Members of the public expressed shame and disappointment at a functional review conducted by the firm Mott McDonald which would downgrade the current hospital services and force residents to seek healthcare abroad.
Residents who attended a hastily called public consultation in the middle of the annual festival on Thursday, December 28, 2017 were able to hear from Ministry of Health officials the findings of a 126-page report onÂ proposals for the development of health services on the island.
Ministry of Health officials took great pains to distance themselves from the contents of the report, stating it had been a requirement established by the Department for International Development (DFID) in order for the island to be able to receive funding for a new hospital. The terms of reference were designed by DFID and the international consultancy Mott McDonald, which is also currently conducting the economic growth strategy for the island, won the bid.
The report is a functional review of the Ministry of Health including environmental health, primary and secondary health care, health headquarters, and health financing.Â Sharing the document with the public was an effort to garner their views ahead of the ministry’s presentation to DFID and the FCO on their preferred option due by January 25, 2018.
The initial report submitted to the Ministry of Health team had met with resistance and adjustments were then made by the consultants, shared Secondary Care Manager Arlene Ponteen at the public meeting.
Six options, including the status quo were presented. Assumptions made for all options were that Health Promotion and Prevention services, Community anti-natal, post-natal care, medical outpatient care, day care surgeriesÂ would continue on island. Major trauma cases, complex births, and complex pediatrics surgeries would be done off island.
Status Quo – Continuation of general surgery, medicine, routine paediatric surgery and most maternity deliveries on island.
Option 1 – Continue to provide adult and paediatric general surgery on-island.Â Planned caesarean sections provided off-island.
Option 2 – Continue to provide adult general surgery on-island. Caesarean sections provided on-island through a visitingÂ obstetrician/ gynaecology service.Â All paediatric surgery provided off island.
Option 3 – Continue to provide adult general surgery on-island.Â All paediatric surgery and planned caesarean sections provided off-island.
Option 4 – Continue to provide adult general surgery on-island.Â All paediatric surgery and paediatric medicine to be provided off island. (A visiting paediatrician will provideÂ outpatients on-island). All caesarean sections to be provided off island, including any expected complex births.
Option 5 – Adult and paediatric outpatient and day case surgery provided on island, supported by a visiting anaesthetist.Â Paediatric medicine provided on-island. Midwifery led births provided on-island.Â Inpatient adult general surgery and paediatric surgery provided off island. Complex adult medical admissionsÂ provided off-island. All caesarean sections to be provided off island, including any expected complex births.
According to the report, based on current usage and the consultants projected population growth of 300 people, by 2025 Montserrat will only need 10 hospital beds. Current staffing in the ministry is sufficient to maintain status quo, it noted.Â Option 1 – 11 beds;Â Option 2 – 12 beds;Â Option 3 – 12 hospital beds;Â Option 4 – 10 beds;Â andÂ Option 5 – 5 hospital beds.
Montserrat currently has a 30-bed hospital. The option which was ranked top after the evaluation and scoring process was Option 2 with 12 beds. After further discussion with the ministry, the report was adjusted to recommend 20 beds.
“This option identifies that, to meet the future needs of the population with those services whichÂ can be provided safely on island, the future requirements is for 20 beds which includes a highÂ dependency bed for post-operative patients and emergency transfers. This level of future bedsÂ would provide the best compromise between making best use of available resources, ensure thatÂ in the majority of admissions, patients would be admitted to their service area specific to theirÂ condition and meet the future needs of residents beyond 2025. Beds would be arranged aroundÂ four bedded bays, double rooms and single occupancy rooms. Making the most appropriate useÂ of the hospital services in the future is predicated on providing effective preventative, primary andÂ community based services,” the report states.
“Compared with the future estimated cost of delivering the current profile of acute hospital servicesÂ (Status Quo option) at around XCD $16.7 million, the cost of delivering Option 2 for acute hospitalÂ services and the primary and community service changes has been estimated at XCD $17.2Â million; an additional XCD $0.5 million. Despite the increased cost, combining the non-financialÂ benefits appraisal with the financial appraisal, the overall preferred option for the new hospitalÂ facility remains Option 2.
“Adding in the costs of flights for those patients requiring access to services off-island has beenÂ estimated at XCD $0.4 million and the notional costs of those services specialist tertiary servicesÂ accessed in the UK and USA at XCD $1.4 million; bringing the total operational cost to XCD $19Â million per annum.
“Decisions about the future financing options arrangements to support the costs of the provision ofÂ this service will be subject to the next report on the health financing strategy for Montserrat.”
The report noted that haemodyalisis services was cost prohibitive while CT Scan and mammography services should either be done by a private clinic or overseas.
Nurse Brenda Daley, who is also an anesthetist said Montserrat’s morbidity and mortality rate areÂ quite good. The current staff at the hospital do surgeries and handle pediatric deliveries with success. She noted that with the option to use a visiting general surgeon and anesthetist there would be no place for her. The message she told the panel that the report was sending to the world was that “Montserrat is no longer safe.” Residents, she said would have “very little or no access to health care.Â Scrap the report and put it in the bin as it is not good for Montserrat.”
Other voices from the audience queried what would be the onward costs for upgrading the airport to handle the increased number of medivacs, considering the airport was not approved for night flights. Another mentioned that at times the weather is not conducive to flying, which would jeopardize the health of patients who needed emergency surgeries. The cost of family members who must travel to care for sick patients was also identified as a major concern.
Montserrat is “blessed with good nurses and surgeons despite operating in a makeshift hospital,” noted Camilla Watts. She said the report should be scrapped as the options presented were incomprehensible. She added that the report was totally disrespectful to the carers over the years.
Rev Florence Daley reflected on the old Glendon Hospital in the 60s which did hip replacement surgeries with remarkable results and where csections and premature babies were given great care and thrived despite there being no incubators.Â “Those babies lived because they were cared for. A big hospital doesn’t give care, its the nurses.Â We’re telling the people of Montserrat they are less than nothing.” She also expressed shame that such a report had been produced.
Other residents noted that having a good hospital with quality healthcare on island was a foundational element needed in order for Montserrat to see have increased tourism arrivals. Tourism is identified by the Mott McDonald consultants in the economic growth plan, which they are also conducting.
Another resident noted that in years past Montserrat’s current hospital was identified as high risk for DFID staff and it was not recommended for them to bring their families. Further reduction in the capability of the hospital, sends a message that “if it wasn’t good enough for DFID staff then it isn’t good for us to be here as we are also British citizens.”
Listen to the ZJB broadcast of the public consultation posted by Montserrat Radio Echo on