Chief Medical Officer Dr Roshan Parasram says one of the reasons people experience long waiting times at public healthcare institutions is because T&T has a non-communicable disease (NCD) epidemic.
Parasram said NCD prevention is not something the Ministry of Health (MoH) will achieve overnight but requires five to ten years of effort. He said the MoH is trying to deal with NCD at the primary healthcare level.
It was one of the answers public health officials put forward as the Joint Select Committee (JSC) on Social Services and Public Administration convened a hearing into T&T's response to the prevalence of NCDs on Wednesday.
With the JSC completing a series of town hall meetings on public healthcare recently, members questioned public healthcare administrators on concerns raised by the public, especially waiting for a long time to get service, tests, surgeries, and medicine. JSC Chairman Paul Richards said that in one case, a young woman went to a public healthcare institution with severe breathing difficulties and was forced to wait. In another, a couple with heart conditions were given a follow-up appointment a year after their initial intake. The wife passed away during that wait, he said.
Parasram said: “The waiting times, especially in an A&E setting, are related to the large prevalence of NCDs in Trinidad and Tobago. We had significant discussions at the last meeting related to the work that the ministry is doing to try to move towards prevention. Moving towards prevention is not something that will cure the ills of the system overnight. It takes five to 10 years to be in process.”
In the meantime, RHA's try to increase their staff to accommodate the large patient load. However, there are challenges. For instance, North West Regional Health Authority (NWRHA) CEO Anthony Blake said one problem was that many middle managers are not management-trained. He explained that some were career nurses and doctors and got promoted to managers, but did not learn leadership. Therefore, the NWRHA signed an agreement with the University of the West Indies to train clinical professionals in management, and the first cohort completed training two months ago.
But a bigger issue was that the national pool of nurses was also insufficient, as Blake said recruiters from the United States of America, Canada, and the United Kingdom lure qualified practitioners away. He said this affects the nurse-to-patient ratio. As a result, the NWRHA is working with the MoH and the Ministry of Foreign and Caricom Affairs to recruit foreign nurses.
He said they are also engaged in a permanency exercise. With the restart of the Port-of-Spain General Hospital's Central Block, coming in 2025, 100 nurses are on specialist full-time training to assist with nurse retention.
Parasram clarified that the nurse-to-patient ratio varies by department. Whereas an Intensive Care Unit requires one nurse for one or two patients, a general ward would differ. Parasram said Small Island Developing States like T&T face retention issues as RHAs have challenges, especially with retaining ICU-trained nurses.
MoH Permanent Secretary Asif Ali said each RHA's ratio differs. Another factor in patients' long waiting times was T&T's universal access to free healthcare that couples with a policy that allows non-national care in cases of public health diseases, immunisation and acute emergencies. Parasram said non-nationals who require care are also a growing population.
Another concern picked up in the JSC's town hall meetings was the lengthy time waiting for tests. Some RHA's acknowledged this was an issue as equipment experiences downtime. Blake said because of the patient load on several machines, they sometimes exceed the manufacturer's recommended operational hours. It makes it difficult to plan maintenance based on the public needs. Additionally, many suppliers do not stock parts and they have to order abroad, which can take four weeks, which leaves downtime on equipment.
Regarding complaints of healthcare personnel referring patients to their private practice, Ali confirmed that the MoH is investigating one complaint in the NWRHA district.
While RHAs acknowledge that it happens, South-West Regional Health Authority CEO Dr Brian Armour said patients must come forward to the Quality Department and submit a complaint, as they cannot probe without evidence. He said some people may be reluctant to complain about their healthcare provider for fear of victimisation.