Health ministry needs more staff to manage workload

| 01/10/2021 | 47 Comments
Cayman News Service
Nellie Pouchie

(CNS): The failure of the Ministry of Health to implement long standing recommendations by the Office of the Auditor General relating to healthcare provision is due to a lack of senior staff, Acting Chief Officer Nellie Pouchie told the Public Accounts Committee on Wednesday.

She said that twelve people in the ministry deal with the core responsibilities but they really need another ten to meet the recommendations made by the OAG, which include creating a strategic plan and developing a policy, as well as managing the day to day work and dealing with the ongoing pandemic.

When asked by the PAC why nothing had been acted on, she said there were numerous vacancies in the ministry’s top jobs.

Pouchie, who took over as the acting CO at the end of 2019, said that her job has been dominated by the COVID-19 pandemic. As a result, she has been unable to address the issues raised by the auditor general since the outbreak of COVID-19. But adding to the problem of managing the pandemic, when she took on the top job there was no deputies and no chief financial officer or policy staff in the ministry, which also deals with environmental health and the challenges of waste-management.

She said it has taken time to fill the roles, and the action required to fulfill the recommendations in the OAG reports needs additional posts to be created and filled, including communications staff, a business manager, human resources, information staff and a number of other experts, including an epidemiologist.

She said that the ministry must now also begin looking for a chief medical officer, since Dr John Lee will be leaving at the end of the year. She said that replacing the CMO in the middle of a pandemic was a priority and this was now under discussion, and she anticipated that the job will be filled before Dr Lee leaves.

She said the ministry was also seeking to strengthen the Public Health team and said it was very difficult to be “forward thinking” with inadequate resources.

Working with the backdrop of the pandemic, Pouchie told PAC, staff were focused on dealing with that and not shaping the necessary policies and frameworks that the ministry has been told it needs to work on that will improve the efficiency of health services delivery in Cayman.

She said that the ministry is lacking data and research abilities as well, and this was all part of the much needed increase in personnel and expertise. However, much of the recruitment needs have been covered in the current budget, she noted.

The Health Services Authority is operating in line with an expired plan and Auditor General Sue Winspear has previously pointed out in various reports that the health system is riddled with problems and no policies, plans or strategies have been implemented to address them.

In this latest review of progress on the healthcare recommendations, Winspear said Cayman still has no overarching strategy or policy for healthcare and the legislative framework is outdated and deficient.

“As a result, Cayman’s healthcare system is not providing best value to its people and practices for inspecting healthcare facilities, registering healthcare practitioners and developing Caymanian doctors are still lacking,” she said in the report that the PAC was reviewing at this hearing.

But Pouchie was unable to effectively explain why the ministry has dragged its feet over the issues that the OAG has been raising for the last five years, other than the lack of relevant staff and the pandemic. The acting CO also said she had little information to offer on why the recommendation by the auditor general to remove the duty and the mark-up on drugs and medicines to help reduce the costs to the public.

Pouchie said the ministry continued to grapple with healthcare costs and what it can do to cut costs for government and the public. She also revealed that the ministry has not even begun the work needed to introduce the wellness aspect of the ministry to help cut costs, but she implied that dealing with critical care, especially for the elderly, was the priority for them.

See the PAC hearing on CIGTV below:

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Category: Government oversight, Health, Policy, Politics

Comments (47)

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  1. Anonymous says:

    This is the outcome of systematic issues right across the Civil Service. Individuals promoted to positions without the necessary qualifications or experience, these individuals then employ and promote their friends, family and fellow church congregation to protect their position and cover up their ineptitude. This then creates a situation where poor performers are the norm and the Senior Managers are complicit in sustaining broken services and misguided strategies all for their own gain. Very sad that family, church and personal wealth is more important than the future of the country and as a Caymanian I have allowed this to happen.

  2. Anonymous says:

    Shambolic ministry with poor management and has been ask for years.
    Pathetic and poor performance by the new CO who clearly wasn’t the best person for the job, is out of her depth and was appointed for ‘other reasons’.

  3. Anonymous says:

    I’m all for good governance etc but it can’t be unreasonable for that ministry to not have gotten to some things.

  4. Not impressed at all says:

    So this ministry now only has one single sphere of influence – and the deputy chief officer says they need 20 additional people. Under the previous deputy chief officer the ministry was responsible for five separate spheres of influence – and she managed to do her job – remarkably well in fact. I was very surprised to see that she was not given the position of chief officer, and that it went to someone not qualified for the job; but then I heard that Jon Jon had been involved in her selection and suddenly it all made sense.

  5. Anonymous says:

    The best thing about the covid pandemic – it provided excuses to under-achievers all over the world!!

    Wonder what crutch they will use next?

  6. Anonymous says:

    Just wondering if we should open the border when the HSA executive suite have no operational plan or anticipated recruitment strategy. Wonder what other obvious things they are putting off. Anyone else seeing these limp canaries in the coal mine? Real lives and families factoring in this imbalance.

    • Anonymous says:

      Said the armchair quarterback, how about you go out and do something productive with your life today while the adults work.

  7. Anonymous says:

    Thousands face masks being distributed, yet there is no regulation in place on how to properly dispose it. One would expect bio-hazard bins in public places, workplaces, which are collected daily and property disposed of. By the way, face masks must be replaced every 3 hours, at least this is what is done on long flights.

    CNS: We don’t need bio-hazard bins in the classrooms or on the streets. The WHO recommends closed bins (see here). The virus may stay on a contaminated mask for up to seven days, not indefinitely.

    • Anonymous says:

      CNS. So if it’s true that the virus can remain on a mask for up to 7 days, CDCs words not mine, doesn’t that raise the obvious question as to whether mask are facilitating the spread versus preventing it? Especially with young kids who haphazardly handle the mask, cough in it, etc etc. No one seems the least bit interested in asking the question. And let’s be real most people wear the same mask unwashed for days on end.

      It’s just weird that in jurisdictions with upwards of 80% vacinantion rates and mandatory mask policies we are still seeing a massive 4th wave of infections.

  8. Anonymous says:

    How can someone blame their lack of preparation on all the free time they’ve had by not having to deal with COVID community transmission until now? I am less afraid of COVID than I am of having to need to rely upon the deep incompetence of the HSA, and I worry for all my fellow Caymanians that stand to be harmed because of that bozo culture.

  9. Anonymous says:

    So, the $64.00 (CI) questions is, what is Sabrina going to do about all this? It’s not surprising that Dwayne the Brain 🧠 caused the problem, the dump, garbage collection, healthcare…. Need I say more.

  10. Anonymous says:


  11. Anonymous says:

    In 70s we used to have a Health Services Law outling the role of Govt and Health Fees law and Fees regulations. All these gone by the creation of OAG pointed out good to revive the Health Services Law which can incorporate the overarching policy and guiding priciples and roles of various agencies such as HSA , CINICO ,Health Practice Commission,Health Insurance Regulator etc are directing the Ministry rather The Ministry directing them under a Health Services Law.I think it is good to have a dialog with OAG re their recommendations for implementation as they are meaningful.

  12. Anonymous says:

    Two years of Acting as Chief officer is difficult task. When you are acting you can not be forceful as you may come back to your sustantive post and work with colleagues. First need to fill the CO post on regular basis and deal with.

    • Anonymous says:

      Rubbish. She had full authority and for a long period of time. This wasn’t a 6 week Acting appt.. She just isn’t good enough and shouldn’t have been appointed. Far better other candidates were interviewed …

  13. Anonymous says:

    Kenneth Bryan can retrain out of work tourism workers to fill jobs as doctors, lawyers, etc.

  14. Anonymous says:

    Caymanians in years gone by, was snartesr. Hardest working, with the best work ethics in the world, but now that’s gone mow, they have become lazy. Call in sick, come in late people. That won’t even answer their phones most of the time. And the Government are the fault, with can’t fire them. Have laws in place that they can sue if ever get put off from getting paid for not doing their jobs, and don’t matter what they do, they are told that everyone is working hard, doing a good job, world class civic Service .

    • The All-eeing Eye says:

      Sad, ain’t it !!! Now tell us why there is no one interested in making things better. If they can’t, or won’t do their job, replace them with someone who will! Who is really in charge of this? The answer is “No One!”

      Does our Premier know about this??? Will someone please call it to his attention?

    • world class promotion says:

      What we need to do to sort out this mess is draft in an H.R. expert to take over as Chief Officer, problem solved!.

    • Anonymous says:

      snartesr for sure.

    • Anonymous says:


  15. fed-up-with asses-for-ministers says:

    2.05 what utter nonsense. An excellent candidate was available for the chief officer post, who was much better qualified for the post than Pouchie. But due to Minister Seymour “messin’ where he should’na been a-messin'” (to quote Nancy Sinatra), the other candidate was passed over. No wonder she walked.

    • Anonymous says:

      This is the lamest excuse but typical of lazy ass workers, “I need more help/this work is so hard”. Pull up your britches, buckle down and get the work done instead of searching for excuses. Can’t is a coward to lazy to try! If you can not stand the heat Miss Pouchie then get out of the kitchen.

  16. More dead weight is not the answer says:

    Same can be said for our police force. At 400+ officers, what exactly do they do to properly police this spec of an island? Throwing more money employing friends and relatives just because they have connections is not the answer. Clear out the dead wood and hire responsible and competent people who take pride in their jobs.

    Too many CIG employees are just their for a steady paycheque, sapping the system. And too many middle and upper management keeping young bright talent down, what a waste, give young bright minds a chance, don’t waste them! Because of this Cayman will always be dependent on work permitted overseas workers to make up the shortfalls. It’s like an addiction and CIG are definitely addicted.
    To add, people can always adapt and learn no matter their age. If they don’t want to learn or retrain make them step down and or step aside.
    I have seen this first hand shortly after being on a work permit myself here, many young enthusiastic Caymanians approached me and wanted me to train them to do what I did but their Caymanian managers prevented them. 20 plus years later the same trend continues in the CS
    At least today there some apprenticeships and internships available but we are still behind way behind the curve. Real progress in Cayman flows like frozen molasses I guess.

  17. Anonymous says:

    The Cayman “World Class Civil Service”…where people go to get promoted to their level of incompetence.

    • Anonymous says:

      My daughter went to the USPS office in AZ, in an attempt to find her missing package. It turned out it was delivered to a PO BOX, based on the zip code and whatever extra 4 numbers they attach to it. When she asked them what about the address that was written on the package? They responded: we never look at the address, only at zip code. So instead of delivering a package to a legit address, they drop it at the PO Box based on a zip code. She got home and said: “I think they make them take “the mental debility” test, whoever passes the test is hired.”

      • Anonymous says:

        Nice story but doesn’t ring true – how can the USPS deliver to a zip code when it’s not a unique address?

        • Anonymous says:

          I suspect it is that postal delivery works frm the bottom of the address up. So first the country, then the ‘zip-code’, then the address line. The country postt office sorts it to the nearest matching zip-code, the zip-code code post office sorts it to the nearest address/box number. In the US where they have a 5 digit zip code, and a 5+4 digit zip code, an error on the zip code line can get your mail sent to the wrong place. Which starts the problem.

          Or the sorters just made a mistake.

  18. Anonymous says:

    They have entire departments as well as ministry staff, as well as NGOs and private sector offering resources.
    Pouchie is not the right person for this job and was promoted too quickly. The responsibility lies with the former Minister of the moon and the Deputy Governor.

    • Anon says:

      Yup; ask how it is that a minister can get his unqualified friend put in a chief officer position, when there were far more suitable and qualified people available – and all this with the deputy governor’s knowledge and blessing. And then we wonder why Cayman seems to be moving backwards…..

    • Anonymous says:

      But Seymour was Alden’s buddy, how could their be anything wrong when you have the brightest and the best as our leaders! Still trying to find out where is the Red Bay representative’s office at and when is he going to get that excuse of a park cleaned up and remove the collapsed roofs.

  19. Anonymous says:

    When you need more staff to do the things you should be doing, the most likely cause is existing staff doing things that they shouldn’t be doing.

  20. Anonymous says:

    Typically the CS blaming everyone but their pure laziness.

  21. Anonymous says:

    Blame the pandemic for everything. It is the civil service answer. Meanwhile the private sector pivots and adapts and continues to offer first class solutions. Can someone please shake the tree. We cannot afford for this to continue. Fund them properly and hold them to private sector standards, or privatize them!

    • Anonymous says:

      Don’t need more staff, need workers

      Keep those that are willing to work and give them an adequate amount of work.

      Release the rest.

  22. Anonymous says:

    nope. the current underworked, overstaffed,overpaid, lazy civil servants just need to work harder.
    read miller shaw or e&y reports.

    • The All-eeing Eye says:

      Sad, ain’t it !!! Now tell us why there is no one interested in making things better. If they can’t, or won’t do their job, replace them with someone who will! Who is really in charge of this? The answer is “No One!”

      Does our Premier know about this??? Will someone please call it to his attention?

  23. Anonymous says:

    A) Succession Planning
    B) problem of “no chief financial officer” – then don’t promote the then Chief Financial Officer to be Acting Chief Officer. (See step A)

  24. Anonymous says:

    Sorry- but this is a poor workman blaming his tools. It is for the CO to make sure that the ministry has sufficient resources to do its job.
    What we have here is just poor management .
    Sorry, Ms Pouche just isn’t up to the task for this post. Better applicants overlooked and not an open and transparent recruitment process.

    • fed-up says:

      Jon-Jon meddling where he shouldn’t have been a-meddling. Ministers are not supposed to be involved in the appointment of senior civil servants. Tha’ wha’ you get!

  25. Anonymous says:

    Stop closing entire schools and you wouldn’t have so much work!!!

  26. Anonymous says:

    Maybe they just need the right people with the right skills. I often find that the senior people working in the government ministries, authorities and departments don’t always have the skills, qualifications and training that are appropriate for the positions that they hold. This is one of the reasons why the government always needs to rely on outside consultants.

    Let look at getting the right people in the senior positions in government before we go out and hire more people.

    • Anonymous says:

      Cayman doesn’t have the right people for those jobs and there is strong resistance to bringing in qualified people from outside Cayman. So what are you going to do?
      Keep underqualified and underperforming Caymanians and accept poor results, or seek out good employees and accept they have to come from somewhere else?

      • Anonymous says:

        Oh do tell where from? And when we end up with an underperforming foreigner…then what?!! Go to hell with your stupid self.

        • Anonymous says:

          From any of the countries of the world that have better education and a healthier work ethic and attitude. There are plenty of them. And when a person on a WP is underperforming and found to not be suitable for the position, they are easy to remove, their permit is not renewed and another more suitable candidate replaces them.
          Compare that to the job for life that underperforming Caymanians enjoy.

          • Anonymous says:

            Yes, of course. Particularly those who already fabricate their credentials to get here. What’s worse would be that the vetting process locally is absolute crap.

            Every country has this issue and every country has to put their own first. Fascinating how so many reach these shores and forget that.

            This is all very disappointing of course but it is also pointless of all the armchair consultants here providing their “expert opinions” on resolving it.

            Already a bloated immigrant system however the simple solution is always, find someone from “any of the countries of the world” cuz they is all just so much smarter.

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