Editorial | Create standards authority for health facilities

THE ATTENTION on how inadequately the Government regulates private hospitals ought not to stop there. Questions should be asked, too, about the quality of oversight of the State’s institutions, and if the body tasked with the job – a division of the health ministry – is arm’s-length enough. We think not.

These issues have arisen in the face of this newspaper’s recent revelation that only four private hospitals – although the health ministry lists nearly a dozen to which patients from public institutions may be referred – were certified by the authorities.

This state of affairs is a failure of the health ministry and its head for four years, Christopher Tufton, the reported resistance of private hospitals to being regulated under the Nursing Homes Registration Act (NHRA) of 1934 notwithstanding. The NHRA clearly wasn’t intended to regulate hospitals as we understand them.

While nursing homes – defined in the law as “premises used or intended to be used for the reception of and the providing of nursing care for persons suffering from any sickness, injury or infirmity, and includes a maternity home” – may, in that context, be properly stretched to include hospitals, the legislation’s omissions provide an insight into the original intent of Parliament. Nowhere in the law is there a definition of medical doctor. It, however, provides one for registered nurses and midwives. Indeed, the only reference to a doctor in the entire, albeit relatively short legislation, is the chief medical officer, to whom nursing homes have to apply for registration.

LITTLE ATTENTION TO CLINICAL MATTERS

Further, the health ministry’s “guidelines for community and private health facilities”, as posted on its website, deal primarily with the supervision of homes and matters of their safety, like the number and sizes of the fire extinguishers that should be in these institutions. There is scant attention to clinical matters, or to the obligations of doctors and nurses in a hospital environment.

In this context, and against the backdrop of the reported resistance of private hospitals to acquiesce to cover under the NHRA, we understand why Minister Tufton would resort to the Public Health Act in an attempt to force compliance.

Under that law, at Section 16, if either the Government’s central health committee or local health boards advise the minister of dangers to public health anywhere in the island, and there are “no powers under any law other than this section whereby such condition may be removed or guarded against … the minister may, by order, direct the enforcement of any measures recommended by the central health committee or by a local board … or any other measures that he thinks expedient for removing or otherwise guarding against any such condition and the probable consequences thereof”. The current situation, Minister Tufton apparently believes, meets that bar.

2004 AMENDMENT TO NHRA

The further question is, where does that leave the public hospitals? It is notable that a 2004 amendment to the NHRA provides a carve out for state institutions, declaring that the law does not apply to “any public or regional hospital under the National Health Services Act or any premises maintained or controlled by a local authority”. This exclusion also applies to the Government’s psychiatric facilities.

The National Health Service Act facilitated the 1990s creation of four regional health authorities, to which public health institutions were ceded based on their geographic locations. The law empowers the minister to make regulations for the authorities and their institutions, including “the admission into, the treatment at, and the discharge from any public health facility of any person or class of persons”.

The minister’s regulations, unlike the skeletal guidelines for private facilities, are readily available on the health ministry’s website. Moreover, the annual reports of the regional authorities, which are to be submitted to the minister within six months of the close of the fiscal year, and subsequently tabled in Parliament, are woefully behind in their publication.

Given the grand balls-up with respect to the regulation of private hospitals, and the lack of transparent oversight in public ones, it is urgent that legislation be passed establishing an independent Medical Facilities Standards Authority to act as watchdog over the entire health-delivery system. This doesn’t need reinventing the wheel. The health ministry’s Standards and Regulations Division could be hived off, forming the core of this agency, similar to what happened with the enforcement arm of the Bureau of Standards Jamaica. The change, if we are serious, can be achieved within a few months.