The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government cannot simply “wave a magic wand” and hope that merging the Public Hospitals Authority (PHA) with the Department of Public Health will cure all the public healthcare system’s woes, a well-known physician said yesterday.

Dr Duane Sands, the FNM’s Elizabeth candidate, told Tribune Business that the plan to merge the two into a Bahamas Health Services Authority needed to be properly thought through to “avoid a disastrous implementation”.

He expressed concern, though, that with the Government pushing to create National Health Insurance’s (NHI) “single governance structure” prior to the imminent general election, the resulting politically-motivated rush could undermine patient care co-ordination.

Dr Sands said that while “in theory” an enlarged Bahamas Health Services Authority could generate improved efficiencies and economies of scale for the public healthcare system, there were likely numerous “kinks” that would result from the merger.

He added that the Government was effectively moving ‘full circle’ in respect to the PHA, which was created by the first Ingraham administration during the 1990s in a bid to reduce bureaucracy and ‘red tape’ within the public healthcare sector.

Now, the PHA is being brought back under the Ministry of Health, which will oversee the Bahamas Health Services Authority’s operations under the revised governance structure for NHI.

“In principle, it’s an interesting approach,” Dr Sands told Tribune Business of the proposed merger. “If you know the history of the PHA, it was created to eliminate the bureaucracy at the Ministry of Health and the central government, and the challenges in making decisions, particularly as it related to procurement and staff.

“The PHA has, unfortunately, not been as effective as intended, and it’s added another layer of bureaucracy on top of the Ministry of Health. While there have been some positives at the PHA, in the net it’s not lived up to expectations.”

Dr Sands said he sat on the first PHA Board, and added: “The idea of the PHA was to create a leaner, more efficient operation, and not be of the civil service mentality and inertia.

“Here we have the Government of the Bahamas going full circle again and moving the PHA back into one massive entity. The question is whether this will make it more or less efficient, and no one knows.”

The draft Bahamas Health Services Authority Bill, which has just been released for industry consultation and feedback, and obtained by Tribune Business, says the PHA’s merger with the Department of Public Health will help “accelerate” NHI’s implementation.

“The Cabinet of the Bahamas has approved a single governance model that will accelerate the implementation of Universal Health Coverage, while providing effective oversight of the programme,” the Bill’s ‘objects and reasons’ section states.

“The structure of the single governance regime will provide for quick and effective decision-making with transparency and accountability, as well as the alignment of health systems, and will result in greater efficiency, continuity of care and the seamless delivery of patient-centred services in the Government health sector.”

Proper implementation will be key to achieving these objectives, and Dr Sands expressed doubts as to whether this would occur, given the Christie administration’s desire to launch NHI before the general election is called within the next two months.

“The problem is we are trying to rush this thing,” he told Tribune Business. “The devil is in the detail.

“This is the type of thing that in theory might ease the trans-agency exchange of data and medical records, and make it easier to procure things because you have economies of scale and so forth.”

Dr Sands, though, warned that amalgamating two government agencies with different cultures and personnel would be far from easy, especially given the “entrenched fiefdoms” that exist at both the PHA and Department of Public Health.

“Trying to put them together is not something you can wave a magic wand at and it happens,” he told Tribune Business.

“This [NHI and the merger] is similar to the Republican ‘repeal and replace’ of Obamacare. In a couple of days, you’re going to take something that exists and replace it overnight without consulting; you’re just going to do it, and not expect chaos and confusion to result? Come on.”

Dr Sands added that “last minute pieces of legislation”, such as the Interception of Communications Bill, which could impact the doctor-patient relationship and confidentiality of medical records, and the Bahamas Health Services Authority Bill, “have huge implications for the delivery of care and ought to be done carefully”.

“I know what the criticism will be; that the FNM says don’t do it now,” he told Tribune Business. “Fine. The criticism is do it properly. Don’t rush it. Think it through carefully to avoid what is likely to be a disastrous implementation.

“NHI is going to be an utter disaster with this roll-out and the waste of lots of money.”

Dr Sands said key unresolved issues surrounding the PHA and Department of Public Health merger included the reporting structure, where the decision-making authority lay, and what the Bahamas Health Services Authority’s priorities will be.

The structure proposed under the Bill mirrors that proposed in the September 2014 report by the National Health Systems Strengthening Committee, the contents of which were disclosed by Tribune Business last year.

That report called for politicians to “buy into” the healthcare system’s new governance structure and care delivery model, and “ensure standardisation and overall quality of care”.