Editorial: Invite us all, Mr Dalley

Horace Dalley is right to have invited Dr Alfred Dawes for a chat on the health sector. But not only Dr Dawes. And not only to rehash the woes of the sector, which have already been widely aired.

Rather, Minister Dalley should initiate a broad, frank, problem-solving dialogue on the basis that, at least for the medium term, there will not be much more public money to throw at health. So, in the public system, at least, there has to be a shift in priorities, a greater sense of realism among the users of its services, as well as more efficient use of resources. Its managers have to do more with less.

In laying the groundwork for this stakeholders' dialogue, which is urgent, Dalley has simultaneously to rebuild public trust in the management of the health systems, which was squandered by the ham-fisted, pompous and defensive style of his predecessor, Fenton Ferguson. He started well by sacking the boards of the University Hospital of the West Indies (UHWI) and the Western Regional Health Authority, which has responsibility for the Cornwall Regional Hospital, which, with the UHWI, accounted for the deaths of 19 preterm babies from hospital-acquired infections.

In the event, Dalley must go further by replacing the governors of the other regional health authorities, whose institutions, although not directly implicated in the dead babies scandal, displayed the kind of environments, as a series of recent audits revealed, where only fortune, perhaps, prevented similar nosocomial infections. The identified problems, in our view, were only partly the result of a lack of money. The greater weakness was in management, a failure for which the boards are ultimately accountable.

The crisis revealed in those audits - the extent for which Dr Ferguson tried to hide from the public, which in the end contributed to his reassignment - was not particularly surprising. Dr Dawes, when he was president of the Jamaica Medical Doctors Association, often alluded to them. He now claims a culture of intimidation and fear in the health sector and an institution of politicised management and policy expedience.

PLAIN POLITICAL STRATEGY

Dr Dawes is, of course, correct that it was an expectation of votes that caused the previous administration to remove user fees from the public health system in 2008 and the same political considerations that prevented the present government from reintroducing them, despite agreed negative consequences on the quality of health-care delivery.

And here is where we believe that Mr Dalley has a real opportunity. The current crisis has made people more willing to listen and be more amenable to truth-telling.

The Government's health budget this fiscal year of J$49.5 billion is, nominally, 20 per cent more than the previous year's. Excluding debt-servicing costs, it accounts for 15 per cent of the Budget. The truth is that in the current fiscal circumstance, and given the competing demands, there won't be too much more to get.

Efficiency has to be the order of the day - achieving more with the same resources by focusing more on primary and preventative health care. Community nurses and busy public-health officers doing their jobs effectively will help to lessen the demand on big hospitals and complicated equipment - if there are fewer cases of disease to treat.

Dalley should gather the stakeholders, including users of the services, to talk frankly of the possibilities - and the cost of health care.