By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

THE Government plans to proceed with implementing 500 fees at the Princess Margaret Hospital (PMH) from July 1, amid warnings that it "can't put essential services at risk".

Dr Duane Sands, minister of health, told Tribune Business that many of these fees had been "legislated and in place for more than 40 years", but were never enforced due to the "false" cultural and political narrative that healthcare is free.

With the Public Hospitals Authority (PHA) facing an annual $28 million funding deficit, and the Government's Budget woes preventing this from being covered by Bahamian taxpayers, the Minister said he had little choice but to "bridge the gap" through new revenue measures and/or spending cuts.

While many Bahamians were demanding improved healthcare service quality, Dr Sands said they were often failing "to connect the dots" between such desires and how this was to be paid for.

He added that the Government's political opponents were bound to exploit what will amount, in many cases, to fees equivalent "to 10 per cent" of the cost of services provided, and said he would be "shocked" if the Progressive Liberal Party (PLP) "admits fiscal responsibility is a good thing".

Although the proposed increases to morgue charges had attracted most public attention, Dr Sands told Tribune Business: "This is one of more than 500 fee changes.....

"July 1 is when we plan to introduce the permitted fees. The fees have been legislated and in place for more than 40 years. The problem is they were never enforced because of the culturally and politically false view that healthcare is free.

"The problem is that I've got to find $28 million a year, and if I can't find that $28 million deficit; if I can't bridge it or close that gap, I find myself in a situation where essential services are put at risk." The PHA Act already allows the Authority to levy fees, with the schedule gazetted decades ago, but many were never collected as the Government continued to subsidise its operations from the Consolidated Fund - the central pool into which all taxpayer revenue streams are placed.

Dr Sands, though, warned that the Government's financial difficulties - saddled with $300 million-plus annual deficits and a national debt approaching $8 billion - meant this era had to end if Bahamians are to enjoy continued access to quality healthcare.

"We can no longer assume the Consolidated Fund is going to make up that [PHA] shortfall," he explained, "so I either cut my expenses by a comparable amount, or increase revenue or a combination of the two.

"I know for a fact the whole world is going to come kicking and screaming, saying what a horrible human being I am. For me, what I say is: 'Let's take the chaffing', and if we have the revenue to provide the service safely we will eliminate some of the challenges - people saying this is terrible, we don't have this, don't have that, you have failed to provide what you need to provide. Some of the public discord will go away."

Dr Sands urged Bahamians to recognise the new fiscal realities, and how it will impact them and the services they receive, emphasising that the PHA's $28 million deficit cannot simply be 'wished away'.

"The culture that this administration is seeking to introduce is one of fiscal responsibility, and I guess you can call it a level of fiscal conservatism, but the idea you can hope the money will be there and hope the Consolidated Fund will be able to pick up $20 million for Bahamasair, $28 million for the PHA, $10 million for this operation and $20 million for that operation, those days are gone," he told Tribune Business.

"Everybody has got to get their house in order if you are going to provide a specified menu of services without reducing the options. If you say I can't raise the money, there is no more waste to cut, the only reasonable thing to do is reduce the services and that's unpalatable for many.

"I can guarantee that when we say you should pay what ought to be paid, I will be burned in an effigy as a heartless, uncaring soul," Dr Sands added. "Believe me, the political spin has already started. Because the rhetoric is welcome and appeals to the base of a political organisation, they will use it, and use it and use it, even though they recognise the right thing to keep this economy afloat is to get as close as we can to a balanced Budget.

"I would be shocked if any member of the side opposite or their surrogates recognises being fiscally responsible is a good thing."

The Minister of Health said Bahamians must understand that the quality of healthcare services they are demanding requires increased investment that must be paid for somehow.

"The people of the Bahamas, if you demand a particular level of service as Bahamians are demanding, and say that what is provided now is inadequate and you have to improve the service and make the investment, that investment requires revenues," Dr Sands told Tribune Business.

"It is convenient not to connect the dots, and look at this as a silo and pretend it is a unique concern. You cannot say you are not prepared to adequately fund the hospital and, at the same time, complain we don't have the money, we have run out of medicine, don't have the latest equipment and don't fund equipment maintenance.

"We have to ensure the conversation has a level of honesty and openness, so people can understand why this bitter medicine is necessary. Had we taken a smaller dose of it over the years, we wouldn't have to swallow such a big dose now."