The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Minister of Health "cannot say" how much the Christie administration spent on National Health Insurance's (NHI) launch, saying only: "It's more than $100 million."

Dr Duane Sands acknowledged that many Bahamians will be amazed the Government cannot give a precise dollar figure, which he blamed on the former administration's fragmented governance structure for the scheme.

He said responsibility for NHI had been split between six different ministries, with no central co-ordination and controls over spending, resulting in the scheme becoming a 'mini version' of the unknown spending commitments that ballooned the 2016-2017 fiscal deficit to $695 million.

"I wish I could give you an answer to that," Dr Sands replied, when asked how much had been spent on preparations for NHI's April 2017 launch. "People say how could you not possibly be able to give an answer to that? "It comes down to the fact that NHI didn't exist in a single office: Labour, Works, the Ministry of Grand Bahama, the Attorney General's Office, the Ministry of Health and the Prime Minister's Office, all of whom would have expended tax money under the rubric of NHI preparations."

Dr Sands said the bulk of payments to consultants, and Fleishmann Hillard, the Canadian public relations advisers to NHI, did not come from his ministry.

"When we look at the bills for KPMG and NHI public relations, most of them were not paid out of Health," he added. "The Minister of Finance is trying to clean up and figure out what the total expenditure was, but we don't have a definitive answer to that. It is more than $100 million actually spent, but how much more than that, I can't actually tell you."

The Minister added that the Minnis administration remained uncertain as to the level of NHI-related spending commitments made before its predecessors demitted office on May 10, representing obligations on which monies have yet to be spent.

The Christie administration signed numerous construction contracts for the upgrading of existing health clinics, and building of new ones, during its final days in office as part of a strategy to strengthen the public healthcare system in readiness for NHI.

However, with the Bahamian public demanding solutions rather than finger-pointing, Dr Sands said he wanted to move beyond the former administration's actions.

"The truth of the matter is I am less concerned about what was spent than what has actually been committed to," he told Tribune Business, "and I'm even more concerned about how I reprioritise and get value for healthcare moving forward.

"The Bahamian public have heard enough about what went wrong. They'd like to know how we're going to fix it, and we've already been talking about improvement projects at the Princess Margaret Hospital and redevelopment of Accident and Emergency.

"We have identified human resources, infrastructure and primary care products, all of which are designed solutions to improve the quality of care we deliver as the primary agency with responsibility for health."

Dr Sands, though, reiterated that the Government's plans were restricted by the spending commitments and contracts signed by its predecessor, "many without any out clause".

As a result, he revealed that the Minnis administration will be unable to undertake all the $98 million in capital works projects identified in a September 25, 2017, letter sent to him by Herbert Brown, recently-retired Public Hospitals Authority (PHA) managing director.

"I believe the Prime Minister, the Deputy Prime Minister and the Cabinet have signalled to the Bahamian people that we will not spend significantly more than we capture in revenue," Dr Sands told Tribune Business.

"Given the fact that we have an explicit goal to balance the Budget within this term, it means that if the revenue performance is not there, we're going to have to make some painful decisions to bring expenditure in line with the money we have.

"Not every one of those works is going to happen. We are beginning the process of reprioritising. We are certainly going to start with Accident and Emergency, continue with the Rand cafeteria and kitchen relocation, and the Rand doctors on-call suite," he continued.

"The radiology project has been pushed back, but we're online with electronic medical records and health systems strengthening. We have to look at the Family Island capital development projects. It was earmarked to build many, many new clinics, and some of them will never happen.

"The health Budget is not unlimited, and certainly doesn't have hundreds of millions of dollars for capital development."

Dr Brown's letter to Dr Sands revealed an $89 million public healthcare funding shortage, as less than 10 per cent of the PHA and wider healthcare system's financing needs have been covered.

For the PHA alone, only 3.1 per cent of the $44.583 million capital works deemed essential for the Princess Margaret and Rand Memorial hospitals in 2017-2018 have been funded to-date, with Dr Brown's letter implying that the Christie government approved numerous projects without any idea - or monies - of how to pay for them.

The PHA's 'health systems strengthening' projects are in slightly better shape, with just $27.051 million needing to be found for initiatives costed at $35.289 million. However, Dr Brown's letter revealed that another $14.413 million is required to renovate the Department of Public Health's clinics.

And it also points out that the Government's 2017-2018 Budget failed to fund the $4.2 million increase in salaries and allowances for junior doctors in the public healthcare system. The increase came from the Bahamas Doctors Union's (BDU) new industrial agreement.

Dr Sands said that while "there's absolutely nothing earth-shattering" about the contents of Dr Brown's letter, it illustrated how the former government had pressed ahead on NHI without solving the existing public healthcare system's problems.

"It speaks to misplaced priorities and trying to tackle a new problem when huge challenges remain in our healthcare system," he told Tribune Business. "The biggest problem was diverting critical funds from absolute necessities to pie in the sky.

"It [NHI] was an overarching strategic plan inconsistent with reality. It's all well and good to say to say we'll spend $400-$500 million in total for healthcare with NHI, and provide the infrastructure with maintenance, staff, equipment and support. Then you ask the question: How are we going to fund it, how are we going to pay for it?

"That was the missing ingredient. Every time the Minister of Health [Dr Perry Gomez] was asked, he'd defer that question. The then-Prime Minister said you're not going to pay for it in the first year," Dr Sands added.

"That's no way to run a country with record GFS deficits that have huge implications for the quality of life of ordinary Bahamians. They were selling people a dream."

Many Bahamian healthcare professionals had argued that the Christie administration would have been better served allocating the multi-million payments made to NHI consultants to strengthening, and improving the quality of care and treatment outcomes, in the existing public healthcare system.

The KPMG accounting firm received $8.3 million between April 2016 and June 2017, while Sanigest Internacional and PricewaterhouseCoopers (PwC) received $1.2 million and $1 million, respectively.