Monday, June 25, 2007

Health Authoritiy of Anguilla - Letter of Resignation

26 June 2007
Honourable Mr. Evans McNeil Rogers
Minister of Social Development
The Secretariat
Dear Mr. Rogers:
Based on previous discussions, your letter of 10th May 2007 and your various recent statements to Board members and individuals in the community, we note that your proposed intention to “reconfigure and/or re-constitute” the existing Board of the Health Authority of Anguilla (HAA) is outside the existing legal framework. Given, that as far as we are aware, this would be in contravention of the current legislation governing the HAA, we submit the following:
Per previous documentation, your procrastination and failure to replace the three Directors who completed their appointed terms on 31 December 2006 have meant that to date, the Board is without its full complement of seven members, in keeping with the requirements of the HAA Act.
Per our documented discussions and correspondence, this failure to replace the three Directors has seriously affected the efficient functioning of the Board and the HAA as a whole, as two of the retiring Directors represented the Medical and Nursing expertise mandated by the Act. Denying the Board the critical expertise of these professionals meant that the supporting Board Committees responsible for monitoring Medical, Patient Care and Nursing have been negatively affected. It also demonstrated a reckless lack of commitment to the functioning of the health services, as well as disregard for the four remaining members who were required to devote extra energy and time to ensure the efficient functioning of the HAA.
We wish to reiterate that your acknowledged awareness of this situation and your continued laissez-faire approach are alarming for the future of Health Services. Your conduct and lack of support for the HAA, as outlined in our letter of 7 February 2007, have demonstrated your divergence, not only from the Government’s established plan for health, but also a disregard for the legislation which governs the HAA, the National Strategic Health Plan and the Annual Services Agreements between the Ministry of Health and the HAA. It is only logical that if there is to be a divergence from the above, such changes should be communicated to the Board and all the stakeholders. To date we have not been privy to such information.
We fear that the current situation that you have deliberately orchestrated to undermine and sabotage the effectiveness of the Board is unfortunate. Such actions have only served to destabilise the HAA and needlessly put the achievements of the past three and a half years at risk, as well as negate the hard work and efforts of the Ministry in advancing reform in the health sector in years prior.
While the HAA is still in its infancy stages, given the enormity of the task which loomed before us in January of 2004, the current and past management and staff, Board and Committees have undoubtedly worked tirelessly to achieve significant impact on the modernization and improvement of the health system in Anguilla.
The noteworthy contributions, which we have summarized in the attached appendix have included not only overseeing the smooth transfer of responsibility for managing the health services from under the public service domain to the Health Authority; but also the continued restructuring and expansion of the primary and secondary services, improved patient care and goodwill as reflected in the positive feedback received from client/patient satisfaction surveys and testimonials.
Additionally, we feel that the move towards a performance-driven organization, improving the standard of care to internationally acceptable levels through the pursuit and award of health systems accreditation with the Canadian Council on Health Services Accreditation, have not only provided tremendous success for the health reform system on the island, but have also attracted the respect of international agencies such as Pan American Health Organisation/World Health Organisation (PAHO/WHO) – CPC and CARICAD; and paved the way for Anguilla’s designation as a model for public sector reform in the Caribbean and a contractual engagement by PAHO/WHO-CPC Office to facilitate a pilot project of mentorship in health systems accreditation in other parts of the region.
Indeed, the Anguilla Health sector reform experience is now seen as a regional and international bench mark. We feel that that is something about which you, your colleagues and all Anguillians can be justly proud. We hasten to point out that these accomplishments have been achieved with less funding for the health services under the HAA.
While you and other members of your Government have acknowledged and praised the Authority’s achievements, it is unfortunate that you as Minister of Health appear not to be sincere. Rather than supporting the Authority, as noted in our previous communication, you saw it fit to expend some EC$100,000.00 of the limited social development budget to replicate work that had already been done (and in some cases, already being implemented) by the HAA, using local, regional and international expertise. This is even more disconcerting coming at a time when the HAA reforms have allowed it to gain the confidence of the private sector as demonstrated in the partnerships to fund critical projects.
Mr. Rogers, the health reform process on Anguilla has been blessed with an unwavering and unusually high level of commitment from a number of individuals in the public and private sector, who have laboured to successfully lay the basis for taking our health services to new and higher levels. As professionals, we are grateful for the opportunity afforded us to serve our island home and be part of this national process. We have remained steadfast in our commitment to the collaborated effort in ensuring that the people of Anguilla receive the best in the health care in accordance with the established goals and objectives, but this accomplishment can only be sustained with careful long term planning and the respect and cooperation of all the partners.
Our experiences under your tenure as Minister of Health point to what we perceive to be a fundamental divergence on the principle/concept of health sector reform, which, according to the 2000 Manifesto of the Anguilla United Front, was intended to create an “autonomous mechanism of health services provision, to ensure that they are as free as possible from political interference.” We are of the view that such a body implements the Ministry’s policies in accordance with predetermined standards such as are outlined in the National Strategic Health Plan and the Annual Services Agreements. Your actions and statements point to a regression to a body which implements policy under the direction of the Minister where the independence of the Board is not respected.
We understand that you desire to replace the existing Board and it is apparent that under the current legislation, there are no grounds for you to accomplish this in the arbitrary and divisive manner in which you are currently engaging. Our cooperation is therefore critical for you to achieve your personal agenda and consequently, rather than subject this now regionally acclaimed organization to such acrimony, in accordance with Section 10(1) of the Health Authority of Anguilla Act, we regrettably submit our resignation as members of the Board of Directors of the Health Authority with immediate effect.
This en masse resignation is unfortunate, as the HAA was created with a deliberate attempt to ensure continuity, for all the obvious reasons. Your stated and implied disrespect for the work of your predecessors, has unfortunately, blinded you in this regard. We submit our resignations in an effort to shield the HAA from the current negativity and with the hope that your vision for health will be effectively communicated to the new Board, your Ministry and your Government, for despite our attempts to have you clearly verbalize the plan to which you allude, it remains an unarticulated construct of your mind.
We thank you, the Government of Anguilla and former Minister of Health, Mr. Eric Reid for the opportunity to serve our country and wish the Health Authority continued growth and development.
______________________ __________________
Dr. Phyllis Fleming-Banks Mr. Fabian Proctor
Chairperson Deputy Chairperson

_______________ _____________________
Mr. John Gumbs Miss Vernette Richardson
Director Director
Cc. Executive Council, HAA Board Committee Members

Significant Achievements (2004 – 2007)
1. Smooth transition and stable operating health environment, evidenced by high staff turnout (75% +) to general staff meetings and participation in annual Recognition and Awards programme.
2. Improved patient care – no post natal deaths, many trauma cases alive today due to care provided within the first 24 hours,
3. Move towards a performance driven organization. Thirteen successsful Quarterly Reviews with developing confidence among Managers in the management of health programs and budgets.
4. Award of prestigious health system accreditation by Canadian Council of Health Services Accreditation.
5. Best practice for health sector reform. Case Study documentation by CARICAD as model for public sector reform in the Caribbean.
6. Contractual engagement by PAHO/WHO-CPC Office to facilitate pilot project of mentorship in health systems accreditation. Participating countries include St. Vincent and the Grenadines, St. Kitts and Nevis and St. Lucia.
7. Positive feedback from clients on satisfaction surveys – improved environment of care, quality and taste of meals and medical and nursing care.
8. Client/patient satisfaction with quality of care of dental services provided.
9. Restructuring of Primary Health Care to health districts providing walk-in clinics, maternal and child health, pharmaceutical services, specialist clinics by appointment, home visiting and screening.
10. Twenty-four (24) hour accident and emergency operations with a Doctor on site at hospital.
11. Established agreement with HIMA-San Pablo of Puerto Rico for the provision of tertiary care and emergency evacuation.
12. Substantial reduction in complaints about clinical care. All written complaints are acknowledged and addressed by Executive Management or one of the standing Board Committees.
13. Reduction of waiting times at Accident and Emergency department.
14. Greater emphasis on day surgery.
15. Staff development and training including –
a. Recertification of EMT’s by Washington D.C. Fire Services;
b. Basic Cardiac Life Support (BCLS) training for doctors, nurses and EMT’s.
c. Certification of A&E doctors in Advance Cardiac Life support (ACLS);
d. Attachments for Ward Managers at Princess Margaret Hospital in Dominica;
e. Implementation of online continuing education for medical staff, Dental Assistants and Physiotherapist Assistant.
f. 2-staff awarded fellowships for Care of the Elderly in Jamaica (6-months);
g. Recruitment and training of Infection Control Nurse
h. Psychiatric training for additional Nurse and three aides in preparation for opening of Psychiatric Ward.
i. Ward Manager pursuing degree in hospital administration in U.K.;
j. X-ray Technician pursuing training in radiology in USA
k. Employee pursuing Health Administration in UK
l. On going Customer Service training for staff;
m. On going Managerial development training for managers;
Continued recruitment of Anguillian health professionals from abroad.
Resolution of issues surrounding the transfer of health services and assets which prevented the completion of audits and the consequent implementation of audits.
Service Expansion/Projects
  1. Expansion of Diagnostic Imaging Services to include CT and Ultrasound. Reports will be read and reported by off-site Radiologist through tele-radiology.
  1. Expansion of Dental Services with the installation of an additional dental chair with appropriate staffing. (This will reduce waiting times for appointments and address walk-ins, emergencies and expansion of school health programme).
  1. Commissioning of Recovery Room / Stabilization Unit (ICU) to strengthen the health infrastructure. This will improve the management of trauma and other life saving medical conditions.
  1. Visiting Specialist Clinics in Urology and Endocrinology
  1. Completion of Maternity Wing
  1. Completion of Psychiatric Wing and recruitment of visiting and eventually a full-time Psychiatrist.
  1. Establishment of Health Endowment Fund within the Anguilla Community foundation
  1. Forging a partnership with the private sector to support the funding of the Authority as demonstrated in the organization of the HAA Golf Classic, (which to date has raised some US$30,000.00 for the Authority).
  1. HAA sponsored Talk Show “Health Matters” for increased communication with and feedback from the public.
Areas For Improvement
1. Collections performance. While there has been some improvement, it is noted that this requires a culture change.
2. Improved customer relations and interactions with patient by front line staff and care-givers.
3. Development of primary care services in the Western Health District. There is need for a polyclinic in this area that provides for an expansion of services to address the local and tourism needs.
4. Major upgrade to Princess Alexandra Hospital – expansion of accident and emergency, conversion of open wards to more private and semi-private accommodation, installation of second operation theatre, expansion of pharmacy,
5. Dialysis services – new facility required
6. Major infrastructure upgrade required to Dental unit at the Valley