The Public Accounts Committee on Wednesday continued with its investigation on why government has not implemented recommendations made by committee reports.
A report issued by the Office of the Auditor General in January 2017 about ensuring quality healthcare and a healthy population, made nine recommendations, and in 2018 and 2019 the PAC added a further five.
Auditor General Sue Winspear told the committee, “These recommendations are really important because the intention is about improving the health of our Caymanian residents, whether served by the public or the private healthcare system, and ensuring greater economy, efficiency and effectiveness, out of that health system.”
A follow-up report issued by Winspear in August found that a number of dates had been missed and there has been limited progress.
Nellie Pouchie, chief officer in the Ministry of Health and Wellness, said at the PAC meeting that while five years was a long time, the recommendations predated her taking up the role – she started in late 2019 – and she subsequently was busy dealing with the COVID pandemic. She said she also had to operate for some time without both a deputy and a chief financial officer.
“So, it’s not that the ministry doesn’t see these [recommendations] as important. They were accepted and deemed to be relevant,” Pouchie said.
The ministry has yet to complete staff restructuring and has not been able to return to any from of “normalcy” because of the pandemic, she added.
Pouchie said it is not the case that nothing at all can be done because of COVID but the limited resources were a reality at this point.
The recruitment processes for vacant positions, including top level health policy and data analysis staff, are ongoing to address the severe personnel constraints. The ministry currently has 12 core staff and is ultimately planning to add another 10 positions to get where it needs to be.
Pouchie also said she was not aware that she had to table the government minutes that are now 18 months late.
Financial Secretary Kenneth Jefferson noted at the meeting that auditor general reports have pointed to at least half a dozen other government minutes that have not been tabled, ranging from a report on the Segregated Insurance Fund to the Cayman Islands Monetary Authority’s financial statements.
He explained that a report responding to PAC recommendations would normally be drafted by the chief officer in consultation with the minister, who would get it approved by Cabinet and then table the paper as government’s official response accepting or rejecting the recommendations in the PAC report.
Recommendations in the original auditor general’s report included updates to the national health policy, the need for an operational plan to monitor and track progress, legislative reviews, stronger relationship between government and private healthcare providers, and reviews of the registration of practitioners and inspection practices.
In addition, government should establish a performance management and reporting framework, evaluate the CayHealth programme and distinguish in its statistics between Caymanians and non-Caymanians.
Committee members specifically focussed on the lack of data that results from the non-implementation of the recommendations.
Katherine Ebanks-Wilks, parliamentary secretary to Minister of Financial Services André Ebanks, said that the failure to have a streamlined process and the lack of the national healthcare data does make decision making more challenging.