Ministerial Response to the Thirteenth Report of the Joint Select Committee of Parliament on Ministries, Statutory Authorities and State Enterprises (Group 2) on the Commissioning Process for the New Scarborough General Hospital
RESPONSE TO THE S/COMMENTS OF THE 13 TH REPORT OF THE JOINT SELECT COMMITTEE In keeping with Sianding Orders 71B(13) and 79B(13) of the Senate and House of Representatives respectively, the following is presented responding to the recommendations/comments of the Joint Select Committee as contained in the Report: Objective 1 Clarify the relationship between the Tobago Regional Health Authority (TRHA) and the Ministry of Tobago Development, the Tobago House of Assembly (THA) and the Ministry of Health. We recommend that urgent consultations be held at the managerial level to assess the accountability and reporting requirements of the TRHA to the THA, Ministry of Health and the Ministry of Tobago Development with a view to resolving some of the existing ambiguity regarding the multiple authorities which exercise oversight of the TRHA. In the end, there must be clear and distinctive jurisdictional boundaries in respect of the three bodies exercising oversight. The TRHA notes the recommendation of the Committee.
Objective 2 Identify the changes made to the organisational structure from the year 2011 S A. We recommend that a process be established to conduct periodic reviews of the organizational framework against other applicable models to ensure that the resources of the TRHA are organized in the most efficient manner so as to effectively respond to the growing demands for health care services in the island of Tobago. B. In addition, steps should be taken to fill the position of Director of medicine on the Board of the TRHA. The TRHA acknowledges and notes that conducting periodic reviews is inherent in effective management of any organization. The TRHA is in the process of establishing its five-year Strategic Plan 2014-2018, to guide its delivery of quality health care in keeping with the growing demands of the population as well as the dynamic needs of the health sector. This is to ensure a healthy population in accordance with national policies determined for reduced occurrences of communicable and chronic non-communicable diseases, and a population that is aware of its responsibility in this regard. The TRHA is aware that steps are being taken to ensure the composition of the Board of Directors is in keeping with the RHA Act No. 5 of 1994, Second Schedule, Section 1, Sub-clause (2) (a) (iii) that "at least one member of each Board shall:... be a registered medical practitioner." TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 2
Objective Determine the status of recruitment and filling of managerial positions in the organisational structure S A. We strongly recommend that the TRHA review its Human Resource Management plans and ensure that comprehensive succession and human resource planning strategies are included. B. Also consideration should be given to a proper compensation/incentive regime/scheme for the purpose of reducing skills flight or brain drain in the Tobago Health Sector. C. Clear time-frames should be set to fill vacant managerial positions. The TRHA acknowledges and notes that a review of its current Human Resource Management Plan is one aspect in the development of its comprehensive and progressive Strategic Plan, to ensure that it not only attracts the right staff (in terms of fit and competence) but is also able to retain such individuals long-term. The TRHA will be presenting a proposal to the Tobago House of Assembly for the upgrade of salaries for its executive, middle-management and technical staff The TRHA's Human Resource Management Plan dictates the urgent filling of both managerial and critical positions required for the effective delivery of quality health care services. TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 3
Objective 4 Identify the status of the commissioning of the new services to be offered at the hospital Cardiology Services S A. We firmly recommend that additional efforts to recruit a Cardiologist include the modification of the proposed compensation package for this position in order to enhance the number and quality of prospective candidates. B. We also recommend that the recruitment process for this position be advertised at a regional or hemispheric level to increase the possible number of applicants. C. We further recommend that the conditions of employment include a requirement for the Cardiologist to assist with training junior doctors in this specialty and that the necessary training be provided for local doctors in the area of Cardiology as a means of ensuring that future demands for skills in this specialist area can be satisfied locally. The TRHA acknowledges the recommendation made to modify the compensation package for this position and notes this has been seen as a requirement to attract prospective candidates, including nationals practicing in this field abroad. The TRHA will be advertising this position again which will include at the hemispheric level. As part of its recruitment campaign use is presently made of the portal "Caribbean Jobs.com ". The TRHA notes that it is already a requirement for such senior doctors to train junior doctors. Similarly it is necessary for the TRHA with the support of the THA and Ministries of Health and Public Administration to make available national scholarships for locals to be trained in this and other specialized areas, i.e., Neurosurgery, in order to meet the demands for a comprehensive secondary-care/tertiary level health delivery system. TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 4
CT Scanning and Digital Radiology We recommend that immediate action be taken to speedily rectify the issues with the printer(s) in the imaging department. It is untenable that a new hospital was commissioned and lacks a basic facility in its early stages of operation. The TRHA is pleased to report that the connectivity issue with the printer was resolved in June 2013. Similarly, the TRHA in October 2013 commissioned a Picture Archiving Communications System (PACS) which allows for remote communication of scans/images taken to doctors on/off site. The TRHA's Information Communication & Technology (ICT) department is nearing the completion of the installation of a Wide Area Network (WAN) which would allow for the deployment of PACS to TRHA Health Centres. Pathology including Histological Analysis and Microbiology We recommend that given the general shortage of pathologists in Trinidad and Tobago (in contrast to the increasing deman& for forensic autopsies and general pathology services) that the Ministry of Health in collaboration with the University of the West Indies Faculty of Medical Sciences develop an incentive regime in order to encourage aspiring doctors to specialise in this area. The TRHA acknowledges and agrees with the recommendation for collaboration. The TRHA advises that it has contracted a sessional pathologist for the provision of autopsies and other pathological services and that a House Officer is assigned to work in this department; a commitment has also been given by the doctor for the arrangement to be converted to a full-time one as soon as he becomes fully available. The TRHA is presently in discussion with the Faculty of the University of the West Indies (UWI) with respect to the being an approved training site for graduate medical education and training. These discussions were very fruitful with all parties aiming for the first intake of students by February 2014. TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 5
Kitchen S A. We recommend that subsequent to the completion of the kitchen facility, that a maintenance regime be established to ensure that fixtures and equipment in the kitchen are checked and repaired on intervals rather than allowing the facilities to deteriorate to the point of disrepair or total shut down. B. Furthermore, we recommend that all Occupational Health and Safety standards be clearly communicated and displayed in a prominent area for the guidance and benefit of the works and users of the facilities. The TRHA acknowledges and notes that a preventative maintenance plan is in place to ensure all fixtures and equipment in the kitchen and throughout the hospital are checked routinely as specified by the various manufacturers, with repairs undertaken as may be required. The TRHA acknowledges and notes that its Occupational Safety and Health (OSH) Officers and Quality Department are required to and have been consistently reviewing all areas of operation and providing the necessary recommendations to management for improved on safety standards. All measures have been taken to ensure safety standards are implemented in a timely manner; including the display of safety reminders. Through the TRHA's Education Department routine safety and health programmes are provided for staff depending on their areas of work. Laundry We recommend that the work required to complete the laundry be executed with alacrity in order that the laundry be opened. The TRHA acknowledges and notes that the necessary remedial works are scheduled to begin on January 20 th and completed by January 29 th to allow for the re-testing and certification of the compressed air and steam systems. The projected date for the next phase of commissioning and training of staff is the week of February 2014 for eight days. TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 6
( Thirteenth Report of the Joint Select Committee of Parliament on Ministries, Statutory Incinerator We strongly recommend that the TRHA conduct the necessary toxicity tests of the fumes being emitted from the incinerator to determine whether a potential health hazard/risk exists. In addition, subsequent tests should be conducted as a means of monitoring air quality in the vicinity of the incinerator. The TRHA acknowledges and notes that the incinerator at the has been approved by the EMA and has a built-in water-scrubber to reduce emissions. The TRHA will ensure that routine air quality tests are conducted periodically. ********** TRHA Response to the 13th Report of the JSC on the Commissioning Process for New 7