HSA-board reforms include flat fees, annual evaluations

The Health Services Authority board, which has come under fire for its many meetings and associated attendance fees, is getting an overhaul, Premier André Ebanks has confirmed to lawmakers.

In response to a question from Leader of the Opposition Joey Hew, Ebanks said Health Minister Katherine Ebanks-Wilks had already initiated “immediate governance reforms to strengthen oversight” of the HSA board and management.

Those changes include introducing a flat fee for board members, rather than the current arrangement whereby the members are paid per meeting. Ebanks, speaking at Premier’s Question Time in Parliament on Wednesday, 15 Oct., said this was being put in place “to discourage excessive payments and unnecessary meetings”.

Board members will also be required to undergo training in public sector governance, financial stewardship and health care ethics, as well as annual performance evaluations.

The Cayman Compass reported last month that the HSA board had met 190 times over an 18-month period and was paid almost half-a-million dollars during that time.

Half-yearly reports required

The premier said the health ministry had received a half-yearly report from the HSA, covering 1 Jan. to 30 June this year, and noted that, despite there being a provision in law since 2003 for the submission of six-month reports, none had ever been presented to Parliament, until now.

“It is essential to recognise that this report serves as a crucial step in improving the financial accountability of the HSA,” the premier said.

He added, “By submitting this report, the ministry aims to foster a more structured approach to governance, ensuring that all stakeholders are informed and engaged in our efforts to enhance the public health service.”

Ebanks said government had reviewed a report from the Internal Audit Service on the HSA board remuneration and activities and planned to implement the recommendations included in that report.

He also added that the HSA had been requested to provide the health ministry with a proposed implementation plan and to submit regular progress updates.

In the longer term, the premier said, Ebanks-Wilks was planning to conduct a “legislative and policy overhaul, which will include, among other things, revisiting the HSA Act to ensure it adequately supports board accountability”. She is also requiring minutes of HSA meetings to be supplied to her on a regular basis, he added.

Information regarding board payments and meetings, released to the Compass under the  Freedom of Information Act, revealed that the HSA board held 126 meetings in 2024 and a further 64 meetings through the end of June this year. In that same 18-month span, members received a total of $490,850 in compensation, based on the pay-per-meeting schedule.

Under the stipend scale for board members, the chair receives $750 per meeting, the deputy chair $600, and members $500.

Opposition MP Chris Saunders had raised concerns about HSA board payments at a parliamentary Finance Committee meeting in June, when he noted that the total annual payments to board members had increased from just under $19,000 in 2016 to more than $250,000 in 2023.

The question about the HSA board, posed by Hew, was the first question ever asked in the newly established Premier’s Question Time.