yes. I hear you.

Hon. Walter H. Roban: Thank you, Mr. Speaker.
They are celebrating 75 years of existence.
And I definitely will get a special mention to Minister Mi-chael Weeks who I know is a long- standing member of
that club. They have had a week of remembrance, of
celebrations and of tributes. I , along with MP Ming and
Minister Darrell, who sits in another place , and another
Senator who sits with the Opposition were there on Saturday night. It was an excellent event held in their hal-lowed headquarters.
What is exciting about the Leopards Club is
that they have a very exciting young leadership. It is
known as a club that has more mature persons involved. But I was excited to see such young leadership
driving the club under the leadership of De Roy Butterfield. I was excited so much that I rejoined on Saturday
night. I was a member. I actually was on the executive
a couple of years ago. But I had left the Island to study and thus my membership concluded. But I rejoined on Saturday because I am so excited about that club, and
not only being a part of its history but also its future. So
I just want t o congratulate them. I believe those events
concluded last with a night of jazz. But the Leopards
Club is on the move. And I am so excited to bring tribute to them on their great achievement of 75 years.
Thank you, Mr. Speaker.

Thank you Deputy Premier.
MP Weeks, would you like to have a contribution?

Hon. Michael A. Weeks: Thank you, Mr. Speaker.
Mr. Speaker, I would like to be associated with
the remarks for the Leopards Club International. I too, like the Member who just sat down, have been a longBermuda House of Assembly standing member and served on the executive and the
like.
But I just want to give a little history of the Leopards Club, Mr. Speaker. There was a time when we
lived in a segregated society. And Leopards Club had one of the first hotels that Black people could live in. So
a lot of the famous people who came, Blac k people who
came from overseas, actually lived in the Leopards
Club hotel. And they had a radio station back in the
1940s , 1950s and 1960s. That was classified as one of
the first Black radio stations in Bermuda, because
again, we came up in a segregated era, and the Leopards Club played its part. So not only have I served long
years in the Leopards Club, my father before me was
also one of the early members of the Leopards Club.
So for 75 years they have really withstood the test of
time. So hats -off to 75 years of Leopards Club.
Mr. Speaker, I would also like to offer congratulatory remarks, and I hope the House will also send some congrats. There have been three chief inspectors
of the Bermuda Police Service who are now raised to the rank of Superintendent: Superintendent Dennis
Astwood, Superintendent Sherwin Joseph and Superintendent Jerome Laws. Superintendent s Dennis
Astwood and Jerome Laws have come right through
the ranks of the Bermuda Police Service. And hats -off
to these fine gentlemen for becoming superintendents in our service.
Thank you, Mr. Speaker.

Thank you, Mr. Speaker. Good
morning, colleagues.
Mr. Speaker, I would like to send congratulations to the St. Paul AME Church. I had the privilege, together with some of my other colleagues, to attend
their Men’s Day two Sundays ago. And the theme for
the day, just in case you are interested, was Living Our
Testimony. I certainly wish to congratulate several of the persons who took part on that day, and most par-ticularly the Chairman of the Men’s Day Programme,
my Branch Chairman, Tarik Bean- Darrell. I will associate Ministe r Weeks and MP Ianthia Simmons -Wade.
Specifically, there were two very young men
who gave a scripture reading and the litany. And I mention them especially because they were very young. The first one was a 10- year-old Isaac Moniz. I cal l him
Isaac. Isaac is my political nephew. He comes to every
one of my monthly clinics and joins me with them because he is a strong PLP supporter. The other one is
Zaya Daniels, 12 years old , who read the litany. And I
was very impressed with them.
Of course everyone knows the shepherd of the
church there is Rev. Nicholas Dill [sic].

Mr. Speaker, I would like
to be associated with the congratulations sent out to St.
Paul [AME Church] and the Men’s Day Committee in
particular, the organiser of the Men’s Day, MP Tyrrell.
Tarik Bean- Darrell, being my cousin, did an outstanding job of organising that, and it was a wonderful expe-rience for me on that Sunday morning.
And also that afternoon to attend the Girlguiding Thinking Day once again at the Anglican Cathedral.
And I would like to associate Minister Michael Weeks,
who attended as well. It was an outstanding Thinking
Day. Very thoughtful, environmentally focused T hinking
Day. And it caused many of us to think about many things on that day, as well.
Finally, Mr. Speaker, on another good note, I
would like congratulations sent to young Oliver
Betschart , the young golfing protégé. I will associate
the whole House. MP De Silva is there raising his hand, MP Burgess as well, MP Tyrrell and Minister Weeks. He won the Hurricane Tour Texas Junior Open. He is
now coached by a childhood friend of mine, David
Ogrin, who won the Texas Open, beating Tiger Woods
in 1995.
And now Oliver is the junior version under his
tutelage in Texas, down there in New Braunfels where
he goes for coaching from time to time. He is a good
old Texan and a Bermudian. And he also represents
Switzerland through his grandfather’s connection ther e,
Leo Betschart, whom I knew over 50 years ago in the Belmont Hotel kitchen, where I used to spend a lot of
time when I was a waiter. They fed me well before I
went down to Tucker’s Town and got fed equally as
well, and probably even better.
492 26 February 2024 Official Hansard Report

Bermuda House of Assembly But those congratulations I would like [to extend] today. But Oliver warms my heart with the development that he is making. And he served us proud by
being one of the youngest ever to play in the PGA tour,
along with Kenny Leseur this last year when both w ent
15 years old, coming under the Swan farm. Thank you.

Are you finished? Okay. Thank you.
MP De Silva —
You are still on your feet. I thought you wanted
to go on. You had a few more seconds, a few more minutes left there.
MP De Silva.
Hon. Zane J. S. De Silva: Thank you, Mr. Speaker.
Mr. Speaker, I rise today to ask this House to
give congratulations to the great Liverpool Football Club, who fielded, as you know, Mr. Speaker, a host of
youngsters to win the Carabao Cup over the weekend.
Thank you, Mr. Speaker.

Members and our listening audience,
that now leads us to the business of today. And as all
will know, we are here for the first day of the actual debate of this year’s budget. And today, eight hours are
allocated between two ministries. The first this morn ing is the Ministry of Health, which will be led by the Minis-ter of Health. And we will be calling on her momentarily
after the Deputy Premier moves us into Committee of
Supply, at which time we will start the debate. And as I indicated it will be four hours.
Once we get into Committee of Supply (again
for the listening audience) , the Speaker is out of the
Chair and will be out of the House until we come out of Committee today. And we will be ably led by the Deputy
Speaker and his panel of Chairmen who will conduct
business today while the Speaker is not in his Chair .
With that said, Deputy Premier.

Hon. Walter H. Roban: Thank you, Mr. Speaker.
Mr. Speaker, on behalf of the Minister of Finance, I wish to move that the House do now resume
in Committee of Supply to consider the Estimates of Revenue and Expenditure for 2024/25.

Honourable Members, we are now in
Committee of Supply for further consideration of the Estimates of Revenue and Expenditure for the Year
2024/25. We will be doing the Ministry of Health, Heads
21, 22, 24 and 91. I call on Minister Wilson.
Minister, you have the floor.
Hon. Kim N. Wilson: Thank you. Good morning, Mr.
Chairman. (Mr. Chairman, the clock? Okay.)
Mr. Chairman, I move the following Heads,
namely, Head 21, the Ministr y of Health Headquarters;
Head 22, the Department of Health; Head 24, Hospitals; and Head 91, Health Insurance, to be now taken
up under consideration.

Continue, Minister.


Bermuda House of Assembly MINISTRY OF HEALTH

Hon. Kim N. Wilson: Thank you, Mr. Chairman.
Mr. Chairman, the Health Ministry’s budget is
found on pages 154 to 174 of the Estimates of Revenue
and Expenditure.
Mr. Chairman, today I am pleased to present
the budget for the Ministry of Health overall, starting
with Head 21, the Ministry of Health Headquarters ,
again, Mr. Chairman, found on pages 155 to 158 of the
Budget Book.

HEAD 21 —MINISTRY OF HEALTH
HEADQUARTERS
Hon. Kim N. Wilson: Mr. Chairman, the mandate of
the Ministry Headquarters is “to make Bermuda healthier.”

Expenditure Overview

Hon. Kim N. Wilson: Mr. Chairman, a total of
$10,302, 000 has been allocated for Head 21 Headquarters for 2024 /25, which represents a decrease of
$7,000 over the original budget of 202 3/24. Save for
the small decrease, the budget for Head 21 Headquarters is unchanged from the previous year.
Mr. Chairman, I will now speak on each of the
programmes and business units under this head.

General

Hon. Kim N. Wilson: Mr. Chairman, the programme
2101 (General) comprises 15 FTEs [full -time equivalents] and a budget dedicated to grants administration, the implementation of universal health coverage, health disaster coordinat ion and accounting services. The
programme’s total budget on page B -155 of the Budget
Book is $8 ,693,000. Of that, $3 ,980,000 is set aside to
support the implementation of universal health coverage and to cover expenses associated with the day -today operations of the Ministry, including the Accounts
section.
Mr. Chairman, $4,161,000 is for grants , and
$82,000 is for health disaster coordinat ion, which is a
legacy of the Ministry’s national health emergency
function. The balance of $470,000 supports the Ministry’s cooperative s ervices policy directorate.

General Administration

Hon. Kim N. Wilson: Mr. Chairman, pursuant to item,
business unit 31000 General Administration, the Government is committed to strengthening our health system to bring healthy people in healthy communities . I
am sure you have heard the jingle. If you would like, I
can sing it for you?
[Inaudible interjections and laughter ] Hon. Kim N. Wilson: I know. Exactly. Exactly.
Mr. Chairman, a key component of this is the
multi -year journey toward delivering universal health
coverage (UHC) for the necessary health care services. The aim is to ensure that all residents of Bermuda have access to core health services of high quality when they need them without suffering financial
hardship. Mr. Chairman, w ith a focus on integrating
health services across the continuum of care—that is ,
public health, mental health, acute and post -acute care,
and community services —the implementation of UHC
will seek to contain health care costs, as well as employ
prevention and health promotion strategies to produce
better health outcomes for our Island’s population.
The health system transformation to achieve
UHC requires the strategic planning of upcoming projects and ongoing engagement with key stakeholders to ensure decisions and actions impacting UHC are patient-focused and timely. For this there is an allocation
in the Ministry’s Headquarters budget in the amount of
$948,000 to fund the programme management office
(or the PMO) for delivery of UHC , and a further
$988 ,000 for consultants.
Mr. Chairman, the PMO is managing the coordination, implementation, execution and integration of
all projects and associated workstreams in 2024 /25
and beyond. And this is to accelerate changes toward
the UHC. The PMO is also support ing the transitional
governance structure headed by the UH C Steering
Committee whose purpose is to facilitate the engagement of the many and wide -ranging health system participants through stakeholder working groups and forums.
The PMO is up and running now with a programme director, communications coordinator, two
project managers with two additional project managers
starting very shortly. Mr. Chairman, the UHC Steering Committee comprises representatives of several government departments, as well as the Bermuda Health
Council, Bermuda Hospitals Board, Bermuda Medical
Doctors Associ ation, Bermuda First and patient representatives. It continues to focus on stewardship , on
governance, health care service delivery and health
care fi nancing.
Mr. Chairman, in the 2024/25 budget year,
working with the UHC Steering Committee, the five
health forums and our health partners, the Ministry of Health will look to progress the more than 21 projects
underpinning the following key health initiatives . And
they are as follows, Mr. Chairman:
• health care modelling;
• National Digital Health Strategy implementation planning;
• national health systems metrics;
• clinical coding improvements;
• UHC core health services;
• implementing the completed integrated care
pathways and advance new integrated care
pathways; and
494 26 February 2024 Official Hansard Report

Bermuda House of Assembly • health regulations and health care workforce
strategy.
Mr. Chairman, with the transition governance
framework now in place and the key health initiatives and projects identified, the aim in 2024/25 is to establish the core health care services to be included in a
universal health care benefits package for all residents and to undertake a full assessment of the demand and
cost to deliver these core services.
Mr. Chairman, we will create a more efficient
and value- driven health system where our residents
enjoy better health outcomes. And with that said, we
must all commit to doing what we can to live a healthier life. Living healthier lives reduces the burden on Bermuda’s health system and produces economic benefits. Mr. Chairman, that ends the presentation for line
item 3100 0, General Administration. And again, Mr.
Chairman, I remain on page B -155.

Grants Administration

Hon. Kim N. Wilson: This is business unit, Mr. Chairman, 31015, and it is found at page C -18 of the Budget
Book, and there it lists the benefit, Mr. Chairman, of the Health Ministry’s grants to several agencies providing
essential front -line services to aid public health and social assistance and also a grant for health education.
The total budget for this business unit is $4,161,000.
These grant funds are allocated as follows:
• $3 million, Mr. Chairman, for the Lady Cubitt
Compassionate Association (LCCA) . And, Mr.
Chairman, that has been allocated to cover
overseas medical care for uninsured and underinsured persons;
• $1 million for the Bermuda Health Council;
• $61,000 for the Sexual Assault Response
Team (or SART ); and
• $100,000 for the Dr. Barbara Ball Public Health
Scholarship.
Mr. Chairman, charities and other key agencies provide the Ministry of Health with supporting services that are vital to the community and complement
the Ministry’s mandates. The LCCA, the Bermuda
Health Council and the Sexual Assault Response
Team are all critical services and are fundamental to
the success of the Ministry. The LCCA as an organisation has been a part of Bermuda’s community since
1932. In the 1950s, the LCCA began assisting resi-dents who needed to travel abroad for medical treatment not available in Bermuda. And t oday the LCCA
administers the Patient Overseas Financial Aid Pro-gramme, working with residents with limited or no ability to pay, to find the right solution.
In fiscal year 2024/25, Mr. Chairman, the
LCCA will receive $3 million to cover the costs associated particularly with exceptional cases involving medical treatment where the patient’s responsible costs are greater than $50,000. Mr. Chairman , also included in the Grants
budget is $100,000 in funding for the Dr. Barbara Ball Scholarship. The Ministry of Health awards the Dr. Barbara Ball Public Health Scholarship annually to Bermu-dian students with proven financial need seeking ca-reers or professional development in the area of public
health. The scholarship is offered in honour of Dr. Barbara Bertha Ball who was the first born- Bermudian
woman to practice medicine in Bermuda and a tireless
champion for people’s rights. This s cholars hip covers a
range of health care fields of study that directly benefit
public health and are a priority for the public health
needs in Bermuda, Mr. Chairman. It is another example
of this Government’s commitment to strengthening our
health care workforce and one of eight strategic principles that were outlined, Mr. Chairman, in the Bermuda Health Strategy 2022– 2027.
This year 10 successful first -time awardees received $10,000 each in support of their continuing studies at universities in the West Indies, the United States
of America, Canada and the United Kingdom. And, Mr.
Chairman, if you would oblige me, I would like to name
the 10 successful scholarship recipients:
• Ms. Elisha Bailey -Lewis, who is studying medicine at St. Georges University in Grenada;
• Ms. Jordan Bascome, studying medicine also
at the American University of Antigua, Antigua;
• Mr. Joshua Corriea, who is studying medicine at the St. George’s University of Grenada;
• Ms. Dy -Juan DeRoza, who is studying public
health at the University of Toronto in Canada;
• Ms. Storm Gibbons, who is studying medicine at St. Georges University in Grenada;
• Ms. Ronnelle James, who is studying nursing at Glasgow Caledonian University in Scotland;
• Ms. Roshae James, who is studying nursing at the University of Salford in the United Kingdom;
• Ms. Harlee Purvey, who is studying health sci-ences at Western University in Canada;
• Ms. Veronica Swan DeGraff, who is studying
medicine at the St. George’s University in Grenada; and
• Ms. Tiontae Thomas Clarke, who is studying
nursing at the Virginia Commonwealth University in the United States of America.
And we will continue, Mr. Chairman, to encourage our young people with careers in the health care sector , recognising that Bermuda has an ageing population with associated health care needs including a high burden of non- communicable chronic diseases
that we are seeking to prevent and treat. And the development of health care professionals through the signature schools Health and Social Care Pathway and
the Dr. Barbara Ball Public Health Scholarships is an
investment in the development of our people and a
healthier Bermuda. Another grant recipient , Mr. Chairman, is the Bermuda Health Council.



Bermuda House of Assembly Bermuda Health Council

Hon. Kim N. Wilson: Mr. Chairman, I want to highlight
the work of the Bermuda Health Council, which is a
quango under the Ministry. They receive operational
funds in part from a Ministry grant and are positioned to
continue to advise and make recommendations to the
Ministry on health system matters.
Mr. Chairman, the Bermuda Health Council’s
mandate is to regulate, coordinate and enhance the delivery of health services. The grant for the Bermuda
Health Council can be found on page C -19, and its cost
centre is 6895 under the Ministry of Health. In 2024/25
the Health Council’s grant will be $1 million , which is
the same support level as the prior thee years. The
Council continues to play both leading and supporting
roles in critical initiatives related to health system improvements such as progressing t he work toward
achieving UHC and strategic initiatives around digital
health procurement and health system financing.
These projects are in addition to their regulatory activi-ties related to health professionals, health businesses,
medical equipment and health insurers.
The Health Council will also be systematically
working to enhance access to cost -effective public
health programmes and care pathways, streamlining licensing and registration processes in support of foundational work toward achieving UHC, improving quality of life through kidney transplantation and related initiatives, and enhancing population health education and
health workforce capacity.
The Health Council’s total revenue is primarily
supplemented by a transfer from the Mutual Reinsurance Fund [MRF ], licensing fees paid by health insurers, and licensing and registration fees paid by health
professionals for a total budget of $4,300,000 for the fiscal year 2024/25.
Mr. Chairman, in 2023 /24 the work of the
Health Council centred on four strategic focus areas
which aligned with its mandate: regulate, coordinate,
enhance and support the public health programmes,
and a core operational focus on accountability and
good governance. Some of the year’s achievements ,
Mr. Chairman, are as follows:

Regulate and Coordinate

Hon. Kim N. Wilson: Mr. Chairman , as the primary
regulator and registrar of the health system, the Council facilitated or supported the registration functions of all
health professional bodies , who represent over 1,300
health professional exclusive of the Bermuda Medical
Council. And they supported the health professional
conduct committees and managed licensing functions
for radiation- emitting equipment, diagnostic imaging facilities, clinical laboratories, hospitals, nursing homes
and residential care homes.
To further build on its enhancement from the
prior year, t he Health Council developed a block -chain-enabled online database for initial and renewal licens-ing and registration processes. The Health Council piloted the database with select health professionals, followed by a soft launch with the re- registration of optometrists and opticians. This and other modernisation efforts are tedious during the development and initial
rollout phases, but will reduce the administrative burden on statutory board members, thus enabling more
effective use of their knowledge and experience to en-hance their specialised fields and improve population
health in Bermuda. During fiscal year 2024/25, the Health Council will continue its rollout of its registration
database for all l icensing and registration processes
under its remit.
The Health Council remains a primary hub of
health system information, populated through its complaints -handling processes. The Health Council’s
awareness played a key role in drafting legislative
amendments for enhanced regulation of medical and
dental ch arges for services provided in hospitals by
community physicians and dentists. These pending amendments will ensure standardised reimbursement
across the system and eliminate out -of-pocket costs for
applicable services.
The Health Council’s awareness and expertise
also places it in an ideal position to understand gaps in
the public’s understanding of systems matters. Mr. Chairman, the Health Council began planning for implementation of an educational programme to enhance
the public’s understanding of the health system and all
that it offers. The goal of this work is to ensure that the
public understands how to access necessary products
and services, navigate the health system effectively and advocate for better individual and population health
outcomes.

Enhance and Support

Hon. Kim N. Wilson: Mr. Chairman, in fiscal year
2024, the Health Council continued its efforts to enhance data integrity and move to more automated outputs of system analysis. This aligns with the Health
Council’s goals around publishing reports more regularly and enhancing the public’s awareness and understanding of health system trends. The Health Council also put forth amendments to the hospital fee schedule
that would allow for more efficient and effective fee reviews and standardised coding of hospita l services.
The Health Council transformed its process of
conducting health technology reviews to the most ro-bust internationally recognised processes for conducting health technology assessments. And in addition,
the Council partnered with the University of West Indi es
and EuroQUOL research foundations to create preference values for different states of life for Bermuda. This
project makes Bermuda one of a few countries in the
world to have completed this important work. These enhancements in processes and information will be used
to inform considerations for the importation and
496 26 February 2024 Official Hansard Report

Bermuda House of Assembly regulation of high- risk health technology and licensing
of health businesses, as we seek to ensure that residents have access to necessary health services and
products that support improved population health.
Mr. Chairman, during fiscal year 2024, the
Health Council collaborated with Ignite to enhance support provided to grant recipients of the Innovation Programme. The Innovation Programme, Mr. Chairman,
has been in operation since 2019, and while interest in
the programme has grown over time, the Health Council has noticed gaps in plans for sustainability and scal-ing of proposed initiatives. Ignite provides entrepreneurs with the knowledge and skills to fully plan business ideas and execution of proposed progr ammes.
And as of January of 2024, nine applications were re-ceived and eight pending submissions to this new partnership for health- related programmes focused on supporting those living with non -communicable chronic diseases, those ageing in place and those living with
chronic mental health conditions.
The Health Council also managed the Island’s
National Kidney Transport coordination (or the KTC
programme). And to limit barriers to access to kidney
transplants of clinically eligible individuals, the Health
Council has proposed enhanced funding models for transplantation and associated care. The Health Council remains committed to promoting this programme as
it not only provides patients with better health outcomes and improved quality of life, but it is also more cost -effective than dialysis as an alternative renal replacement therapy option.
Mr. Chairman, during fiscal year 2024, the kidney transplant coordinating team began working with hospitals in the UK to expand our options for cost -effective quality transplant centres. A transplant in the UK
can be more than $200,000, less expensive than that
of a comparable US service. Each transplant that the Health Council supports creates an approximate
$700,000 in health system cost savings over a 10- year
period.
Mr. Chairman, in 2023/24, the Health Council
began drafting regulations related to the enactment of its authority to license health service providers. The
regulations include addressing the importation of high-risk health technology and financially vested referrals
in support of system goals around ensuring the provision of quality, clinically necessary care and achieving
universal health coverage. The Health Council also
proposed amendments regarding the enforceability of
currently legislated requirements regarding health data submissions in support of system goals regarding residents’ access to cost -effective high- quality care.
As a primary regulator of the health system, Mr.
Chairman, the Health Council is constantly looking to ensure that legislation appropriately reflects and supports intents, thereby allowing for a stronger foundation from which it can lead and support the sy stem through
the actual and potential challenges of an ageing population and a growing burden of chronic non- communicable diseases and mental health challenges.

Accountability and Good Governance
Hon. Kim N. Wilson: Mr. Chairman, the Council provides timely financial transparency, and by working in
close collaboration with the Auditor General have year
over year unqualified audited financial statements. The
Health Council’s annual reports and financial state-ments are completed through fiscal year 2022 and the
ones for fiscal year 202 3 are in progress. The Health
Council looks forward to completing this financial audit
and then preparing for the audit for fiscal year ending
March 2024 .
The Health Council’s strongly skilled and experienced team of 25 continues to have a successful paperless office, with most of its information shared via
electronic means. With more than 90 per cent of its staff
being highly skilled Bermudians, with the majority under the age of 40, and almost 70 per cent of the team
carrying graduate degrees in health- related programmes, the Council provides a strong environment
for career growth, critical and impactful solutions development and regional health innovation leadership. To
improve its effectiveness, the Council also continues to review and enhance its information technology tools so that it can continue to become more efficient and thus
be a more cost -effective resource to both the Government and the health system alike.

Looking Toward the Future
Hon. Kim N. Wilson: Looking forward to 2024 /25, the
Health Council will continue to advance proposed legislative amendments, particularly those related to enhancing access to evidence- based cost -effective care.
The Health Council will enhance the efficiency and ef-fectiveness of its processes regarding its regulation of
professionals, businesses and insurers.
As the population and its health needs evolve,
it is important for the Health Council to maintain agility
in how it accomplishes its mandate. This past year focused primarily on the planning and development
stages of new initiatives, and the next fiscal period will involve a shift to more implementation and enforcement, and monitoring and evaluation of new initiatives.
Mr. Chairman, the Health Council continues to
promote collaboration between the public and private
sector. And in fiscal year 2024/25, it will be more intentional in its efforts to include the third sector in collectively progressing the health system and the health of
the community forward, a key aim of this partnership being to tie improvements in social determinants of
health to the enhancement of population health.
Mr. Chairman, the Health Council also recognises that ensuring health system access for its population means ensuring that Bermuda has the necessary
businesses and professionals to meet the needs of the


Bermuda House of Assembly population. In fiscal year 2025, the Health Council will
continue to support the next generation of professionals by providing skills development and health systems
exposure through its internship programme.
And lastly, Mr. Chairman, I would like to
acknowledge the Bermuda Health Council board and
staff whose diverse experience and commitment to
public health contribute to its continuing successes.
This ends my presentation for line item 31015,
Grant Administration.

Corporate Services
and National Health Emergency
Hon. Kim N. Wilson: This is unit 31020, Corporate
Services, and business unit 31997, National Health Emergency. Mr. Chairman , the estimated budget for
Head 21, Corporate Services Unit, again line 31020, is
$470,000. This unit comprises the Ministry’s Policy Directorate and the staff that work closely with me, as Minister, as well as the senior management team to un-dertake research and assist with the development of
policy and regulations. Mr. Chairman, t he budget allocation for what was known as the Nationa l Health
Emergency is $82 ,000. This unit undertakes critical
health disaster coordination for the Ministry . It focuses
on planning and preparedness in accordance with the
Pan American Health Organization’s plan of action for
Disaster Risk Reduction, ensuring we are well positioned to manage the public health risks associated
with disasters and extreme weather emergencies.
This completes my presentation, Mr. Chairman, for line item 31020, Corporate Services, and 31997, National Health Emergency. Mr. Chairman, t his
also completes my remarks on all business units held
under the programme entitled “ General. ”

Office of the Chief Medical Officer

Hon. Kim N. Wilson: The second programme under
Head 21, Ministry Headquarters, Mr. Chairman, is the
Office of the Chief Medical Officer. The Office of the
Chief Medical Officer, Mr. Chairman, can be found on pages 155 to 158 of the Estimates of Revenue and Ex-penditure. Mr. Chairman, programme 2102 under Head
21 is the Office of the Chief Medical Officer (OCMO) .
That is found, Mr. Chairman, at page B-155 of the
Budget Book. And i ts total budget for fiscal year
2024/25 is $1, 609,000, which funds two business units,
31030, Health Care Registration and Regulation, and
31040, Epidemiology and Surveillance Unit. The office
ordinarily consists of eight fulltime equivalents .
The remit of the Office of the CMO consists of
five primary duties , Mr. Chairman. And they are as follows:
1. registration and regulation of health care professionals;
2. pharmaceutical drug control;
3. epidemiology and surveillance; 4. statutory public health responsibilities; and
5. health emergency planning, resilience and response.
Mr. Chairman, t he Office of the CMO currently
manages the registration and re- registration of medical
practitioners as well as the registration and regulation
of pharmacies. The OCMO also provides administrative support to the Bermuda Medical Council, and the
CMO is an executive officer of the Bermuda Medical
Council. The office retains functions relevant to medical
practitioners and pharmacy regulation. This includes oversight of the registration processes, the management of patient concerns and ensuring best practice
clinical standards are in place and maintained to protect and support the delivery of ongoing high- quality
medical and pharmaceutical care in Bermuda. In addition, Mr. Chairman, this office manages the administration for the Professional Conduct Committee for medical practitioners on Island.
The OCMO’s pharmaceutical drugs control responsibilities include registration of pharmacies and
monitoring the importation of prescription drugs. This
ensures that controlled or banned drugs are imported
by appropriate, responsible health care businesses and individuals. Additionally, Mr. Chairman, the office ensures that Bermuda stays within its assigned quotas of
controlled drugs and reports on controlled drug impor-tation to the International Narcotics Control Board
(INCB), which is located in in Vienna, Austria. The
INCB monitors compliance with the United Nations International Drug Control Conventions. This office also
ensures that medications imported to the Island are in
keeping with the provisions of the Pharmacies and Poi-sons Act.
Health protection and community health assessment are two essential public health functions car-ried out by the Office of the CMO . And that is the Epidemiology and Surveillance Unit (ESU). The ESU mon-itors the occurrence of diseases on the Island, both infectious diseases and select chronic non- communicable diseases, to help prevent and control their spread and impact. The ESU receives reports from individual
health care providers and laboratories and investigates
unusual disease occurrences. The provision of contact
tracing and case management functions are integral to preventing and/or mitigating any future outbreaks of
disease.
In January 2024, the ESU team successfully
hosted a measles outbreak exercise. And this exercise
represented the culmination of efforts of the ESU team
and their colleagues in the United Kingdom Health Security Agency, in which it was evaluated by public
health experts from the Caribbean Public Health
Agency (CARPHA) who will provide an evaluation report with recommendations for Bermuda.
Mr. Chairman, the OCMO will also host a team
from the United Kingdom Health Security Agency in
March 2024. This team will be evaluating Bermuda’s
communicable diseases and surveillance practices and
498 26 February 2024 Official Hansard Report

Bermuda House of Assembly processes. And during this upcoming visit, the UK
Health Security Agency team will also meet with clinical
staff, lab staff, port health, the Ministry of Health and
BHB officials. This team will also provide an evaluation
report of our surveillance systems in Bermuda with suggestions on ways to improve surveillance and early notification of communicable disease in Bermuda. This
exercise will allow the Office of the CMO to recommend
changes to strengthen communicable disease surveillance and mitigate against outbreaks of these diseases.
Periodic community health surveys are also
conducted to monitor and document the health of Ber-muda’s population. And, Mr. Chairman, you would have
heard me speak about t he STEPS to a Well Bermuda
survey, which is planned for 2024 /25, and this is just
one example. Data from community health surveys will
help provide population health information which is essential to setting health system priorities . And the results of the STEPS survey will provide a snapshot of the health status of our population and will be used to tailor our strategic plans for health in the future.
And if I can just pause, Mr. Chairman, for a
commercial to encourage anybody who is called to par-ticipate in the STEPS survey, we are looking for about 2,500 participants, to please do so because the information that we gather from the survey will help us to
strategically plan not only for the future, but we will have
a better understanding of the health needs in Bermuda
and help us to guide initiatives that are purely based on
evidence.

[Inaudible interjection]
Hon. Kim N. Wilson: Oh, the survey is three parts. So
there is the survey itself, there is a mini -medical physical where they measure the circumference of your stomach and a finger prep for blood tests and the like.
So it is a three- part survey. It is anticipated that it pro bably would not take much more than an hour. And then
when they come back, they can do all of the medical
information as well. But it is really critical, we are looking for about 2,500 people to participate.
Through the Department of Statistics, the
households are randomly selected. And then from that household, an adult over the age of 18 is the one who
is going to be earmarked to participate. So we are encouraging anyone, if you get the call, to please do so
because the data that we collect are critical for helping us to advance initiatives that are based on evidence, based on need of our outcomes, based on data in Bermuda.
Mr. Chairman, additional functions of the Office
of the CMO are to facilitate legislative functions, advise government departments on health matters and to support the essential regulatory work of statutory boards and councils. The [OCMO], Mr. Chairman, also serves
as Bermuda’s public health focal point for communications with regional and international authorities such as the World Health Organization [WHO], the Pan American Health Organization ( PAHO ) and the United Kingdom Health Security Agency, as well as the Caribbean
Public Health Agency (CARPHA).
Essential collaboration with these partners provides Bermuda with access to facilities to develop and
train our public health professionals and to support and
implement strategic plans and technical assistance for
the prevention, [mitigation ] and management of public
health emergencies including, Mr. Chairman, preparedness for disaster management and extreme weather events.
Mr. Chairman, the Office of the C hief Medical
Officer is developing health emergency plans. In the
past year this team provided services to care for oxygen-dependent patients who need uninterrupted power
supply during hurricanes , and develop ed and exercised
a polio outbreak plan. This was well received and positions Bermuda to be able to deal with outbreaks of polio
in the future. The Office works closely with the Health
Disaster Coordination Unit.
Mr. Chairman, i n 2022 /23 the Office of the
Chief Medical Officer led the development of Bermuda’s first Joint Strategic Needs Assessment [JSNA] .
This is a critical part of our progress toward universal health coverage as it helps to set out our starting point.
The JSNA (which is the Joint Strategic Needs Assessment), coupled with the data that we will be collecting
from the upcoming STEPS survey 2024, will help us
understand the priorities for action and form the baseline for improvements over the coming years.
Mr. Chairman, the Office of the CMO budget is
$752,000 and is allocated to health care registration
and regulation. Over the past year the section has ensured the administration of a variety of professional services relevant to more than 200 registered medical
practitioner professionals, processed over 130 requests for controlled pharmaceut ical drug licence requests and completed more than 5 0 pharmacy inspections. The Registration Section continues 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, duties and efforts.
For fiscal year 2024/25, $ 857,000 is budgeted
for the work of the Epidemiology and Surveillance Unit
(or the ESU). Capacity building in public health has
been supported by CARPHA, the UK Health Security
Agency, as well as assisted the staff of the ESU, as well as the staff in the Department of Health to meet the
challenges of preventing and controlling emerging and
re-emerging diseases.
The OCMO is now better equipped to manage
outbreaks of vaccine- preventable diseases such as
whooping cough and measles. In February 2024, the Office of the CMO, working with the Department of
Health, facilitated a visiting IT expert from the Pan
American Health Organization. This expert specialises
in electronic immunisation registry setup and has


Bermuda House of Assembly helped numerous countries throughout the region
strengthen existing national immunisation record databases.
The just concluded visit successfully trained
private doctors and responsible staff on how to input vaccine administration data from patient files into the
national electronic immunisation record. Through the
tireless work of the Public Health Emergency R esponse Team (or PHERT) and the Surveillance As-sessment Response Team (SART), the Office of the
CMO coordinates and collaborates with a broad range of health and other community stakeholders Islandwide to prevent and mitigate public health threats.
Mr. Chairman, the OCMO has continued to
provide critical support to the vaccination programme
to ensure that all eligible residents of Bermuda are vaccinated and protected from COVID -19 virus. Working
with the colleagues in the Foreign Commonwealth Development Office, the OCMO worked tirelessly to secure vaccines for the most vulnerable residents of Bermuda. These latest vaccines are targeted against the Omicron variant. These vaccines have been administered through collaboration with doctors’ offices, community pharmacies and the Hamilton Health Clinic. As
of the 20
th of February 2024, this Omicron bivalent vaccine has been administered to over 1,000 persons
aged five and over. This vaccine continues to be available at doctors’ offices and the Department of Health.
Mr. Chairman, finally, the development of the
important chronic disease register continues to evolve and be refined. We are redoubling efforts at establish-ing chronic renal disease and hypertension registers.
The OCMO has continued to support the HEARTS i n
the Americas initiative in the Hamilton Health Centre.
The Department of Health clinical staff has diagnosed,
managed and followed just under 100 hypertensive clients. The blood pressure control rate for this cohort is currently over 50 per cent. And these results are very
encouraging. The hope is to have the initiative expanded into the private sector.
This ends my presentation, Mr. Chairman, on
programme 2102, Office of the Chief Medical Officer.
And also it concludes my remarks with respect to Head
21, the Ministry of Health Headquarters.

HEAD 22 —DEPARTMENT OF HEALTH
Hon. Kim N. Wilson: Mr. Chairman, I would like to invite you now to pages B -159 to B-169 of the Budget
Book, representing Head 22, the Department of Health.
Mr. Chairman, it gives me immense pleasure
to present the budget for Head 22, the Department of
Health, again found at pages B -159 to B-169 of the
Budget Book. The total current expenditure is estimated to be $31 ,300,000 for 2024/25. This represents
an increase of $ 871,000 compared with the original
2023 /24 budget , which is a 3 per cent increase. To hold
current expenditure at 2023/24 levels, given the 4.5 per
cent uplift in salaries, was a great challenge, and the approach taken primarily was to delay recruitment of
vacant posts.

Vision and Mission

Hon. Kim N. Wilson: The Health Department ’s vision
is healthy people and healthy communities . The d epartment’s mission is to promote and protect optimum
health and well -being in Bermuda. The 276 Health Department officers, which is found at page B -162, work
in 26 public health programmes , and that represent s 30
discre te business units . And those are also all located
in the Budget Book , Mr. Chairman. They are there to
assess the health and well -being of our general population. The 2023/24 original estimate w as 290 posts.
The 14- post reduction in 2024/25 represents posts that
will not be funded this year and therefore will not be able to be recruited until 2025/26.

Administration

Hon. Kim N. Wilson: Line item 2205, Administration,
comprises the business units of Administration, Health
Promotion, Comprehensive School Health and Childcare Regulations. Under unit 32230, Administration,
Mr. Chairman, the 2024/25 budget estimate for business unit 32230, Administration, is listed on page B -
160 and is $465 ,000. Under section 32240, Health Promotion, Mr. Chairman, that budget estimate for Health
Promotion and Wellness (and that is business unit of the department listed at cost centre, Mr. C hairman,
32240, and I am still on page B -160), that cost represents $623,000. Mr. Chairman, this is a 17 per cent in-crease over 2023/24 and can be accounted for not only
by salary uplifts, but also additional modest funding for
health promotion events and funds that will also be provided to support the Well Bermuda Strategy reboot in
2024/25.
Mr. Chairman, the Health Promotion and Wellness Programme is committed to develop ing and implement ing public health policies, programmes and
products that will promote health and wellness in the
community in collaboration with public health partners
as well . The annual Health Promotion Calendar is a
product the Health Promotion Programme uses to in-form the public of the many health promoting activities
and observances of the department and the community
health partners. In the 2023 calendar, each month focused on a physical activity and calories burned doing
an hour of that activity. Two Health Department health
events on the calendar that helped promotion annually
sponsor Public Health Week and Celebrating Wellness.
The Public Health Week 2023 theme was
Health for All. And Health for All envisions that all people have good health for a fulfilling life in a peaceful, prosperous and sustainable world. The right to health is a basic human right. And everyone must have access
to the health services that they need when and wh ere
they need them without financial hardship. And events
500 26 February 2024 Official Hansard Report

Bermuda House of Assembly during the week focused on mental health and celebrating Bermuda’s cultural heritage.
Mr. Chairman, in 2023 the Department of
Health in collaboration with the Bermuda National Athletic Association, the Bermuda Tourism Authority, the Ministry of Social Development and Seniors, and the
Ministry of Youth, Culture and Sport hosted our inaugural Move More Bermuda seniors game. The Move More
Bermuda seniors game is part of the Health Department’s Move More Bermuda campaign, which was
launched in 2011. And these initiatives aim to promote the importance of incorporating physical activity into
our lifestyles.
Mr. Chairman, we celebrated people over the
age of 50 who enjoy being active and enjoy a little
healthy competition. The Move More Bermuda senior
games provided our participants with various track and field events that suit their abilities and their preferences. There are many benefits for those over 50 having an active lifestyle, and according to the National Institute on Aging, staying active can help you to keep and improve your strength, have more energy, improve
your balance, manage and prevent some di seases,
sleep better, reduce stress and anxiety, reach or maintain a healthy weight, control your blood pressure and perk up your mood. And over 50 local and international
competitors took part in the event. And it is scheduled
to be held again this year i n May.

Mental Health

Hon. Kim N. Wilson: Mr. Chairman, stigma hinders
mental health help- seeking behaviours. Considering
the small size of Bermuda’s community , it is hard for
some people with a mental health challenge, disorder
or illness to seek help. It is therefore imperative to develop strategies in our communities for destigmati sing
mental health. According to the World Health Organization, one in seven 10- to-19-year-olds experience a
mental disorder, depression, anxiety and behavioural
disorders which are among the lead ing causes of illness and disability among adolescents.
In 2023, thirty health professionals formed the
first cohort of the Community Adolescent Mental Health
Training Programme. The cohort comprised school -
based health professionals, including school nurses, allied health professionals including speech patholo gists,
occupational therapists and physiotherapists; the
Healthy Schools coordinator; and social workers. Participants in the programme learned about stigma and completed the Youth Mental Health First Aid course,
which was facilitated by Dr. Judith Bruce G olding of the
Mental Health First Aid in the United Kingdom. They
learned about adolescent development and signs and
symptoms of common disabling mental health problems and crisis situations, learned when and how to re-fer students and learned how to promot e anti -stigma in
the school environment. The training of a second cohort is in process for 2024. Mr. Chairman, after the success of this first cohort, we have commissioned an instructor training
course through Mental Health First Aid UK to train local
professionals to be instructors in Youth Mental Health
First Aid, thereby strengthening our local cap acity. In
other words, we are starting the train- the-trainer programme for Mental Health First Aid for our adolescents.

HEARTS in the Americas

Hon. Kim N. Wilson: Mr. Chairman, HEARTS in the
Americas is the Pan American Health Organization’s
flagship initiative for improving high blood pressure
control and heart disease risk management in doctors’
offices using a standardised treatment protocol.
HEARTS has been implemented in 24 countries in the Americas. In 2023 the Department of Health implemented HEARTS in the Hamilton Health Centre clinic,
and preliminary results have demonstrated that patients on the HEARTS protocol have improved health,
Mr. Chairman. In 2024/25 it is planned to add several
general practitioners’ offices before the protocol is rolled out and available to the entire health system.
The HEARTS protocol , Mr. Chairman, is a simple, practical and easy -to-follow treatment protocol that
can vastly improve the control of high blood pressure. The HEARTS protocol features specific drugs and spe-cific doses to control blood pressure in a format that is
easy to understand and implement in Bermuda’s health
system as we aim to help save lives. Other countries
that have adopted HEARTS are seeing faster sustainable control with consistent actions being followed by
physicians, clients and their relat ives. In addition to
medication, HEARTS includes counselling and support
for lifestyle change and diet which, added to reducing
high blood pressure, can reduce obesity and the risk of
heart attack and stroke.
The burden of non- communicable diseases in
Bermuda and an aged population create serious vulnerabilities in our population and especially when coupled with infectious diseases. The HEARTS protocol is
in direct alignment with the Bermuda Health Strategy
2022 –2027, namely, promoting healthy living and preventative care. The implementation of the HEARTS
protocol is an example of how the health system must support Bermuda’s aged, unwell population with modern treatment protocols coupled with lifestyle intervention programmes to maintain health and support quality
of life.
Mr. Chairman, the Celebrating Wellness 2023
annual event was geared toward increasing awareness and promoting measures to address the epidemic of
non-communicable diseases ( or NCDs ), which continue , regrettably, to severely impact the health, economy and development of Bermuda. The focus was
Family Fun Night with Extreme Sports. T o combat
NCDs we need to make commitments to live a healthy lifestyle, moving more every day, choosing water, eating more vegetables and protecting our mental well -


Bermuda House of Assembly being. It is important to note that we must work together
as a community if we are going to tackle the chronic
diseases and the non- communicable diseases like diabetes, heart disease and cancer. The goal of the Department of Health is to reduce the number of Bermuda residents who are at risk for chronic disease.
The Health Promotion Team has planned several initiatives for 2024 including the Well Bermuda Health Promotion Strategy Refresh, launching of the
Health podcast, behaviour change training, using the
COM -B model for behaviour change that cites capacity,
opportunity and motivation as three key factors capable
of changing persons’ behaviour.

Nutrition Services

Hon. Kim N. Wilson: Mr. Chairman, in 2024/25 budget
estimates of the Nutrition Services business unit, line
item 32110 on page B -59 is $253,000. And this is an
increase of $51,000, which represents 25 per cent over
2023/24, which is justified given the high instance of diet-related disease in Bermuda. About half of an increase is from salary uplifts and regrading, and the remainder, Mr. Chairman, is intended to enhance programmes.
In 2023/24, Nutrition Services continued as a
sub-programme of both the Community Health and
Health Promotion and Wellness Programme. During this period, the programme received support through
the engagement of a service provider to ensure uninterrupted service delivery. The programme is presently recruiting a second dietician to increase capacity to introduce new initiatives and health promotion intervention programmes, which is appropriate given the prev-alence of diet -related diseases in Bermuda. Diet -related diseases in Bermuda, Mr. Chairman, include
overweight and obesity, cardiovascular disease such as hypertension and stroke, and of course diabetes.
Programme initiatives include the Grow, Eat,
$ave programme, Bermuda’s parish gardening competition ; Pivio, which just started, is a lifestyle intervention
programme; healthy cost -effective food demonstrations; adult health prevention clinic group nutrition clas-ses in support of hearts; and lastly, the Health Promo-tion and Wellness podcast , Healthy Bits.
If I could just pause for a minute, Mr. Chairman,
to give a plug for the Grow, Eat, $ave programme,
which is the gardening programme that is offered. Year
over year, I was invited to attend the graduation of the
participants of this programme. And I thought last year, Why don’t I do this myself? Which I did. And the benefits are incredible. So I can speak firsthand of the
amount of money that I saved with my own little, small
garden. The programme is ably led by a number of volunteers, first and foremost by Chaplain [Kevin] Santucci. And they teach us all kinds of aspects about gar-dening: The impact of pollination of gardening, composting, natural gardening, organic gardening. It is a wonderful programme if anybody has an
opportunity. It is perhaps one of the best -kept secrets
with respect to this. It is a free service. It is offered to members of the public. You sign up, and I assure you,
you will enjoy not only being outside a nd engaging in
physical activity, but growing your own produce and
saving— hence the name Grow Eat $ave. That is just a
plug for that programme.
Mr. Chairman, in addition, Nutrition Services
also remains dedicated to improving interventive programmes that support sustainable nutrition while also seeking opportunities to emphasise the importance of
achieving food security for the country. A recent Bermuda omnibus survey examined the types of food that
individuals have ceased purchasing, shedding light on
the challenges posed by rising food costs on the Island.
And the survey confirmed that fruits and vegetables are the food items that some residents have stopped purchasing due to unaffordable prices. This highlights the
need for commitment to promoting sustainable nutrition. Consuming five servings of fruit or vegetables
daily is fundamental in preventing chronic disease.
In addition to that, Mr. Chairman, the most recent omnibus survey provided some other good news.
Approximately two in ten residents are no longer buying
sweets and snacks or treats, given their cost, and 7 per
cent have stopped buying junk food. I am going to repeat that: The most recent omnibus survey provided some other good news that approximately two in ten
residents are no longer buying sweets, snacks and
treats, given their cost, and that 7 per cent have
stopped buying junk food. The Ministry uses thi s survey
to track support for the sugar tax overall, and over half
of the respondents remain in support of the tax.

Well, well, well!

Hon. Kim N. Wilson: Mr. Chairman, the Customs Tariff
Act was amended as promised in last year’s Budget Statement, 2023/24, to focus the sugar tax on sodas
and drinks with sufficient added sugar [and] candy
made primarily from sugar and chocolate. Items with
small amounts of additional sugar such as nutritional
bars, low -sugar drinks or non- dairy creamers had seen
an adjustment and a reduction in the Customs duty
rates.
Mr. Chairman, encouraging the population to
cultivate their own fruits and vegetables not only makes these foods more accessible, available and affordable, but also fosters a sense of empowerment. This year the
eight -week Grow, Eat, $ave programme had 73 graduates (and I was one of them), with 69 per cent of them
increasing their daily intake of fruits and vegetables to
five servings and 82 per cent improving their access to
these foods.
I am going to bring you some of my greens. I
am going to bring you some. I will bring you some.

[Inaudible interjections]
502 26 February 2024 Official Hansard Report

Bermuda House of Assembly Hon. Kim N. Wilson: I am harvesting now, so I will
bring some. I have got greens, I have got beets, I have
got carrots (a lot of carrots), beets, kale, tomatoes, cucumber, romaine lettuce.

[Inaudible interjection]

Hon. Kim N. Wilson: No, but it is small enough for me
and my family. And I am seeing a reduction. Mr. Chair-man, I am seeing a reduction in my food costs.

[Inaudible interjections]

Hon. Kim N. Wilson: I do not know. I cannot explain it.
But my lettuce tastes better than what you buy in the grocery store. And sometimes my husband laughs because I have a little bench, and I just sit there and look at my garden. He says, It’s not going to grow any faster.
But it is just looking. It is just being outside and just cultivating it.

[Inaudible interjections and laughter ]

Hon. Kim N. Wilson: So I encourage anyone to make
an attempt to grow your own fruits and vegetables. We
know the benefits of being outdoors and exercising. We
know the benefits of eating five fruits and vegetables a
day. It is cost -effective. You can have a small squarefoot garden like I have. You do not need a lot of [space].
They have the vertical garden, all of that. You can do it. So I am encouraging everyone to take a benefit. Thank you.
So, encouraging the population again, Mr.
Chairman, that to cultivate their own fruits and vegeta-bles not only makes the food more accessible, but
available and affordable. The Bermuda Parish Garden-ing Competition, which is another objective that we have, another initiative to help persons garden and encourage them to grow their own fruits and vegetables, and this is the Bermuda Parish Gardening Competition,
which aims to promote gardening in every parish regardless of skill level, garden size or whether individuals participate individually or in groups .
A total of 103 entrants participated in this competition, with 65 successfully completing submissions
for awards. Participants submitted a variety of gardens
for judging, including 11 community gardens, 7 large
gardens, 19 small gardens, 13 non- traditiona l gardens
and 15, Mr. Chairman, school gardens. Let them learn early, right? Eighty -two per cent of all surveyed individuals reported an increase in their fruit and vegetable
intake of five servings a day from their own garden. And
what we also found during this competition is the
schoolchildren who were participating would go home
not only with their harvest, but also encouraging their
parents to also understand the importance of good nu-trition and the five fruits and vegetables a day.
And the Complete Health Improvement Lifestyle Prevention Programme (or CHIP) has been rebranded, Mr. Chairman, to Pivio. And Pivio is a nineweek programme with 18 health information and support sessions committed to helping persons make sustainable behaviour changes. Enrolment for the new
course was limited; however, we are looking for 22 filled seats for our next session starting in March of this year.
The previous class started in May 2023 with eight dedicated participants who graduated in August 2023.
Group improvements included (and listen to this, Mr.
Chairman):
• 57 pounds of weight loss;
• 22 inches of waistline (22 inches!);
• 97 points decrease in blood sugar; and
• 182 points decrease in cholesterol.
And performance measures indicated 100 per
cent increase in consumption of the five servings of fruit and vegetables for all of the participants. Mr. Chairman, 90 per cent of senior homes inspected by the pro-gramme met the requirements for a nutritious and varied diet to promote good health. And the Department of
Corrections also was inspected, and 100 per cent of the
correctional settings met their requirements.
Mr. Chairman, Nutrition Services received referrals for medical nutrition therapy for 81 under -insured and uninsured persons across the lifespan. The
breakdown of clients included 66 adults, 11 school -
aged children and four infants. Collaboration continues
with the King Edward VII Memorial Hospital’s maternity ward to re- establishment the baby -friendly hospital initiative.

Healthy Schools

Hon. Kim N. Wilson: Mr. Chairman, the 2024/25
budget estimate for the Comprehensive School Health,
also referred to, Mr. Chairman, as Healthy Schools, is
business unit 32265, and that can be found at page B -
160 of the Budget Book. And that represents a $13,000
budget line it em. The present Healthy Schools Coordinator has been re- assigned from another Health Department business unit, which has funded her salary for
many years. Restructuring the Health Promotion sec-tion has been part of the MCS [management services]
study in 2022, and the report is before decision- makers
in the Cabinet as we speak. In the meantime, savings
needed to be found in this year’s budget until the unit is officially restructured. And the excellent work of the
Healthy Schools Coordinat or will continue uninterrupted.
Healthy Schools, Mr. Chairman, promotes
health in schools through such government departments as Education; the National Drug Control and Mir-rors; community health partners including the Bermuda
Diabetes Association, Bermuda Cancer and Health,
Bermuda Underwater Exploration Institute and the Department of Health; and school -based programmes
such as the Child and School Health, Nutrition Ser-vices, Oral Health, Community Rehabilitation Services and Environmental Health.


Bermuda House of Assembly Healthy Schools’ 10 Components for Health
have been adopted by 31 of the 33 public and private
schools since 2007. Let me repeat that: The Healthy
Schools’ 10 Components for Health have been adopted
by 31 of the 33 public and private schools since 2007. The Healthy Schools programme collaborates with
schools to implement the 10 components of health and
integrate them with academics. Schools receive tips for
making improvements and feedback about what health looks like on their campuses. And each May the
schools compete in a self -assessment of how they
complied with that year’s health components. And their
progress is celebrated at the annual Healthy Schools
Awards ceremony held in June.
In compliance with the school nutrition policy,
the Healthy Schools team is working more closely with
the Department of Education to limit all fast -food deliveries to schools for any reason and fast-food- focused
fundraisers to no more than once per month in schools.
Healthy Schools has provided schools with recommendations for non- fast-food fundraisers and rewards . All
public and private schools have at least one filtered bottled-water filling station and/or filtered water system,
making fresh, clean water the easiest choice. Healthy
Schools also supports those schools that choose to implement their own water -only policy.
A healthy lifestyle assembly is also provided by
Healthy Schools in as many preschools, schools and
camps as possible that includes fun and interactive discussions about the importance of adopting, practicing
and maintaining healthy habits. In 2024/25, Healthy Schools will continue to encourage schools to grow edible plants, fruits and vegetables. Also to help students understand their own health- related fitness, Healthy
Schools will continue to work with the Education Department’s curriculum officer for P hysical Education
and Health to improve the completion of the fitness ground assessments for P5 to S4 students in terms 1
and 3.
Healthy Schools and the Education Department’s Facilities Manager, in partnership with Environmental Health, will carry on working closely with school
custodians and cleaning companies that clean schools
to raise schools’ environmental clean liness standards
through frequent cleanliness inspections. In addition,
Mr. Chairman, since 2020 Healthy Schools has been
working with public and private schools to ensure optimum environmental health in schools by having
schools reduce clutter in classrooms and other sc hool
areas , and improve compliance with the Bermuda
School Asthma Policy.
Finally, Mr. Chairman, since the summer of
2021, Healthy Schools has been coordinating out -ofschool camps during all school breaks and after -school
programmes throughout the school year . To ensure
children’s safety and health, Healthy Schools provides
support and public health updates, monitors safety and
health standards and conducts surveillance visits as
needed. Line item 32290, Child Health Regulations . Mr.
Chairman, the budget 2024/25 estimate of the Child
Health Regulations, which again is business unit
32290, can be found at page B -160 and is $370,000.
Mr. Chairman, the increase of $62,000 is entirely due
to staffing and budgeting for four posts to sustain the
programme.
Mr. Chairman, over the last fiscal year all eligible day care providers, those caring for a maximum of
three children in a home setting, and day care centres,
those caring for more than four children in a centre set-ting, received their STARS certificate . (And just for expediency, when I say day care providers, I am going to
just say DCPs, Mr. Chairman. And then for day care
centres, DCC.) So again, day care providers are those
caring for a maximum of three children in their home
setting, and day care centr es ar e those caring for more
children in a centre setting. Mr. Chairman, all of those
would have received their STARS inspection.
The STARS inspection tool is a comprehensive
tool and allows the officers to evaluate various aspects
of child care while providing support and guidance
throughout the process. A dedicated website was created listing the overall STARS rating and the scores received. This website assists with increasing transparency and provides another tool to aid the public when
making an informed choice in selecting the best child
care settings for their family.
In the coming months, we will be embarking on
a PR [public relations] campaign to inform the public of the STARS inspection and the benefits. Mr. Chairman,
I am happy to report again that the majority of the
DCPs, the providers, met or exceeded the minimal
standard, receiving three stars, which is satisfactory,
four stars is very good, and five stars, excellent. The
few DCCs (which are the day care centres) that did not
meet the minimal standard were provided with monitoring and support and were able to improve their rating
within the inspection period. None were placed on a
provisional licence, as was the case last year. The data
indicate that areas of noncompliance for the DCPs and
the DCCs are decreasing, which is good news.
Quarterly stakeholder meetings allowed for updates from the Child Care Regulations programme to
the day care centres and the day care providers. And they allowed for feedback and suggestions to the child
care regulation programme. (Let me say that again.
Sorry, Mr. Chairman.) So the child care regulations
team continues to have quarterly stakeholder meetings
with the day care providers and the day care centres so
that they can received feedback and suggestions, as
well as continued networking amongst child care professionals. Those who were unable to attend the meet-ings were able to access the recordings. Based on the
feedback we received thus far, adjustments to reports
created following the inspections were instituted.
In response to a concern raised, the child care
regulators programme collaborated with the Customs
Department and the Ministry of Education in an import
504 26 February 2024 Official Hansard Report

Bermuda House of Assembly duty exemption for child care and child care centres,
which was granted and well received. So they were
able to make application. If it was for educational materials, playground equipment, et cetera, they were
able to receive a duty exemption for the impor tation of
those products, Mr. Chairman. And again, that was well
received by the day care providers and the day care
centres.
And to further receive feedback from the day
care providers and the day care centres, a relationshipbuilding and collaborative baseline survey was used. And the data continue to be collected. And based on
the feedback, Mr. Chairman, the team will be able to
work on the areas identified and share the results with
the day care providers and the day care centres. And
the intention is to create a similar survey for our agency
partners. And, Mr. Chairman, the collaboration be-tween CCRP [the Child Care Regulatio n Programme],
the Bermuda College and the Department of Education
resulted in a child care certificate being reintroduced in
September 2021. We look forward for those interested in the field of early childhood taking advantage of this
on-Island training and utilising the skills gained through
the training in our day care setting.
And I just want to pause for a moment and recognise the Child Care Regulation Programme team, they do a tremendous job in ensuring that they keep
our children in the care of centres and home care safe through the implementation of the STARS programme.
So, kudos to that team.
This ends my remarks, Mr. Chairman, with respect to section 2205, Administration.

Community Health

Hon. Kim N. Wilson: Turning now , Mr. Chairman, to
Community Health.
Mr. Chairman, the Department of Health, which
is section 2201, and that again is found under Community Health in the Budget Book at page B -159. Mr.
Chairman, the Community Health Department has 13
business units and has a 2024/25 estimated budget of
$23,188,000. Overall, this represents an increase of 4
per cent over the 2023/24 original budget and is on par
again with the salaries uplift that I have been speaking
about previously, Mr. Chairman.
Under l ine item 32030, Child Health: The
2023/24 budget estimate for Child Health, listed under
business unit 32030 on page B -159, is $3,075,000. The
Child Health budget [2024/25] will increase by
$148,000, which is a 5 per cent increase. Mr. Chairman, the Child Health unit consists of four sections: Immunisation; Child Health; School Health, which includes Asthma Education; and Travel Health. These
sections provide preventive and curative health services for infants, children, adolescents, adults, seniors and the traveling public. These are conducted through
various clinics, schools and community settings. Services include health and developmental assessments, screenings, referrals, treatment of minor
ailments, health education, health promotion, anticipatory guidance, adult and senior immunisations and
travel consultation for travel to high- risk areas. Mr.
Chairman, Bermuda’s expanded programme on immunisations (or EPI) plans for the needs of vaccines in
the child and adult schedules. EPI procures most of its vaccines through the Pan American Health Organization’s revolving fund. This process assures safe, effective and quality vaccines. Universal access for many of the vaccines is provided through the public and private
sectors.
Mr. Chairman, all of the sections in Child
Health, 32030, continue to be impacted by resource
challenges. However, team members in all sections
have worked hard to engage with their clients and deliver the programme objectives. Data on immunisation
coverage, Mr. Chairman, are 85 per cent for two- yearolds, which does represent a decrease of 1 per cent
from the previous year and still below the global target
of 95 per cent coverage. Low vaccination coverage in-creases the community’s vulnerability to re- emerg ing
vaccine -preventable diseases such as measles,
whooping cough and diphtheria.
There are 14 reported instances of vaccinepreventable diseases, a reduction from the previous years of 25. This could be due to mask use, improved
respiratory etiquette or reduced travel in general. Vaccine hesitancy remains a challenge, and we are working on strategies to provide the community with education relating to vaccine- preventable diseases. The
Healthy People BDA app was launched in April of 2023 during the Vaccination Week of the Americas celebration. And this app acts as an informational resour ce for
immunisation and child health and makes it easier for
people to remember and plan childhood vaccinations
and boosters.
We are pleased to report that the Healthy People BDA app won first prize for the mobile app of the
year in the 2023 tech awards.
Mr. Chairman, the EPI training is conducted
annually for health care professionals in public health,
private and institutional settings, as well as allied partners. Data from the 2023 electronic immunisation reg-ister (EIR) indicated that 1,044 flu doses were administered at the Eastern, Central and Western areas of the
Island during the annual flu express. To date, the total
[number of] vaccines given since November [2023] to January 2024 is 1,107. Distribution to private facilities
was 2,217. Clients were able to get fast -tracked if they
registered and made payments online.
In addition, the Take the Lead initiative was
promoted to include public officers and central workers within the Ministry of Health. The flu vaccine continues,
Mr. Chairman, to be administered in the clinic with distributions to long- term care facilities and the private
sector. A total of 5,900 doses were procured, and 2,825


Bermuda House of Assembly doses were distributed. This does not include what is
imported by the private sector.
Mr. Chairman, the Child Health Programme
has seen favourable results with 90 per cent of all parents of newborns visited within 14 days of birth, and 88 per cent of those mothers were screened for maternal
well-being at six weeks. Health visitors play a cr itical
role in providing health services for all families with children under the age of five years of age. They have restarted the Moving Mamas free walking group at the
Botanical Gardens and added another location at Rid-dell’s Bay. The aim of this initiative, Mr. Chairman, is to
build community empowerment, increase physical activity and to foster positive social and emotional wellness for mothers.
Also, antenatal breast feeding classes were offered to promote and increase breast feeding rates in Bermuda. Further initiatives to increase antenatal support are being considered and will be implemented
soon. The need for antenatal support was highlighted,
Mr. Chairman, in the first 1,000 Days Integrated Care Pathway survey, and this report was conducted with
KPMG.
Mr. Chairman, the School Health programme
continues to operate short of staff; however, we are actively recruiting. This is reflected in the low 29 per cent
coverage of five- year-old screening assessments.
School nurses are also currently working on promotional activities to increase school health assessment
parental consent numbers. Of the 421 screens con-ducted, 20 per cent, or 84 of the five- year-olds were
identified as overweight or obese. School nurses continue to prioritise tackling childhood obesity and educate on health nutrition.
Two participants within the School Health programme have undertaken the Caribbean Regional Field Epidemiology and Laboratory training intermedi-ate-level course. This will increase capacity for public
health outbreak response and investigation. The School A sthma Education programme is working in
partnership with Open Airways to re- establish and update the school asthma registry in all schools across
the Island. One focus will be to investigate and tackle
school absences due to asthma.
Mr. Chairman, the Travel Health programme
saw reduced numbers this fiscal year. There were approximately 351 travel consultations conducted in
2023. This is due to reduced travel to high- risk countries and fewer group trips from schools, churches and chari ty missions. Consultations provide education on
water, food and vector -borne illness prevention to reduce the risk of Bermuda residents returning with infectious diseases.
Line items 32080, Physiotherapy, and 32120,
Occupational Therapy . Mr. Chairman, the 2024/25
budget estimates for Physiotherapy, listed at business
unit 32080, and Occupational Therapy, listed at business unit 32120, both on page B -159, are $1, 210,000
and $1, 091,000, respectively. Both budget amounts have increased 7 per cent over the 2023/24 estimate. The remit of the Community Rehabilitation Services
Occupational Therapy [OT] and Physiotherapy [PT] services is to maximise the functional potential of children with delays in normal motor development or people with physical movement challenges. This rehabilitation service, which spans the age spectrum, is split
into three teams: early intervention, which is school -
based; paediatric therapy ; and seniors. The staff comprise s nine registered occupational therapists, eight
registered physiotherapists, one coordinator, and one
team secretary who is also shared with the Speech and
Language Pathology service.
Two vacant physiotherapist positions have
been filled, including the addition of a trainee physiotherapist. The recruitment process for the remaining
vacant occupational therap ist position is nearing the final stages. In addition, a trainee occupational therapist
post is being considered with the intent to develop Bermudians early in their career and help strengthen Bermuda’s health care workforce.
Moreover, Mr. Chairman, in line with the Ministry’s commitment to strengthen the health care workforce, the Community Rehabilitation Programme staff
are undergoing specialised training in neural development treatment (or NDT). This certification equips them
with additional advanced strategies tailored to individuals facing neurological challenges in paediatric, including strokes, developmental delay, cerebral palsy and
various other neurological conditions.
Mr. Chairman, within the early intervention
team, dedicated specialists, occupational therapists
and PTs provide early intervention for babies and young children between the ages of zero and four years
of age who are at risk of developmental delays and/or
disability. The OT and PT early intervention service
aims to complete a full assessment of referred clients
within 20 working days to ensure the appropriate inter-vention is provided and mitigate against any delay in
functioning. Approximately 87 per cent of referrals received for PT services and 50 per cent of OT services
were assessed within the established time- frame this
fiscal year, while an estimated 95 per cent of the clients on the PT caseload and 92 per cent of the clients on
the OT caseload were making steady progress toward established goals.
Mr. Chairman, while the early intervention OT
team operates short -staffed, reduced power has led to
a lower percentage of clients being assessed within the estimated time frame. However, clients are consistently
tracked and scheduled in the earliest availa ble assessment clinic, typically within two to three months,
demonstrating ongoing efforts to minimise delays. Assessment clinics take place weekly to quickly identify
and provide intervention for babies and young children
at high risk of sensory motor del ays to facilitate optimal
functioning and quality of life.
In addition, Mr. Chairman, parent and multi- disciplinary training sessions were delivered throughout
506 26 February 2024 Official Hansard Report

Bermuda House of Assembly the year in the community. T hese interventions continue to reduce the number of referrals sent by the early
intervention team to school -based services. Moreover,
as we anticipate heightened participation within the first 1,000 initiative, we aim to further empower parents with the tools and insight necessary to actively promote their
children’s optimal development.
Mr. Chairman, t he school -based paediatric
team aims to increase early recognition of developmental delays and provide a more equitable service for
school -age children with sensory motor delays throughout the year and not just during the school term. It must
also be noted that school -aged children with additional
learning needs due to complex health conditions and/or
sensory motor delays require regular monitoring and intervention to retain their functionality and ability to access education.
The OT and PT school -based services aim to
complete a full assessment on referred clients within 20 working days. Approximately 80 per cent of referrals received for PT services and 75 per cent for OT services
were assessed within the established time- frame, and
an estimated 95 per cent of school -aged clients on PT
caseloads and 90 per cent on OT caseloads were progress ing toward established goals.
Mr. Chairman, during the current fiscal year the
team successfully conducted sensory motor screening
for each child entering Primary 1 in the government school system. Additionally, services were extended to
summer camp attended by children with complex medical needs, ensuring the preservation of skills acquired during the school year and mitigating the risk of regression. Furthermore, this year selected students, based
on their level of severity and in alignment with the pro-gramme’s intervention goals, par ticipated in intensive
neural development treatment sessions as part of the NDT certification workshop for therapists. Several chil-dren from the government school system, including
Dame Marjorie Bean Hope Academy, engaged in off -
site intensive multi -discip linary OT, PT and speech and
language sessions. As these training sessions conclude in March 2024, feedback thus far has highlighted
the benefit of this training and the progress made toward their individual goals.
Mr. Chairman, t he OT and PT seniors’ team
aims to support clients in remaining as independent as
possible in their own homes. The seniors’ team con-ducts home safety and falls risk assessments for all
seniors who are referred to them to minimise the risk of
falls at home. In this reporting period, client and caregiver training were provided to maximise function and promote ageing in place. In addition, several health
promotion and education activities were conducted to
further educate and promote healthy age ing within our
community.
The OT and PT seniors -based service aims to
complete a full assessment of referred clients within 20
working days. Approximately 90 per cent of referrals received physiotherapy services and 95 per cent for OT services were assessed within the established timeframes . And an estimated 85 per cent of clients for PT
caseloads and 86 for OT caseloads were progress ing
toward established goals.
Pursuant to line item 32100, Speech and Language Services , Mr. Chairman, the 2024/25 budget estimate for Speech and Language Services , which is
listed again at business [unit] 32100 (I am still on page
B-159), and it represents a budget estimate for
$1,642,000. This, Mr. Chairman, does represent a 3
per cent decrease over the 2023/24 original estimate
and represents a planned delay in the recruiting of two
vacant speech language pathologists until 2024/25.
Mr. Chairman, the Health Department’s
Speech and Language Programme provides speech,
language and feeding , or swallowing assessments and
intervention services across the community. When fully
staffed , the programme consists of 14 speech and language pathologists [SLPs] and one programme coordinator. Of these, three speech and 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 year s of age.
Eight speech and language pathologists are
school based, providing services across all levels of the
Bermuda Government Schools (from ages 4 to 18).
One speech and language pathologist provides services to students with special needs who attend Dame
Marjorie Bean Hope Academy ( and that represents
children between the ages of 4 to 18), and one speech
and language pathologist provides school -based services to students who attend Bermuda’s private
schools and home schools.
Four posts were vacant in 2023 /24, and recruitment will be underway once the job descriptions have
been reviewed and updated with a view to increasing
staffing for this critical service in 2024/25 .
Mr. Chairman, speech and language
pathologists work closely with parents, school personnel and allied health professionals in private homes and
clinic settings to raise awareness of speech and language delays and disorders, to promote functional
communication skills, as well as to prevent life- threatening complications that may occur during feeding and
swallowing. The Speech and Language Pathology (or
SLP) therapy services include the provision of prevention and promotion information, screenings and assessm ents, consultations, as well as intervention.
Objectives are measured in terms of the provision of timely and responsive assessments. Services also include the delivery and provision of treatment for
those identified as needing intervention. Client improvement —that is , the effectiveness of treatment —is
measured by reduction in the severity of the communi-cation or swallowing challenges.
Mr. Chairman, unfortunately, this year the waiting list numbers for early intervention services continue
to increase. While current programme time guidelines


Bermuda House of Assembly aim to provide an initial assessment for young children
within three months of the initial referral, the average
wait time for an assessment is now running between six months to nine months. Obviously, this is sub- optimal. But the team is confident that the first 1,000 days
project underway can shed some light on these trends
and make recommendations so that we can not only
better meet the need for services for our infants, but
also have insight into the risk factors that need to be controlled to reduce the demand for service.
Mr. Chairman, i n 202 3, there were 75 cases referred to the school -based programme. Fortunately, all
students who were referred received an initial assess-ment within the programme’ s time guidelines of 35
working days. Once identified as needing services, cli-ents are provided with therapy intervention. Currently,
there are no school -based students on the waiting list.
Clients are reassessed on a rolling basis to assess their
status and to measure progress. This also serves as an
indicator to determine if serv ices are still needed.
A combined 338 cases were followed for intervention by Speech and Language Services this year.
Caseloads vary between 40 and 60 clients per officer.
Services to middle and senior schools have been
adapted to be provided through a consultative model where the therapists provide school personnel and parents the appropriate resources and strategies for clients with complimentary direct services.
Line item 32060, Community Health Nursing;
and 32010, Community Health Administration . Mr.
Chairman, the budget estimate for 2024/25 for Commu-nity Health Nursing, which again is line item 3206 0
business unit; and Community Health Administration, business unit 32010, both on page B -159, are
$1,826,000 and $1,2 97,000 , respectively. The Community Health Nursing budget in 2024/25 will increase by
$103 ,000, which represents a 6 per cent increase.
The Community Heath Nursing team comprises a team of highly skilled, dedicated and commit-ted nursing staff. Currently the team operates with only
four full -time nurses and three additional service providers. Despite the challenges posed by the existing
staffing levels, our team has consistently delivered
quality and professional care, maintaining a patient -
centred and evidence- based approach to health care.
To address the current staffing deficiencies
and strengthen our capacity to meet the growing health
care demands of our community, we have conducted
two recruitment drives. These efforts have led to recommendations for the addition of three full -time nursi ng
positions. Including these positions is crucial for achieving the full complement of nursing posts and for enhancing our team’s overall effectiveness.
The utilisation of Penelope software for case
management and electronic documentation, along with
the optimisation phase reflects a commitment to stay-ing technologically advanced. The collaboration between the Community Health nursing team and various
health care providers, both statutory and independent, is crucial in meeting the diverse health care needs of
the community. The initiatives undertaken, such as the
adult prevention clinic and the implementation of the
HEARTS programme, demonstrate a proactive approach to promoting healthy living practices and addressing prevalent health issues like hypertension and
diabetes.
Mr. Chairman, throughout the reporting period,
there were 52 adult preventative clinics held one day
weekly, with 610 patients able to be seen for new and
follow -up appointments. This has significantly increased from the previous year by 66 per cent. There
were over 50 active patients on the HEART hypertension registry since the initiative began in July 2023, and
much effort and training have been conducted to ensure adequate follow -up, patient education and support
to those participating.
The Community Health nurses have also ensured that our home- bound population continues to be
serviced and seen through home visits, reducing the
burden on acute care services. There have been over
5,200 home visits conducted within the community,
providing wound care management, maintaining their
independence and providing additional support with their health needs after discharge from the hospital.
The statistics provided regarding the number of
clinics, client service and number of home visits con-ducted by the Community Health nurses highlight the
significant impact the team has had on the community’s
health. This is a clear indication of the needs of the
community and the requirement of a modernised and
equipped facility to advance these services.
Mr. Chairman, the dedication shown through
home visits for vaccine administration to home- bound
individuals further emphasises the team’s commitment
to ensuring health care accessibility for all and contributes to the overall public health response. Additi onally,
Mr. Chairman, patient surveys have been conducted showing 100 per cent satisfaction with the timely responses of the community nursing team and accessibility. It is particularly noteworthy, Mr. Chairman, that
clients reported either being very sati sfied or extremely
satisfied with the services provided, reflecting a high level of patient contentment.
Mr. Chairman, the engagement in health promotion activities and educational assessments is another positive aspect. By supporting nine health promotion activities and educational assessments throughout
the year, the team is actively contributing to communi ty
well-being. Conducting health screenings and referring
clients according to their needs demonstrates a com-prehensive and pro- active approach to health care.
And it is evident that the funds allocated to these health care areas are not only addressing social determinants
of health, but also fostering partnerships and collaborative working, and promoting a culture of preventative
care in Bermuda.
Mr. Chairman, the Community Health admin
programme consists of administrative support and
508 26 February 2024 Official Hansard Report

Bermuda House of Assembly health education. The cost centre provides administrative support for the programmes for preventative and
curative services, including child, school, travel, immunisations, community nursing, sexual and reproductive health, nutrition, clinical laboratory, rehabilitation, speech and language, as well as two long- term care
facilities, and vaccine storage, medical office supplies
and coordination. The programme ensures conditions
in which the facilities can operate safely, effectively and
efficiently for clients and staff. However, facility issues
remained a challenge for the team during 2023, albeit an improvement from 2022.
The Hamilton Health Centre reopened in April
2023 after a 12- month closure to replumb the building.
Nevertheless, a leaking roof and failing ceilings resulted in relocation of staff and adjustments to workflow
for clinical activities. The clinical laboratory relocated at MVL (which is the Molecular, Diagnostic and Research
Laboratory in Warwick). Changed management for the
collection and transporting of specimens has been undertaken for all clinical services, including a plan to strengthen competencies for phlebotomy and pointed
care testing so that off -site laboratory services impact
client care minimally.
Further reorganisation and re- assignment of
offices was done to maximise office space. Redesign of the Hamilton Health Centre is envisioned and is
needed to modernise and provide the services matched for this area, particularly for persons with disability, mobility -adaptive equipment, and access, safety
and health considerations.
The building permit for the renovation of the
Mangrove Bay Clinic has been obtained. The general construction will be put out to tender soon, and pricing has already been obtained for furniture, fixtures and
equipment. Construction is expected to commence this summer. Hailing from the West End, I am going to, with your leave, repeat that again, Mr. Chairman, because
we have been anxiously waiting for this. And of course
there were budgetary constraints. But needless to say,
again the building permit for the renovation of the Mangrove Bay Clinic has been obtained. The general construction will be put out to tender soon, and pricing has
already been obtained for furniture, fixtures and equip-ment. Construction is expected to commence this summer.

[Desk thumping]

Hear, hear!

Hon. Kim N. Wilson: Mr. Chairman, Lefroy House
Care community. They have undergone major works
and a refit to replace the roof and to upgrade the dining
hall and annex. Unfortunately, a restricted operating licence remains in place, limiting occupancy until further reroofing works are completed in April of 2024. Approval was granted for two emergency bed placements as an interim step to meet community demand for
placements of seniors.
Mr. Chairman, the social worker team remains
in demand. In 2023 there were a total of 120 new [client] referrals, up 22 per cent from the previous year. Of the new referrals, 46 per cent, or 55 were discharged
from services following their primary issues having
been addressed and/or being connected to other services to help in meeting their needs. The remaining 54
per cent, Mr. Chairman, or 65 persons, continue to receive services including support and advocacy to con-nect persons and families with resources to help them
meet their needs.
The complexity of clients has increased, reflected in a 21 per cent reduction in client needs not
being met compared with the previous year. Collaborations with non- governmental organisations to address
homelessness was a significant part of the work this
fiscal year. The main reasons for social worker referrals
continue to be as follows, Mr. Chairman:
1. financial, persons having insufficient funds to
meet their needs including ability to purchase
medication;
2. nursing and care home needs, both long- term
residential care and in- home care needs ; and
3. housing needs.
Mr. Chairman, there were 2,239 events, which
included home visits, individual and family meetings, and collaboration and correspondence with other agencies. There were a total of 25 meetings over the course
of the year with the Long- Term Care Referral team to
maintain consistency in helping to manage the referral process for adm ission into Sylvia Richardson Care Facility.
Lefroy House Care Community was unable to
admit clients due to the physical and regulatory restrictions that I spoke about concerning the repairs to
the roof and the like, which are in process.
Mr. Chairman, the reorganisation of the Community Health structure, done in collaboration with
Management Consultant Services, for modernising the
leadership structure and development of the nursingled programmes in the Department of Health is awaiting a final decision. This strategy, once approved, will
enable training capacities for nursing and public health.
Many of the efforts of the programme in 2023
were directed at supporting staff and rebuilding teams post-COVID -19, as re- integration of reassigned staff
occurred. Temporary staff have provided a significant
contribution during staff shortages. Recruitment is in
process and has thus far realised positive results.
Team- building activities were organised quarterly with
positive feedback and a plan to expand upon the same in 2024.
Under line item 32040, Sexual and Reproductive Health , Mr. Chairman, the 2024/25 budget estimate
for Sexual and Reproductive Health, listed as business line item 32040, again still on page B -159, is $929,000.
Savings are being achieved by delaying the recruitment


Bermuda House of Assembly of a vacant administrative post for part of the year. Mr.
Chairman, the Sexual and Reproductive Health (SRH)
programme consists of two subprogrammes , formerly
known as the Communicable Diseases programme
and the Maternal Health and Family Planning programme. The programmes offer counselling and education on sexual health and healthy relationships, family planning, antenatal care, unintended pregnancy,
emergency contraceptives, gynaecological and mammogram referrals, cervical cancer screening and follow-up, and diagnosis and treatment of sexually transmitted infections including HIV testing and counselling,
and HPV and other vaccines.
Education and outreach services include participation in community health fairs, events and media
campaigns, and collaboration with other private and
public sector agencies. Mr. Chairman, promotion of family planning and ensuring access to preferred contraceptive methods for women, girls and couples are
essential for securing the well -being and autonomy of
women while supporting the health and development of
communities. To reach these goals, Mr. Chairman, sexual reproductive clinics offer comprehensive fam ily
planning services to the uninsured and under -insured
population at low cost.
A pronounced 20 per cent decrease in demand
for family planning services was seen in the last year,
which is concerning given the dropping birth rate and the apparent trends in emigration of Bermudians of reproductive age to the UK.
Mr. Chairman, Sexual and Reproductive
Health has a strong partnership with private obstetricians to provide antenatal care and safe delivery for under-insured and uninsured women. Eighty -five per cent
of pregnant women attending the clinic received four or
more antenatal appointments, and evidence suggests more antenatal contacts with professionals have been associated with greater maternal satisfaction and reduced perinatal mortalities. And that is pursuant to the
WHO report of 2022.
Mr. Chairman, the maternity benefit, which was
introduced in November of 2021, continues to assist
antenatal clients with payment for specialist visits.
Forty -four women were referred for maternity benefits,
with 82 per cent given assistance during the ant enatal
period. And of the 82 per cent referred, 14 per cent left
to deliver abroad or 9 per cent miscarried.
Mr. Chairman, Sexual and Reproductive
Health commenced a new initiative in March 2023 for
male and female clients between the ages of 18 and 26 to receive the HPV vaccine if they did not receive it as
an adolescent. Our target goal was to increase coverage for those eligible from our client -based population
by March of 2024. The HPV vaccine is routinely recommended for anyone from the age of nine through the
age of 26. Human papillomavirus (or HPV) can cause certain cancers in both men and women, and is a c ommonly sexually transmitted infection. Research has shown that HPV vaccines can
prevent more than 90 per cent of the oral, anal or gen-ital cancers that are caused by the HPV infection. A total of 19,061 tests for sexually transmitted infections
such as chlamydia, gonorrhoea, HIV, trichomoniasis
and syphilis were performed between April 2022 and
March 2023. To address the needs of the community in
St. George’s, Sexual and Reproductive Health continues to offer antenatal care, family planning and sexual
health screening, cervical screening and breast examinations.
We have seen an average of eight clients per
month from the period of April 2022 through March
2023. However, due to recent staff shortages, services
have been scaled back. In comparison, the Hamilton
House Clinic had a total of 1,772 women seen for
screening and treatment.
The Community Mental Health Well -Being
team continues, Mr. Chairman, to provide a much- valued service despite challenges with human resources and facilities. A community mental health team is critical to meeting the demand for mental health care in
Bermuda, filling the gaps when individuals are unable
to obtain treatment from private providers. The commu-nity mental health team is focused on helping individuals contend with the challenges to their mental health.

Bermuda Government Clinical Laboratory

Hon. Kim N. Wilson: Mr. Chairman, line item 32090,
Clinical Laboratory. T he 2024/25 budget estimate for
the Clinical Laboratory listed at business unit 32090
and still on page B -159, is $799 ,000. This budget reflects the merged laboratories which were once separated, the clinical laboratory at the Hamilton Clinic Centre and the Bermuda Molecular Diagnostic and Research Laboratory [MDL] in Warwick . The merged laboratory is now renamed and registered by the Bermuda Health Council as the Bermuda Government
Clinical Laboratory.
Mr. Chairman, t he Bermuda Government Clinical Laboratory is a COLA (and that is commission on
office laboratory accreditation), and it is a COLA -accredited laboratory. And the clinical laboratory supports , Mr. Chairman, the programmes within the various clinic s, such as the maternal health and family
planning, the communicable disease clinic, the adult health programme, child health and oral health as
needed. The clinical laboratory also serves as the public health laboratory for Bermuda, assisting with outbreak investigations and public health emergencies.
The laboratory provides specimen referrals for highly
infectious organisms that cannot be tested locally.
Collaboration with the Caribbean Public Health
Agency [CARPHA] Laboratory, or the UK Health and
Safety Agency Laboratory can be arranged to provide
advanced testing of diseases , which has major public
health significance. The merged Government Clinical
Laboratory has the capacity to provide clinical,
510 26 February 2024 Official Hansard Report

Bermuda House of Assembly chemistry, haematology, serology and immunology, microbiology and molecular testing, using a robust quality
assurance system.
Molecular testing for sexually transmitted infections such as gonorrhoea or chlamydia continues to be
the gold standard for sexually transmitted disease identification . The laboratory continues to collaborate in annual projects such as antimicrobial resistant surveillance. Antimicrobial resistance is a global threat that requires much attention and collaboration with several
sectors in the public health system. The Government
Clinical Laboratory continues to enrol in proficiency
testing as a quality assuran ce measure providing competency and assessing the capabilities of all who work
within the laboratory.
Mr. Chairman, the Bermuda G overnment Clinical Laboratory has expand ed testing for government,
using a newly installed chemistry analyser and immunisation analyser and aims to incorporate waste water
surveillance. Along with other data, waste water surveillance can provide early warnings of potential public health threats which will require action. The Bermuda
Government Clinical Laboratory will continue to assist
with genomic sequencing, which informs major stakeholders of the variants of infectious diseases circulating amongst our population.

Lefroy Care Community and
Sylvia Richard son Care Facility

Hon. Kim N. Wilson: Mr. Chairman, under unit 32000,
Lefroy Care Community, and 32015, Sylvia Richardson
Care Facility. Mr. Chairman, the Department of Health
operates two exemplary long- term care facilities, the
Sylvia Richardson Care Facility in St. George’s, and ,in
God’s c ountry, the Lefroy House Care Community in
Sandys.
Mr. Chairman, in 2024/25, the budget estimate
for Lefroy House Care Community listed at line item 32000, still on page B -159, is $5,005,000, and the
2024/25 budget estimate for Sylvia Richardson Care Facility, listed at business unit 32015 , still on page B -
159, is $5,947,000. These amounts are increased by 3 [per cent] and 4 per cent, respectively, with respect to their original budget items from 2023/24. Both facilities
provide care and promote independence and optimum
care for persons aged 65 years and ov er who have significant nursing and care needs requiring 24- hour facility-based care.
Mr. Chairman, the two facilities are residential
care communities providing comprehensive medical, nursing, and environmental and recreational services
to the resident and respite -care elders. Our aim is to
maintain and improve quality of life for elders and their
loved ones. Mr. Chairman, demand for nursing beds
continues to far exceed capacity. Sylvia Richardson and Lefroy House collaborate with Ageing and Disability Services, Community Health and the social work
teams from the Department of Health and the Bermuda Hospitals Board to prioritise and fill the vacant beds as
they become available.
Mr. Chairman, internal projects continue at
Lefroy House to improve and optimise living spaces for
elders. The dining hall roof has been replaced. The kitchen, dining hall and storage areas have been refurbished, and the staff lounge renovation is nearing completion. Windows and doors have been replaced in the
administrative and main building. Repairs will continue
into the 2024/25 budget year with the next phase being
the covering of the roof of the main building and replac-ing the internal ceiling material s to the communal area.
General repairs and maintenance at Lefroy
maintain a safe and comfortable environment for our resident elders and staff. However, an alternative is
needed due to the age and vulnerability of the existing
site. Plans to build a new Lefroy House at a new loc ation are still moving.
Madam Chairman, the Sylvia Richardson Care
Facility has been operating at full capacity. Admissions have come via BHB [Bermuda Hospitals Board] and the
community. The facility has played a role in accommodating at -risk seniors referred for emergency admissions via the Ageing and Disability Services. Maintaining the required minimal staffing levels 24 hours a day
whilst ensuring coverage is found for staff who are out
on sick leave and vacation has resulted in significant overtime expenditure. The operating costs have increased significantly, especially the cost of supplies,
food and utilities. Additionally, the repair and replacement of equipment and maintenance costs have increased, and this has impacted the budget.
This ends the presentation, Madam Chairman,
of the business units for section 2201, Community Health.

[Ms. Lovitta F. Foggo, Acting Chairman]

Oral Health

Hon. Kim N. Wilson: Turning now, Madam Chairman,
to Oral Health. The 2024/25 budget estimate for the Department of Health, Oral Health, section 2202, is
$1,443,000. And it comprises the business unit 32150,
Oral Health Control; 32155, Oral Health Administration; and 32160, O ral Health Prevention. Again, all of these
can now be found in the Budget Book on page B -160.
Savings were found by deleting the recruitment
of a trainee dental officer to the Oral Health Control pro-gramme. Madam Chairman, the Oral Health section
provides comprehensive public health dental services
to Bermuda’s children aged zero to 18 years of age and
seniors aged 65 years and older. Our service is based on high- quality patient -centred care, including dental
examinations, consultations, preventive and dental hy-giene appointments, as well as a range of restorative
clinical treatments including extractions and fillings.
There is an overall strong emphasis on prevention and


Bermuda House of Assembly working with our community, and we also offer emergency service during regular working hours.
The school -based programmes are an essential part of the Oral Health section’s service. Oral health
education is offered to our schools’ children, and a school -based fluori de supplemental programme for
children aged 6 months to 11 years of age.
And this ends my remarks with respect to line
item 2202, Oral Health.

Central Government Laboratory

Hon. Kim N. Wilson: Turning now to the Central Government Laboratory. Madam Chairman, the 2024/25
budget estimate for the Department of Health Central
Laboratory, section 2204, is listed as business units
32200, Forensic Analysis; and 32220, Water and Food Analysis. Both can be found at page B -160 of the
Budget Book. And the estimates are $854,000 and
$583,000, respectively, for a total of $1,437,000.
Central Laboratory’s budget for 2024/25 will increase by $137,000, which is an 11 per cent increase. The drivers for this increase are increases in salaries
due, again, as I have spoken previously, to the uplift,
increased call -out remunerations for fast -track cases,
additional funds for laboratory supplies and lab gases,
import duties, preventative maintenance, contracts for
equipment and increased electricity bills.
Madam Chairman, the Central Government
Laboratory performs a wide range of analytical services divided between two programmes, the forensic pro-gramme and the food and water programme.
Madam Chairman, with your leave, that may be
a convenient time for me to stop and pause for our lunch break, because I am going into a new heading. I
will take your [guidance], though.

Okay. The time now is 12:27.
We are two minutes, three minutes outside of lunch. So we will end at this point as it makes no sense to read
and stop in the middle of a brief. Thank you, Minister.
And I just want everyone to know that this debate will end at 2:35 . . . I am sorry. No. [The debate will
end at] 3:55. At 3:55. I was looking at a different time.
Yes, at 3:55 after lunch. Yes.
Okay. So I call on the Acting Premier.
Acting Premier.

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