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review
Community Articles,

The review of the statutory bodies

First of all, I commend the Turks and Caicos Islands Government on taking the initiative to have a review of the statutory bodies. This was long overdue and so kudos to TCIG.

The review was carried out by the former Chief Financial Officer for the Turks and Caicos Islands Government, Mr. Stephen Turnbull. I will attempt not to repeat the detail findings of the review but rather provide you with some things for the Government and the Statutory Bodies to ponder and consider.

Should the salaries of the CEOs be the same for all statutory bodies?

Should the salaries and allowances of the statutory bodies be on par with the public sector given that the statutory bodies are an extension of the Government.

Should there be qualifications for Board members to sit on these Statutory Boards?

Should the appointment of Board members be bi-partisan?

Should Permanent Secretaries be on the boards?

Should some of the Boards be absorbed into the ministries in the Government?

Does the Govt have an oversight of the Boards?

Why don’t most Boards have a risk management policy?

Salaries

I know it must be heart breaking for some of the hard working civil servants when they see that some staff from the Statutory Boards are being paid higher than them. However, the argument that the statutory bodies used is that they are competing with the private sector to recruit talented individuals and therefore these talented individuals should be paid for what they are worth. Perhaps TCIG needs to review its salary structure again because TCIG too has top talent and perhaps some of them are being underpaid. How should the government deal with this? The TCIG needs to invest in a capital program and revitalize the IT structure so that it can become more efficient and reduce some of the human resources so they can increase compensation to those that remain in the public sector. If we can bring in external labourers and pay them hefty salaries and allowances, then we should do the same thing with our qualified local staff.

Boards

I agree that some persons on Boards should not be there but some of our politicians believe they have to reward their supporters by putting them on boards. I wonder if most of the Boards were non-paying positions, how many persons would be committed and interested in serving on Boards. We really need to rethink the appointment and composition of the Boards. We do our country injustice by appointing partisan and non-qualified persons on Boards.

Permanent Secretaries

I agree that the permanent secretaries should not be on boards but rather a senior govt official from the departments. I think that the permanent secretaries are already overwhelmed, have a lot on their plate and therefore should not be on Boards.

Absorption of Boards into the ministries.

I believe having statutory boards is a great thing to do and so I do not support the principle that some of the statutory Boards should be absorbed in the ministries.Having liabilities on the Boards are not reasons to incorporate them in the ministry. Perhaps what needs to be done is a review of the staffing composition of some of these Boards. Maybe some of the boards are overstaffed while others are understaffed.

One of the Boards that was recommended to be eliminated was the National Health Insurance Board. While there is merit in sharing some of the functions such as compliance with the National Insurance Board but to suggest moving it into a ministry will not solve the problems. The problems will continue to take place. In fact the problems may escalate if there is not a dedicated team within the ministry to deal with them. The operational cost of the national Health Insurance is less than $2 million based on my recollection and so it is not material in the scope of all things.. The major problem with the NHIB is the overseas medical treatment program which is being utilized by all persons paying into the scheme. The Government will have to make a tough decision and just allow individuals to use the local facility for the fee that they pay to NHIB. The overseas treatment program may have to be restricted to the citizens only. This is costing the government far too much finances and liabilities. Another Board that was recommended to the join the ministry was the Community College. I believe the Community College should be in itself a separate body. It is the Government’s responsibility to ensure that its citizens are educated just like the UK does for its citizens. What is the benefit of incorporating the community college in the ministry?

Oversight of the Boards

I agree that given that the Boards are an extension of the Government, the Government should have more oversight of some of the Boards. However, politicians should not get involve in the day to day operations of the Board and therefore should not intervene. I think the ministers should be brief about the Boards operations by the Chairman on a monthly basis for information purposes only. On another note, I think those Boards (with the exception of NIB) that are not getting any subvention from the TCIG, should provide more excess funds to the Government thus reducing the burden on the Government and the citizens of the TCI.

I encourage all of you to take time and read the review as there are many other areas for us to consider.

rit
Community Articles,

Walter Sean Gardiner is the local person that deserves the most credit and recognition for the Ritz Carlton Project

There are too many times in our country where history is being rewritten with errors. IF one does not know the facts, one takes the revised history as the truth. Therefore I am going to document Sean’s involvement in the Ritz Carlton Project in this medium. In my opinion, his involvement was so significant and should not be overlooked. He is the local person that deserves the most credit and recognition for the Ritz Carlton Project.

Before I proceed further with this article, I must mention that bona fide investors do not care about the political party that is in Government. Investors want three main things from a Government, 1) favourableConcessions/Exemptions on imported goods, 2) the ability to import labourers without major restrictions on labour clearances and work permits and 3) A clear and straightforward development process that allows them to complete their project within the timeframe without unnecessary delays.

I believe credit for projects should only be given to a government if the government was proactive in arranging and inviting developers face to face to our country, or the government introduces investment policies to incentivize investors or if the Govt. spends a significant amount of dollars on the marketing or promotion of TCI so they can attract investors and tourists to these islands. Governments should not be like lazy salespersons that do not initiate or convince someone to make a sale but rather just taking a sales order from a client. There are salespersons who want to take a credit for a sale simply because someone came in the store to purchase an item and it so happens that, the sales person was the one on duty when the client came in. The salesperson did not encourage and convince the customer to get any other thing but just waited until the client finish shopping for that item and now wants to take credit for the sale. This is a lazy sales clerk. The sale for that particular item would have happen no matter who the salesperson was on duty because the client wanted that item. On the other hand, an aggressive or proactive sales person would attempt to convince the client to buy other products or services while in the store. A pro active salesperson would also do road shows, meeting potential clients and inviting them in the store to buy products or even taking the products with them to sell them while on the road. If a sale takes place, the credit for the sale of the items rightly should be rewarded to that aggressive or proactive sales person.

There were so many hurdles and setbacks that the developers and promoters of the Ritz Carlton project encountered and in my opinion, it was a complete disincentive for this developer and future developers. (Of course, I am by no means suggesting that opponents to this project should have not use the judicial system as it was their rights to do so) Therefore, I must highlight and recognize the important role that Mr. Walter Sean Gardiner played in bringing this project to fruition.

Like the start up of most businesses, everything starts with an idea. The Ritz Carlton for TCI started with an idea in 2010 when one of the Consultants for the Dessarollos Group was embarking on a plan to expand in the Caribbean. Mr. Walter Sean Gardiner made contact with the consultant and was able to convince the group to purchase the land in Grace Bay, Providenciales. The project was originally scheduled to be completed in 2016 after receiving a development agreement from the government.

The Dessarollos Group had planned to build an 8 storey JW Marriot Brand which would have been the same height as the Seven Stars Resort. However, after the new developers of the West Caicos Project at that time decided not to pursue the Ritz Carlton brand , the Dessarollos group decided to move away from the JW Marriot Brand to Ritz Carlton.In 2013, under the Hon. Rufus Ewing Administration, the Govt decided they would increase the height from 7 storey to 12 storey to maximize the use of the and in order to make major resort development more economically viable for investors.

After the Govt changed its policy, the Desarollos Group increased its original 8 storey plans to 12 storey. In April 2015, the TCIG signed the revised development agreement with the Desarollos Group for the 12 storey project.

As a result in the change in policy by TCIG, there were a few persons or groups opposing this policy primarily based on environmental reasons. Many people felt that the environment was an excuse and that some opposed it for selfish reasons. As a result of this opposition, the Govt and the developers were faced with legal battles in the court for many years . The court ruled in the favour of the opposers stating that there was inadequate consultation on the 12 storey. The Govt appealed the case and sometime later the govt held a town hall meeting in which the majority of people particularly the locals supported the project. The matter was referred back to the court and the judge was satisfied that the Govt complied with the consultation aspect and thus provided the Government with the green light to proceed. However, the court required that the Govt. to commit future developers to perform extensive Environmental Impact Assessment(EIA) followed by consultation.This was the last hurdle for the Ritz Carlton project.

In November 2017, under the administration of Hon. Sharlene Cartwright Robinson, the EIA public consultation took place. At the town hall meeting, the majority of people supported the findings of EIA consultation. Planning was satisfied and issued a building permit to the developers of the Ritz Carlton project.

The official ground breaking for the 124 hotel rooms and 64 condos was on February 26th 2018. I end by thanking and crediting Mr. Walter Gardiner, a son of the soil for his tremendous part he played in this project by not only convincing the developers to invest in the TCI while the country was going through a challenging time economically and politically (we were Governed by the interim Government) but by also encouraging the developers to remain committed to the project despite several years of delays and legal setbacks.

Walter Sean Gardiner, you were truly proactive and therefore as a local deserves the most credit for the Ritz Carlton Project.

In conclusion, one of the reasons we have not been able to get the other islands develop is because we have not been pro active in getting investors (local or international) to those islands. Yes the stamp duty is lower which is an incentive but we need to take the islands to potential developers rather than just hoping and waiting for something to happen. This is what Walter did with the Ritz Carlton project. The ideal thing to do of course is for a group of us to team up and form companies and develop the islands ourselves. He who pays the piper calls the tune.

nhip
Community Articles,

NHIP is not the problem, the cost of health is the problem

Friends, as a former chairman of National Health Insurance Board and a current client of National Health, I feel it is my right to address the financial situation at NHIB. I know I have already made some comments under someone else page but this is my page and so I can elaborate.

First of all, when the National Health Insurance Bill was introduced to us in 2009, I was totally against the implementation because I like most people who opposed at that time suggested that the TCIG should make it mandatory that all persons have private medical insurance through their companies. However, when I became a member of the Board, only then did I realize the importance of this institution. BVI has recently implemented NHIB and the Bahamas is on the verge of doing the same. Both of these countries came to TCI on a fact finding mission and using our institution as a model.

Once you are covered by the National Health Insurance Board, there are no restrictions on your medical costs. NHIB covers all of your overseas medical costs. NHIB pays for your fight and provides you with subsistence during your time away. In addition NHIB covers your pre-existing conditions. Any pharmaceuticals over $25 is absorb by NHIB. Eg. If your pharmaceutical cost you $100, you pay $25 and NHIB pays $75. If you go to private doctor locally, NHIB pays $35 to that doctor/medical facility. One will not get half of these benefits from a private insurance company.

I am quite aware that there are issues among management and staff at NHIB which must be resolved in order for the organization to move forward. This article however is not to address this but to address the financial situation at NHIB. I will go on record and say that the financial situation at NHIB has nothing to do with the management personnel or style of NHIB. The situation we have on hand is that there is increase in the number of medical cases in TCI and therefore the Board is underfunded.

When management and the board of Directors presented the budget last year to TCIG, we knew the budget was not workable. However, as a statutory body, NHIB could not submit a budget showing a loss as it is against the guidelines of Govt. NHIB was asked to find ways to reduce its costs and they did put measurements in place to reduce costs including negotiating cost reductions with the main overseas providers. Unfortunately when it comes to the number of persons who are sick, it is beyond the control of NHIB. For the first half of 2016, there has been 18% increase in the number of patients referred abroad. Imagine if this trend continues, then the increase can be as much as 36% by the end of the year and I can assure you the budget does not reflect the cost to cover these unexpected increases in overseas treatment abroad cases. One also has to consider not only the medical costs, but also the subsistence cost, the travel costs and the pharmaceutical costs associated with these increases in the overseas treatment cases.

I know the first thing critics may say is that we should ban the NHIP plan. If we ban the NHIB plan, then it becomes more of burden for the TCIG and then TCIG will have to find other ways to increase its revenue (through a tax) should it decide to fully absorb all medical costs.

Before I go any further, I should note that NHIB is audited annually by PWC, a leading international company, and the audited financial statements are in the public domain. I should also add that NHIB has monthly board meetings and is attended by PS Finance and PS Health. If they are unable to attend, they send a representative. At every meeting, the financial performance of NHIB is discussed and furthermore NHIB like all statutory bodies must present quarterly report to the Ministry of Finance. For 2016 , I do not know the frequency or the format of the meetings as I was no longer on the Board. I can only speak to what happened when I was there in 2015.

Speaking about finance and since this information is in the public domain, I will share with you a synopsis of the finances for 2015. In 2015, NHIB collected more than $26.9 million in contribution income from their clients. In addition to the above the TCIG contributed a further $17.4 million to NHIB to cover overseas medical treatment, registered unemployed workers (up to 90 days I think) and indigents (persons who are sick really badly and not in a position to work). Now imagine if the TCIG had to fund the entire $44.3 million ($26.9 +17.4), do you really think we should ban NHIB.

On the cost side for 2015, there was a total of $39.6 million in health costs. This includes local medical costs, overseas medical costs, pharmaceutical costs, local and overseas travel and subsistence and reinsurance costs. Another $3.1 is on administrative costs which is minute compare to the overall scope of things.

I hope by now you have a better appreciation of the NHIB. We are now in 2016 whereby the number of cases has increased significantly but medical costs have also increased and so yes NHIB will have a financial crisis especially if the budget is not a true representation.

Here are my recommendations

Before I start with my recommendations, I believe most politicians are afraid to admit this. It is a sensitive issue and it has already happened. I am not a politician so I can say this. We should have never build two fully fledge hospitals. We should have one major hospital in TCI and all other islands have a medical facility along with family clinics in populated settlements.

  1. Having one hospital would have eliminated some of the local medical costs. However, I know we cannot do anything about that but I wanted to list that anyway.
  2. As  a community, we must focus on preventative healthcare. At the moment, all of our funds are being used to treat diseases. We need to institute preventative healthcare platforms in our schools, our churches and homes. Perhaps NBIB can partner with someone and take this as project. There are far too many cases of sicknesses and diseases taking place in our small country.  We need to educate our public on healthcare: eating and living healthy. If we do not address this, we will continue to spend more money than we budgeted for medical care. It is very challenging to budget for medical costs. The key for cutting medical costs is the prevention of diseases and sicknesses. Unfortunately, some of us do not get routine medical care or check up and we find ourselves in late stages of the diseases and then we end up blaming the hospitals.
  3. Everyone who lives and works here should contribute to the plan and be honest in their contribution. When one of our family members get sick, we get upset with the plan when sometimes we do not even contribute to the plan. However, because we are a small island and we know everybody, we called the minister or the premier for help. Is it fair to those who are paying?
  4. Everyone should be treated equally. Currently the plan refers persons to DR, Jamaica, Bahamas and sometime Puerto Rico for overseas treatment. However, there are some who refuse to go to these places and want to go the USA or they want to choose where they want to go. Don’t you  know that some of those same doctors you deal with in the USA are from Jamaica, Bahamas etc
  5. NHIB along with the TCIG need to review the benefits including the coverage of the pharmaceutical costs. Perhaps the TCIG really needs to rethink about the establishment of their own pharmacy. Something has to be done because some pharmaceutical costs can be as high as $7000 for one patient.
  6. For those persons that have private insurance, perhaps the insurance can cover the 80% and NHIB can cover the remaining 20%. Of course the issue will be the referral country as NHIB does not send patients to USA.
  7. Another option is to increase the current rate from 6%. A study will have to be done to determine the best viable rate.
  8. Given that we have two modern hospitals in Turks and Caicos, we need to find ways and means to treat patients locally rather than sending abroad. It will cost us but I believe it will still be cheaper to do it locally. I know efforts have been made already as some doctors and consultants visit TCI often at the hospitals and are able to administer some of the procedures locally.

Before I close, it is important that I explain the difference between NHIB and IHC as there seems to be a lot of confusion.

In my opinion the National Health Insurance Board serves three primary purposes, 1) the registration of individuals so that they can access medical care locally through the main local provider and the selected overseas providers, 2) the collection and payment of funds. NHIB collects funds from employers for their employees and then use those funds to pay for medical costs locally and overseas and 3) the management of overseas treatment abroad.

Interhealth Canada on the other hand is the local provider of medical services to the people of the Turks and Caicos Islands. NHIB and IHC are two separate institutions and are managed separately.

I wish to stress that NHIB is not the problem, the cost of providing health care locally and overseas is the problem. The challenge for the new Government of TCI, is how much are they willing to fund the cost locally and overseas and are they willing to reduce the benefits offered to patients.

NHIB is helping to pay for the local and overseas medical costs and so NHIB is not the problem. The only new cost that has occurred as result of the introduction of NHIB is the administrative cost that I have already mentioned above.

Politicians should not interfere in the running of statutory bodies. Even Board members should not be responsible for the day to day activity of a board. The role of the politician with respect to the Board should be to implement policies and providing funding.

I have provided you with facts, not hearsay.

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