STATEMENT
BY
HON LESTER B BIRD
PRIME MINISTER

“SIX DAYS AFTER: THE IMPLEMENTATION OF
THE MEDICAL BENEFITS REPORT”

ON

TUESDAY, 13TH AUGUST 2002

Fellow Citizens

It has been six days since I last spoke with you about the Report and Recommendations of the Commission of Inquiry in to the Medical Benefits Scheme.

At that time I said I would provide the Leader of the Opposition and the media with copies of the Report, and I would arrange for copies to be printed by the Government Printery for sale to the public at no more than cost price.

An original copy of the Report was delivered to the Opposition Leader that very day and copies were sent to the media on the following day.

Copies are now available to the public at the Government Printery and they may be bought there at any time.

I understand that two of the newspapers here are also selling copies of the Report. I have to point out that, in the case of the Government Printery, what are being sold are exact photocopies of the original document.

When I spoke with you six days ago, I said that I regarded the Report as a most important contribution to the reform and development of the Medical Benefits Scheme which is a national institution valued by all.

I undertook to implement all but two of the Recommendations directed at the Government.

With regard to the two Recommendations, I observed that their implementation posed a problem because of their grave financial implications. Nonetheless, I said I was resolved that Government must make every effort possible to comply as best it can even with these two Recommendations.

Several important measures have been taken over the last six days to implement the Recommendations as they apply to the Government. I want to explain each of these to you in as much detail as time will allow.

But, before I do so, let me deal with the suggestion made by the Leader of the Opposition and some of his more zealous supporters that an electronic copy of the Report was sent to the Cabinet, and that I somehow “doctored” the copy of the Report given to him as well as the copies released to the media.

Sadly this is a case of those who are given to concoction, using their own sins as a basis for judging the actions of others.

The reality is that one of the members of the Commission of Inquiry delivered three original copies of the Report directly to the Governor-General. The Governor-General kept one and sent two to the Cabinet which he is required to do by law. Of the two original copies, I kept one and I sent the other directly to Mr Baldwin Spencer, the Leader of the Opposition.

I now invite Mr Spencer to take the original copy he received, and any of the copies delivered to the media, and compare them with the copy of one of the Commissioners, Mr Oscar Frederick, who must have an original.

I hope that having done so, he will then explain to the nation that he is wrong and he withdraws his distasteful allegation. If he fails to do so, the country as a whole will see his allegation for what it is: nothing more than mischief making.

Let me now turn to the implementation of the Recommendations as they relate to the Government.

Last Thursday, August 8th, I wrote to the Director of Public Prosecutions sending him a copy of the Report and drawing his attention to the Recommendations of the Commission that required him to investigate incidents to establish whether or not persons should be charged with fraud or other infringements of criminal law.

I urged the Director to proceed to carry out his duties as he sees fit, and I undertook that the Government will provide him with such resources as he deems necessary to conduct his investigations.

The Director of Public Prosecutions is a creature of the Constitution. In executing his duties, he is entirely independent, and that independence is protected by the Constitution of this country. No one – not Government or Opposition – can tell him how he should discharge his responsibilities. This fact is well known to the Leader of the Opposition.

Therefore, when Mr Spencer postures by shrieking that I should not “go anywhere near the Director of Public Prosecutions”, and I should have “nothing to do with the appointment of a Special Prosecutor”, he is merely seeking to excite those who are not aware of the law. The Director of Public Prosecutions takes no instructions from me or anyone else in deciding who to investigate and how to investigate them. What is more, Mr Spencer casts grave aspersions on the character of the Director of Public Prosecutions by suggesting that he would allow himself to be so instructed.

I fully expect the Director of Public Prosecutions to carry out his duties as he – and he alone - sees fit, and I would advise everyone, including Mr Spencer, to let him get on with it.

Last Friday, August 9th, I dealt with several other Recommendations as they related to the operations of the Medical Benefits Scheme.

I wrote to the Chairman of the Scheme identifying the Recommendations that are of particular relevance to the Board and instructed that they be implemented immediately.

These included the following:

• The complete overhaul of the financial and accounting system by a reputable company which would be selected under a competitive tendering process, and the introduction of operating manuals governing procurement, accounting and stores.
• The appointment of new external auditors again selected on a basis of competitive tendering.
• The appointment of management auditors.
• The appointment of a Secretary to the Board at a high level.
• The division of responsibilities between the Board and senior management.
• The institutionalization of the requirement that contractors should only be employed after competitive tendering.
• Loans to staff to be discontinued except in cases of a duly substantiated emergency approved by the Board.
• A new schedule of billing by the Chief Surgeon and Specialists that does not permit the Chief Surgeon to bill for each procedure done at the hospital, and allows Specialists to bill MBS for only 75% of the fees.

I told the MBS Board that it is to develop a schedule for implementing these recommendations and I have asked that copies of the schedule be delivered to the Cabinet Secretary, the Speaker of the House of Representatives and the Chairman of the Public Accounts Committee who is also Opposition Leader Baldwin Spencer.

I have further told the Board that it should advise of the implementation of the Recommendations on the prescribed dates or of any delays in implementation, the reasons for the delay and the new date for completion.

This mechanism will give the Cabinet and all elected Representatives in parliament particularly the Leader of the Opposition oversight of the restructuring of the Scheme.

Yesterday, I implemented other Recommendations.

I instructed the Financial Secretary and the Accountant General to do the following:

• First, with immediate effect, and until such time, as appropriate legislative arrangements can be made, put administrative procedures in place to ensure that no advances are made to the Government by the Medical Benefits Scheme unless specifically authorized by Parliament.
• Second, in relation to payment of Government contributions to the Scheme, I recalled that the Commission of Inquiry has acknowledged that the Government disputes owing the Scheme EC$120 million as of 31st December 1999, because the Government has been paying certain obligations of the Scheme since 1998. I instructed that the analysis, already conducted by experts which shows that the Government was also owed in excess of EC$80 million by the MBS, be updated and a full reconciliation done up to 30th June 2002, so that a true figure can be established. This Reconciliation will be done under the supervision of the Director of Audit. I have further instructed that, using the formula proposed by the Commission of Inquiry, a mechanism be established for the payment of the correct balance through Government securities redeemable over a reasonable period. It is my intention to place the full reconciliation before the Public Accounts Committee of which the Leader of the Opposition is Chairman. This way, the Opposition will have full knowledge of the payment process.
• Third, I instructed that a plan be devised for the payment of future contributions on a current basis for urgent consideration and authorization by Cabinet. Again, it is my intention that Government should keep its future contributions as current as possible.
• Fourth, the Commission’s Report indicates that, when its forensic experts examined the files of the Ministry of Finance, they ascertained in a letter dated 16th June from the MBS that $2 million advanced to the Government was to be used to purchase Treasury Bills. However, they could find no evidence of the Treasury Bills in the files of the MBS. I have instructed that this matter be investigated and rectified. I have asked to be advised as soon as the facts are ascertained so that I can inform the public.
• Fifth, the Government commissioned two UK firms to conduct a study of the Mount St John Medical Centre (Equipping and Constructing) loan. I have instructed that, in accordance with the Recommendation of the Commission, these firms of highly experienced professionals should be requested to update their study so that it could be presented to Parliament for the knowledge of all parliamentarians.

With regard to the other recommendations that concern the Government, I have made it clear to Cabinet that in full accordance with the Recommendation of the Commission, Cabinet will no longer deal with any applications for medical benefits.

A small technical team consisting of the Chief Medical Officer, the Medical Assessor and a representative of the medical profession, nominated by the Medical Association, will deal with all applications.

I have also advised Cabinet that arrangements should be made to identify the Medical Benefits Scheme as the prime owner of the new Mount St John Medical Centre, and we have sought legal advice on how this can best be accomplished.

Legal advice is also being sought on limiting the exercise of Ministerial power and giving a stronger role to Parliament in overseeing the operations of the Scheme through the Public Accounts Committee chaired by Mr Baldwin Spencer,

As soon as the legal advice is received, these two measures will be implemented.

Fellow Citizens, you will recall that I said six days ago that two Recommendations of the Commission posed problems. The first was the suggestion that we pay in cash to the Scheme 50% of the contributions owed by the Government. I said at the time that I am resolved that Government must make every effort possible to comply even with these difficult recommendations. As you can see I have asked the Financial Secretary and the Accountant General to devise a Scheme to pay the full sum actually owed to the Scheme, after a reconciliation, through instruments redeemable over a reasonable length of time. I have also asked for a realistic plan by which we can pay future contributions on a current basis.

It is worth noting that while a few misguided persons have called for public servants to demand that their contributions to the Medical Benefits Scheme be paid, no public servant - or anyone else for that matter - has been denied benefits under the Scheme. In other words, public servants and others are getting the full benefit of the Scheme for which they have made contributions, and this is because since 1998 the Government has been paying many of the obligations that fall to the Scheme under the law.

With respect to the conversion of the Scheme into a National Health Insurance Service, you will recall that I said six days ago that a departure from the current system requires a national debate with a full understanding of all the implications including the fact that any Government that changes the system may have to increase taxes to pay the costs, or dismiss a large portion of the public service.

I have been dismayed by the ease with which the Leader of the Opposition, Mr Spencer, and his zealous supporters have spoken about “a bloated public service” and the need to reduce its size. In other words, they have been openly in favour of dismissing public servants from their jobs.

I have also been equally astonished at the manner in which the Opposition Leader has been willing to hurtle over the precipice of demanding the implementation of a National Health Insurance Service without any consideration whatsoever about cost or the increased burden of taxation it could place on the nation if it is blindly accepted.

But, I suppose this is the luxury of Opposition. It permits irresponsibility of the worst kind since no accountability accompanies it.

Fellow Citizens, let me end by saying that my Government is prepared to carefully investigate a National Health Insurance Service that meets the nation’s medical needs particularly the funding of the hospital. Based on the Recommendation of the Commission, we will now actively solicit proposals for such a Service and we will place the best of them before Parliament for debate and endorsement.

Receiving and evaluating proposals for their relevance and usefulness to Antigua and Barbuda will not happen overnight, but we will accelerate the process, and I shall inform you as soon as such proposals are ready.

In this connection, my Government will have addressed fully and substantially all the Recommendations of the Commission of Inquiry that are directed at it. We have done so without hesitation but with the care and attention that marks a responsible Government.

Fellow Citizens, I have opted to do what my conscience and my judgement, born of long years of experience, tells me is right in the interest of all – all of us who live in this country and want to see it progress and prosper.

Thank you for your time, and may God give us the wisdom and the strength to take our nation forward.