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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
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 RECOMMENDATIONS/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.
RECOMMENDATION
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.
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
Objective 2
Identify the changes made to the organisational structure from the year 2011
RECOMMENDATIONS
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 Scarborough General Hospital 2
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
Objective
Determine the status of recruitment and filling of managerial positions in the
organisational structure
RECOMMENDATIONS
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 Scarborough General Hospital 3
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
Objective 4
Identify the status of the commissioning of the new services to be offered at the hospital
Cardiology Services
RECOMMENDATIONS
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 Scarborough General Hospital 4
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
CT Scanning and Digital Radiology
RECOMMENDATION
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
RECOMMENDATION
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 Scarborough General Hospital
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 Scarborough General Hospital 5
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 Kitchen
RECOMMENDATIONS
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
RECOMMENDATION
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 Scarborough General Hospital 6
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
Incinerator
RECOMMENDATION
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 Scarborough General Hospital 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.
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TRHA Response to the 13th Report of the JSC on the Commissioning Process for New Scarborough General Hospital 7