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Health Review Commission makes wide-ranging recommendations

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Wednesday, January 05, 2005 - The report by the Health Review Commission, which investigated the terms and conditions of employment of medical practitioners and nurses made wide-ranging recommendations on the island’s health sector.

The 100-page report was submitted to Cabinet Secretary, Dr. James Fletcher and presented to the medical fraternity on January 4, 2005. The terms of reference for the Commission, which comprised Chairman Sir Richard Haynes, Deputy Chairman Mrs. Jennifer Astaphan, and members, Dr. Barbara Johnson and Cletus Springer was set out in Cabinet Conclusion No. 115 (d) of 2004 and dated February 16, 2004.

The review and recommendations of the report addressed separately, issues relating to the Ministry of Health, Human Services, Family Affairs and Gender Relations; Doctors; Nurses; the Payments System; Victoria Hospital (VH); St. Jude Hospital; Golden Hope Hospital; Other Secondary Care Institutions; Bed Utilisation at Hospitals, Physical Conditions at primary and secondary health care facilities, Ambulance Services, as well as implementation services

Among the many recommendations were that the Ministry assume the responsibility as the employing authority to determine the standard for the employment of doctors and more particularly, for the employment of consultants; the leadership cadre at the policy level be strengthened immediately; the contractual process employed by the Ministry and VH be urgently addressed and responsibility to reside at the policy level to ensure consistency in the practice, pending a decision on the future governance of VH; a Disciplinary Committee be established within the Ministry; and the Standards Bureau be invited to establish clear standards for the importation of all drugs.

In terms of issues relating to doctors, the Commission recommended the establishment of a Board to govern the operations of VH; the removal of VH from the rigid system of payments in the wider public service to facilitate the changes proposed by the Commission; the involvement of doctors and nurses in the management of the health system through appropriate Committee structures; the adoption of a “no compromise” policy in setting the qualifications for the post of “Consultant”; the removal of any differentials in the basic remuneration of Consultants paid by the Government; the enforcement of all legal remedies against doctors who collect fees from patients in their private office in breach of the Hospital Fees Regulations; and the investigation of all reports of failure to respond to calls for assistance by nurses and junior doctors and appropriate action taken.

In the case of nurses, the Commission recommended that the post of Chief Nursing Officer (CNO) be filled as soon as practicable and that the CNO be involved in all matters relating to nurses employed in the public sector; a policy of decentralisation of the management of entities in the primary health care system be actively pursued; urgent steps be taken to empower nurses in the management of all sectors of the health care system; and in respect of VH and/or its successor (when it is transferred to the governance of a Board), the Director of Nursing Services be an ex-officio member of the Board, a member of the Senior Management Team, Chairperson of a Nurses Staff Committee, and a member of a Patient Care Committee.

In addition, the report called for an urgent recruitment programme to be pursued to attract more young persons into the nursing profession; the appointment of Nursing Aides in the secondary care system as support personnel for nurses; an increase in the size of the nursing establishment; no discriminatory measures against former Nursing Assistants who have become Staff Nurses; the introduction of a special programme of assistance to facilitate scholarships/study leave for nurses seeking training in approved areas; and improved allowances for nurses on night duty.

The Health Review Commission acknowledged the assistance of the medical fraternity and said it was grateful to the Minister of Health for his demonstrated keen interest in the progress of their work and for helping to clear the administrative hurdles that surfaced from time to time.

The full Report is available here.

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