The Tribune

“You can really have no notion how delightful it will be

When they take us up and throw us, with the lobsters, out to sea!”

But the snail replied “Too far, too far!” and gave a look askance –

Said he thanked the whiting kindly, but he would not join the dance.

Would not, could not, would not, could not, would not join the dance.” - Alice in Wonderland.’

“Too far, too far” and without sufficient consultation was the medical profession’s answer to the steam roller pace government had set itself to usher in by April the primary stages of National Health Insurance. Last year, Prime Minister Christie was adamant that — unlike the implementation of VAT – there would be no delay in the introduction of NHI. This year, however, he has had to concede that in view of opposition on all sides, postponement is very much on the agenda. The focus now is on “getting it right” — which is what it should have been from the beginning.

Deputy Chief Medical Officer Dr Delon Brennen, the first to concede last week that delay was possible, admitted that if healthcare providers “don’t sign up, we’re in trouble”. And indeed, they were in trouble.

The medical profession flatly declined the invitation to the dance. Government, without sufficient consultation, or even legislation to make it all possible, had gone too far. Private insurance companies were in a quandary. Their members also declined the invitation to the dance. In view of government’s historic failure to efficiently handle the people’s funds, the private insurance companies were adamant that government should not go into the insurance business. It would just be a scandalous repeat of the failed Bank of The Bahamas, compounded by all the other financial failures.

And Bahamians, who already had insurance, freaked out when they realised that, according to the draft legislation, “every person who is eligible for the plan must enrol in accordance with prescribed regulations and at the time of enrolment shall be required to select a primary care provider from the approved list of providers published by the authority by notice in the gazette; and select an administrator from the approved list of administrators published by the authority by notice in the Gazette”. The Tribune was the first to announce its refusal to reduce our employees’ current health plan until we were satisfied that what was being offered would be superior to what they already had. So far we are yet to be convinced.

With so many participants declining the invitation to dance, government has much to rethink, discuss and redraft - hence the delay of an April “roll out.”

Much has to be done to get the Princess Margaret in Nassau, the Rand Memorial in Freeport, and the outlying clinics up to an acceptable standard before it can even offer the public preliminary health care. The Public Hospitals Authority recently announced that it had signed an agreement for $7.5m worth of diagnostic imaging services to upgrade and expand its capacity of what it now has. This is a very high figure for the equipment they are said to be getting. A break down of costs would be in order.

We hope that in the rush to “roll out” they have not forgotten that they also have to have well trained, and disciplined technicians to operate all of this equipment. Public Health Authority Managing Director Herbert Brown has estimated that it will cost about $14m to upgrade the Accident and Emergency section and about $23m to upgrade the Maternity Ward. The ambulance fleet also will be enlarged. He estimated that this will cost $2.4m with another $2m needed to hire additional staff.

A lot of taxpayers’ money is being spent, so we hope that in the end there will be something to show for it. In October last year, Montagu MP Richard Lightbourn raised concerns in the House about reports that more than $10m in pharmaceutical drugs and supplies from the Public Hospital’s Authority was not accounted for. As far as is known, the public is yet to be given an explanation. Then there was talk about the heavy wastage, but no explanation of how this was to be managed going forward.

We hope that by now controls are in place and hospital administration improved. Dr Duane Sands said at the time that the revelation of missing funds highlights the fact that the PHA’s way of operating is dysfunctional.

Government has much work to do around the hospital before it can even offer an acceptable standard of basic health care.

As a letter writer asks in a letter on this page today:

“Anyone walked around PMH recently? You better and you will realise NHI is at least two years away as it will take two years to clean PMH. Go around the back, rats as large as cats! Why are visitors allowed to bring in food to patients?”

Until all persons involved agree on a reasonable plan of health care, services at all government hospitals and clinics should be free for the indigent — as much of it now is. However, those who can support themselves and have insurance to do so, should pay for all services.

We have told the following story before, but it bears retelling to illustrate what we mean.

Several years ago, the late Lady Dupuch was coming down the stairs of a government building when she fell and broke her wrist. She was rushed to accident and emergency at Princess Margaret Hospital where she was X-rayed, and the wrist set by the late Dr Willard Thompson. She received excellent care. However, when she was discharged, we asked for directions to the cashier’s desk, only to be told that because of her age all services were free. Here was a woman, although aged, who not only had insurance, but could pay in cash if necessary. We argued in vain. We pointed out that if she paid, funds would be available for someone who could not pay. But there was no argument. They were the rules. Because of our persistence, a nurse suggested we donate a gift to the hospital.

As we were mulling over a gift to give, we discovered that a previous donor had given an expensive piece of equipment to the physiotherapy department. Its box had never been opened, because not only did no one know how to assemble the equipment, but no one knew how to operate it. And so there it sat — its seal not even broken. That ended any further thought of a gift for the hospital.

The point of this experience is to emphasise that any person who can afford to pay for treatment should pay. Those who can’t afford to pay will receive first class care in an efficiently managed hospital. Also there should be no piece of equipment in the hospital that has a part missing, or that a technician cannot operate.

However, before this can be done, much still has to be accomplished to raise health care to an acceptable standard in government facilities.